Dyspnoea and an unusual chest radiographBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j986 (Published 09 March 2017) Cite this as: BMJ 2017;356:j986
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In a patient with the association of dyspnoea and pericardial calcification(1) an evaluation of jugular venous pressure(JVP) should precede echocardiography, given the fact that a left ventricular ejection fraction (LVEF) of <40% (which was a feature in 20.9% of 43 constrictive pericarditis patients in one study)(2) does not distinguish between dyspnoea attributable to constrictive pericarditis (CP) and dyspnoea attributable to dilated cardiomyopathy. Where echocardiography reveals a LVEF of >50% the distinction that has to be made is between CP and restrictive cardiomyopathy(3), and that, too is hedged in by caveats(3). Surely, for the non-specialist, the most direct route to timely diagnosis and treatment is to bypass echocardiography altogether and to make a direct referral to a specialised cardiothoracic centre through the medium of a referral letter declaring that the provisional diagnosis of the association of pericardial calcification and raised JVP (especially if the JVP is markedly elevated)(4) is CP until proved otherwise.
(1) Kho JS and Howlett DC. Dyspnoea and an unusual chest radiograph. BMJ 2017;356:j986
(2) Oreto L., Mayer A., Todaro MC et al. Contemporary clinical spectrum of constrictive pericarditis: A 10-year experience. International Journal of Cardiology 2013;163:339-341
(3) Leya FS., Arab D., Joyal D., et al. The efficacy of brain natriuretic peptide levels in differentiating contsricitve pericarditis from restrictive pericarditis. J Am Coll Cardiol 2005;45:1900-1902
(4) Giimlette D. Constrictive pericarditis. British Heart Journal 1959;21:9-16
Competing interests: No competing interests