Constrictive Pericarditis

摘要

A patient presented with Ascites for 3 months. Clinical examination showed ascites, presence of atrial fibrillation and a raised JVP. Further evaluation helped make a diagnosis of constrictive pericarditis. The questions that arise at each step of evaluation of such a patient starting from the history to examination and investigation is discussed in this bedside case discussion. A 20-year-old male patient, resident of Bihar, presented with the following: Abdominal distension and facial puffiness for 3 months. Bilateral lower limb swelling for 1 mont Exertional dyspnea for 1 month. The patient was apparently asymptomatic 3 months ago when he began to develop abdominal distension, which was insidious in onset and gradually progressive. There was associated facial puffiness. Two months later, he developed swelling of bilateral lower limbs. He also gives a history of the New York Heart Association (NYHA) Class II exertional dyspnea which was insidious in onset. However, dyspnea has not shown any progressive worsening. There was no associated orthopnea or paroxysmal nocturnal dyspnea (PND). The patient gives a history of easy fatigability. The patient would have intermittent relief in his symptoms with diuretics. However, there would be a recurrence of symptoms on stopping medications. There is a history of early satiety; however, appetite has remained normal. There was no history of palpitations, syncope, or cyanosis. There was no history of jaundice, hematemesis, or melena. The patient does not give any history of previous blood transfusions or high-risk behavior.