Abstract
We describe a patient who suffered progressive right heart failure of unknown aetiology, despite a lengthy series of hospital investigations. Constrictive pericarditis had not been suspected during life, and was ultimately diagnosed as an autopsy finding. The salient clinical features and confirmatory investigations for this unusual disorder are reviewed. The case reminds us to consider the possibility of constrictive pericarditis in patients with unexplained chronic right heart failure, so that prompt investigation and treatment can be instigated.
Highlights
Eighteen months later, the patient was admitted to hospital in extremis
Death was attributed to heart failure secondary to constrictive pericarditis, exacerbated by sepsis and tissue ischaemia
The earlier investigative findings, which were performed over a 12-month duration, were attributable, in retrospect, to constrictive pericarditis
Summary
Initial examination found temperature 34.6°C, blood pressure 65/30 mmHg, and heart rate 85 min-1. An electrocardiogram showed atrial fibrillation and right bundle branch block. She was diagnosed with sepsis and dehydration, and treated with intravenous colloid administration, gradual warming, and systemic antibiotics. Despite these measures, hypotension and tissue perfusion progressively worsened and the patient died shortly after arrival in hospital. Autopsy examination found extensive constrictive pericarditis and chronic hepatic congestion. Death was attributed to heart failure secondary to constrictive pericarditis, exacerbated by sepsis and tissue ischaemia. The earlier investigative findings, which were performed over a 12-month duration, were attributable, in retrospect, to constrictive pericarditis. The initial echocardiograph did not comment on the pericardium, but is unlikely to have been sufficiently sensitive to detect pericardial thickening
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