Question

A 35-year-old man presents to the emergency department with complaints of chest pain. The pain improves by leaning forward. On review, he has noted a flu-like illness over the last several days including fever, runny nose and cough. Upon further investigation his blood test indicates signs/parameters for infection. He denies tobacco, alcohol or drug use. His head and neck examination is notable for clear mucus in the nasal passages. However, his jugular venous pressure is high. Also, during his cardiac examination a high pitched squeaky sound/knock is heard. Abdominal and extremity examinations are normal.

1) What is the likely diagnosis of this patient?(1 mark) CLO4 and 6

2) What is the pathogenesis process that lead to the development of this condition and what complications can occur? (1 mark) CLO2 and 4

3) What is the cause of this disease in this patient? (1 mark) CLO2 and 4

4) What other conditions could cause the same clinical scenario in a patient of this age? (1 mark)CLO2 and 4

Answer 1

1. Constrictive pericarditis

It is a chronic inflammatory process that involves both fibrous and serous layers of the pericardium, and that leads to pericardial thickening and compression of the ventricles. The resultant impairement in diastolic filling reduces cardiac function.

• The patient have the history of flue like symptoms.
• Increased jugular venous pressure
• Pericardial friction rub that is identified by high pitched squeaky sound

These findings indicates Constrictive pericarditis

2. Normal Pathogenesis of pericarditis

Etiological factors causes the inflammatory reponse which results in influx of neutrophils & other chemical mediators which causes change in the permeability of pericardial vascularity, pericardial inflammation & edema. This eventually results in restriction of heart motion and pain with breathing.

In constrictive Pericarditis there is hemodynamic effects resulting in

• dynamic changes in right and left heart filling with respiration
• elevation and equalisation of cardiac filling pressures
• increased venous pressure
• decreased cardiac output

These changes leads to the clinical manifestations

Symptoms

• Dyspnoea on Exertion
• oedema
• chest discomfort
• fatigue
• abdominal symptoms

Signs

• Jugular venous distension
• kussumaul sign
• pleural effusion
• pericardial knock
• hepatomegaly
• ascites

Complications

• Pleural effusion
• Cardiac tamponade

3. Cause of the disease

Infectious disease. The patient had the history of flue like symptoms with, fever, running nose and cough.

4. Causes

• Infectious disease

1. Tuberculosis
2. Bacterial
3. Viral ( especially coxsackievirus and echovirus)
4. Fungal

• Trauma
• Cardiac surgery
• Inflammatory

1. Rheumatoid arthritis
2. Systemic lupus erythematosus
3. Scleroderma
4. Sarcoidosis

• Neoplastic

1. Breast cancer
2. Lung cancer
3. Mesothelioma
4. Melanoma

• Radiation
• End stage renal disease
• Idiopathic causes