Constrictive Pericarditis on Echocardiogram A 55-year-old female marathon runner presents to clinic w/ 6-months of worsening breathlessness (half-marathon time increased by 30 m). She had gained 15 kg and swollen legs. Exam showed BP 100/82, HR 74, JVP 15 cm ASA, Kussmaul's sign, marked pedal edema, and clear lungs. We did a transthoracic echocardiogram to workup right-heart failure. This showed a small‐to‐moderate circumferential pericardial effusion. Look at the thickness and brightness the epicardium. There were classic features of constrictive pericarditis: (A) a dilated inferior vena cava with <50% respiratory variation, (B) a septal mitral annular e’ velocity of 9.5 cm/sec, (C) mild diastolic reversal of the hepatic vein with expiration not meeting diagnostic criteria (D) a leftward ventricular septal shift with inspiration and a diastolic septal shudder by M‐mode imaging of the ventricular septum. These findings suggest constrictive pericarditis. - Omid Kiamanesh, MD @OKiamanesh #Constrictive #Pericarditis #Echocardiogram #a4c #pocus #clinical #cardiology
