Constrictive pericarditis: A cause of exertion-induced dyspnea in a soldier with a prior sternotomy

Abstract

Diagnosing the underlying etiology of dyspnea on exertion in adults can be challenging, often requiring the clinician to distinguish cardiac or pulmonary pathological conditions from metabolic, neurological, or hematological conditions or from chest wall abnormalities. We report such a case involving a 29-year-old, male, active duty Army soldier. With a history of a median sternotomy, symptoms of right- and left-side heart failure, and examination findings suggesting elevated right atrial pressure, pericardial disease was pursued. Echocardiography and cardiac catheterization revealed constrictive physiological features, namely, elevation and near-equalization of right- and left-side pressures and ventricular interdependence, whereas computed tomography illustrated pericardial thickening, ultimately leading to the diagnosis of constrictive pericarditis. The patient was treated with a complete pericardiectomy, leading to symptom resolution and improved exercise capacity. This case report of a rare condition offers a concise etiological and physiological overview of constrictive pericarditis and demonstrates an effective multimodal diagnostic approach. The scientific evidence provided may assist general practitioners in making decisions to differentiate this clinical condition from similar cardiac or cardiopulmonary conditions. Copyright © by Association of Military Surgeons of U.S., 2007.