A 55-year-old woman who is status-post mantle field radiation of the mediastinum for Hodgkin's Lymphoma develops the gradual onset of dyspnea on exertion.  A video of her jugular venous pulse is shown. A pulsus paradoxus is not present and cardiac markers such as troponin and creatine kinase are not elevated. Pulmonary function tests reveal a restrictive pattern.  Which of the following is the most likely explanation for the clinical findings?

  1. Aortic regurgitation
  2. Constrictive pericarditis
  3. Hypertrophic cardiomyopathy
  4. Myocardial infarction
  5. Superior vena cava syndrome

 

/

/

/

/

/

/

Scroll down for the answer:

/

/

/

/

/

/

/

/

/

Answer:  B) Constrictive pericarditis

 This patient had a Hodgkin's lymphoma which was treated with mediastinal radiation causing fibrosis of the lungs and pericardium.  The pericardium contracted causing a constrictive pericarditis and impaired filling of the heart producing a classic physical exam finding seen in the video.  The video shows a dramatic example of Kussmaul's sign which is distension of the jugular veins and elevated jugular venous pressure during inspiration.

 

Kussmaul's sign can be seen in:

  • Constrictive pericarditis
  • Restrictive cardiomyopathy
  • Right ventricular infarction
  • Right ventricular failure
  • Tricuspid stenosis

 

 

VideoSource: NEJMvideos

Comments  

#2 marvin tochukwu 2015-12-26 16:15
constrictive pericarditis
Quote
#1 Vusala K 2015-11-26 04:20
Awesome! Thank you,doc!
Quote
Category: Cardiology Mnemonics

Support Barone

Support this Website

by using these links:

Amazon.com

 

 

Hockey

HockeyMonkey has what you need to play. Click Here!