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Gold standard case presentation
This video demonstrates the heart sounds associated with constrictive pericarditis. It has an early diastolic component which can be mistaken for a physiological 3rd heart sound. It has a similar mechanism but tends to be of a higher pitch, occurs earlier in diastole, and is louder due to the constricted myocardium or pericardium.
There is a pericardial rub which is is not always present, and is positional, and so can disappear upon moving. In this video, it is heard in the tricuspid position, but not else where.
It is unlikely due to the emergency nature of constrictive pericarditis, that you will have it as a PACES case. However it is useful to be able to distinguish it from a physiological 3rd heart sound, and to be able to explain the difference. A pericardial rub is an important heart sound to be aware of and recognise.
The greater the constriction the earlier in diastole of the extra heart sound.
Clinical features of constrictive pericarditis include:
- Prominent x and y descents in the JVP
- Positive Kussmaul’s sign
- Pericardial knock
- Quiet heart sounds
- Extra-cardiac signs: non-pulsatile hepatomegaly, ascites and peripheral oedema
Constrictive pericarditis is caused by tuberculosis, viral infections and rarely malignancy. Symptoms may also be caused by resultant pericardial effusion.
The life-threatening complication of a pericardial effusion is cardiac tamponade.
Definitive management requires a pericardectomy to relieve the constriction, as well as treating the underlying cause.
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What clinical sign is apparent in the JVP?CorrectIncorrect
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What can you hear on auscultation of the heart?CorrectIncorrect
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Worldwide what is the commonest cause of constrictive pericarditis?CorrectIncorrect
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What is definitive treatment for pericarditis?CorrectIncorrect