Association of severe class III angina pectoris and constrictive pericarditis

Abstract

A 74-year-old man was admitted with dyspnea on exertion and angina pectoris class III. Clinical history was marked by pulmonary tuberculosis treated by antituberculosis and a percutaneous coronary intervention of the left anterior descending artery (LAD). Cardiovascular risk factors were age, sex, tobacco, diabetes mellitus and obesity. Cardiac examination showed a blood pressure at 110/60 mm Hg, respiratory rate at 21 breaths/ minute with signs of right heart failure included lower limb edema, hepatomegaly, jugular vein distension, hepatojugular reflux. Electrocardiogram showed sinus rhythm at 80 c/ mn with normal axis and a T wave inversion in posterior. Chest radiography (figure 1A) revealed pericardial calcifications and moderate effusions of the left pleural cavity. CT (figure 1B) showed a calcified pericardium with a nodule in the left lung. TTE (figure 1C-D) revealed a pericardial thickening, distension of bilateral atrium and the inferior vena cava, posterior residual pericardial effusion, normal global systolic function, increased of the right ventricular end-diastolic pressure and signs of obstruction of the interventricular septum and the posterior wall of the left ventricle. Angiography showed a severe stenosis of LAD. Intraoperative exploration confirmed extensive pericardial calcifications. A Subtotal pericardectomy and coronary artery bypass to LAD-LITA (left internal thoracic artery) were performed without cardiopulmonary bypass. Histological examination of resected specimens revealed tuberculosis inflammation. In postoperative, medical treatment by antituberculosis (isoniazid, rifampin, pyrazinamide and streptomycin) was done. Clinical follow up was un eventful.