Left ventricular strain‐curve morphology to distinguish between constrictive pericarditis and restrictive cardiomyopathy

Left Ventricular ◽

Cardiac Tumors ◽

Management Options ◽

Acute Pericarditis ◽

Pericardial Disease ◽

Cardiac Trauma ◽

Pulsed Wave Doppler

The pericardium consists of a fibrous sac and a serous membrane. Because of its simple structure, the clinical syndromes involving the pericardium are relatively few but vary substantially in severity. Cardiac tumors may be either primary or secondary and either benign or malignant, with attachment sites throughout the endocardium. Cardiovascular trauma should be suspected in all patients with chest injuries or severe generalized trauma. Cardiovascular injury may be either blunt or penetrating. This review covers pericardial disease, cardiac tumors, and cardiovascular trauma. Figures show an electrocardiogram in acute pericarditis; acute pericarditis with delayed gadolinium enhancement of the pericardium shown with cardiac magnetic resonance imaging; underlying cause of pericardial effusion requiring pericardiocentesis; pericardial pressure-volume curves; large pericardial effusion with swinging motion of the heart resulting in electrical alternans; typical pulsed-wave Doppler pattern of tamponade; underlying causes of constrictive pericarditis in patients undergoing pericardiectomy; pericardial calcification seen on a chest radiograph; thickened pericardium; typical pulsed-wave Doppler pattern of constrictive pericarditis; typical mitral annular tissue velocities in constrictive pericarditis; a diagnostic algorithm for the echocardiographic diagnosis of constrictive pericarditis; simultaneous right ventricular and left ventricular pressure tracings in restrictive cardiomyopathy; computed tomographic scan showing inflammatory constrictive pericarditis; systolic and diastolic transesophageal echocardiographic images of a large left atrial myxoma attached to the atrial septum; a decision tree of management options for patients with suspected papillary; transesophageal echocardiographic examples of aortic valve, mitral valve, left ventricular outflow tract, and tricuspid valve papillary fibroelastomas; and transesophageal short-axis view of the descending thoracic aorta in a hypotensive patient after a motor vehicle accident. The table lists tamponade versus constriction versus restrictive cardiomyopathy. This review contains 18 highly rendered figures, 1 table, and 77 references.

Importance of left ventricular filling in differentiating constrictive pericarditis vs. restrictive cardiomyopathy

The American Journal of Cardiology ◽

10.1016/0002-9149(80)91007-3 ◽

1980 ◽

Vol 45 (2) ◽

pp. 475

Author(s):

Rene A. Langpu ◽

Theodore I. Tyberg ◽

Allan V.N. Goodyer

Keyword(s):

Left Ventricular ◽

Left Ventricular Filling ◽

Ventricular Filling

Disparate Patterns of Left Ventricular Mechanics Differentiate Constrictive Pericarditis From Restrictive Cardiomyopathy

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2007.10.006 ◽

2008 ◽

Vol 1 (1) ◽

pp. 29-38 ◽

Cited By ~ 94

Author(s):

Partho P. Sengupta ◽

Vijay K. Krishnamoorthy ◽

Walter P. Abhayaratna ◽

Josef Korinek ◽

Marek Belohlavek ◽

...

Keyword(s):

Left Ventricular ◽

Ventricular Mechanics ◽

Left Ventricular Mechanics

Idiopathic restrictive cardiomyopathy: Differences of left ventricular relaxation and diastolic wave forms from constrictive pericarditis

The American Journal of Cardiology ◽

10.1016/0002-9149(83)90156-x ◽

1983 ◽

Vol 52 (3) ◽

pp. 421-423 ◽

Cited By ~ 26

Author(s):

Yuzo Hirota ◽

Toshiaki Kohriyama ◽

Tetsuya Hayashi ◽

Kiyotaka Kaku ◽

Hikaru Nishimura ◽

...

Keyword(s):

Left Ventricular ◽

Left Ventricular Relaxation ◽

Ventricular Relaxation ◽

Wave Forms

Differentiation of constrictive pericarditis from restrictive cardiomyopathy: Assessment of left ventricular diastolic velocities in longitudinal axis by doppler tissue imaging

Journal of the American College of Cardiology ◽

10.1016/0735-1097(95)00434-3 ◽

1996 ◽

Vol 27 (1) ◽

pp. 108-114 ◽

Cited By ~ 339

Author(s):

Mario J. Garcia ◽

Leonardo Rodriguez ◽

Miguel Ares ◽

Brian P. Griffin ◽

James D. Thomas ◽

...

Keyword(s):

Longitudinal Axis ◽

Left Ventricular ◽

Tissue Imaging ◽

Doppler Tissue Imaging

Abstract 1759: A 27 year-old Man from ’the Valley’ with Shortness of Breath

Circulation ◽

10.1161/circ.116.suppl_16.ii_372 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Jennifer E Ho ◽

Yerem Yeghiazarians

Keyword(s):

Lower Extremity ◽

Cardiac Catheterization ◽

Venous Pressure ◽

Left Ventricular ◽

Shortness Of Breath ◽

Significant Past Medical History ◽

Valley Fever ◽

Mitral Inflow

A 27 year-old man with no significant past medical history was admitted with shortness of breath and subjective fevers. He was diagnosed with Valley fever based on pulmonary infiltrates on chest x-ray and elevated Coccidiomycosis immitis IgG and IgM titers and was treated with antifungal therapy. He subsequently developed worsening dyspnea, orthopnea, and lower extremity swelling. On exam his jugular venous pressure was elevated and he had bilateral pleural effusions, lower extremity edema, and a positive Kussmaul sign. The electrocardiogram showed sinus tachycardia with diffuse T-wave inversions. Echocardiography demonstrated thickened adhesive pericardium, exaggerated respirophasic variation of the tricuspid and mitral inflow Doppler patterns and a prominent septal bounce. Cardiac MRI showed markedly thickened enhancing pericardium with an associated small pericardial effusion and prominent septal bounce. There was no delayed enhancement to suggest myocarditis. Cardiac catheterization showed equalization of diastolic pressures in all four chambers, low cardiac output, and simultaneous right and left ventricular pressures showed respirophasic discordance suggestive of increased ventricular interdependence. All of the above findings were consistent with constrictive pericarditis in the setting of disseminated coccidioidomycosis, and the patient underwent urgent surgical pericardiectomy with improvement in his symptoms. Pathology specimens demonstrated fungal spherules and active inflammation consistent with Coccidiomycosis immitis infection of the pericardium. This case illustrates the multi-disciplinary diagnostic approach that is often needed to distinguish constrictive pericarditis from restrictive cardiomyopathy. It highlights classic features of constrictive physiology seen on imaging and cardiac catheterization in a unique case of fungal pericarditis. Pericardial involvement in disseminated coccidioidomycosis is rare, and constrictive pericarditis treated with pericardiectomy has been described in only two prior cases in the literature.