Unusual presentation! devil in details
Our patient, female 50 years old with no previous significant medical history.
Two days before the presentation show was waked at night with unbearable epigastric pain and vomiting, so she went to the ER, ER she received IV PPI and referred for ECG
Her ECG at the ER shows diffuse T wave inversion, and her cardiac enzymes were negative:
She was discharged on PPI and was asked to do Echocardiogram later on; her ECHO was done and showed a strange shadow at the free wall of the right atrium, as shown in the video:
What is your opinion and what to do next?
Please leave your comment below
The first complete answer from Dr Ahmed Hamoda
This is a typical case of constrictive pericarditis, proven with 2 main echo signs:
1- septal bounce
2- respiratory variation across the mitral and tricuspid flow
this was proven in the Cath lab while CA, as you can see in the following video the heavily calcified pericardium.
Please add your comments here
Thickened interatrial septum,
Possible myocardial infilterative disease
Pattern of restrictive cardiomyopathy
For MRI
thanks for your answer
Strangulated hiatus hernia
With right atrial tamponade
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Hiatal Hernia HH
Oral ingestion of a carbonated drink and 2D echo
OR Upper GI Barium Cray
Upper GI Endoscopy
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According to the clinical presentation, I think that we should go for standing X Ray abdomen to exclude GIT emergency like perforated peptic ulcer.
As a cardiologist, I prefer to ask for Right and posterior ECG leads in any epigastric pain case. However, I think it will be OK.
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Non cardiac patient
Refer to internal medicine physician
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Respiratory variations of transmitral doppler flow of 25%… Could be Effusive-constrictive pericarditis or cardiac compression by hiatus hernia restricting cardiac mobility if the presentation is unusual
Echo window not so clear, further images or full study could help
Thanks
Very nice Dr Mohamed
perfect answer
Constrictive pericarditis
perfect answer
please see the updated article for more information
RA and RV dipping ( both are compressed)
There are dopper variation in amplitude
May be constructive pericarditis
For CMR
perfect Dr Ahmed
Why the patient underwent coronary angiography?!
What is the cause of epigastric pain?!
Is ” constructive pericarditis” a retrospective diagnosis at cath. Lab ?!