Acute idiopathic pericarditis with transient constriction

Abstract

A 28-year-old man was referred to a hospital because of acute illness, fever, malaise, and retrosternal chest pain. On the admission, he was eupnoic, the heart rate was 90 beats/min, and the blood pressure was 110/80 mm Hg. Chest roentgenographic findings were unremarkable, and electrocardiography showed near-ubiquitous ST segment (J point) elevations, diffuse PR segment depression and specular elevation in the aVR lead. On auscultation, no pericardial rub was evident. The following laboratory data were obtained: hemoglobin, 13.5 g/dl, leucocite count, 11 10/mm, erythrocyte sedimentation rate, 98 mm in 1 h. Echocardiography disclosed a large pericardial effusion (Fig. 1). The clinical features of active acute pericardial disease subsided with bed rest and nonsteroidal antiinflammatory drugs (ibuprofen 800 mg every 8 h). A specific cause was not apparent after assessment according to our internal diagnostic protocol [1]. Acute idiopathic pericarditis was diagnosed. Six days after, his conditions deteriorated: dyspnea, hypotension, and marked giugular venous distension were noted. The echocardio-