Thread by @OKiamanesh

*Constrictive Pericarditis Tweetorial*
A 50-year-old male with a prior cardiac surgery with right heart failure. Exam shows a JVP of 15 cm and an estimated 20 kg of interstitial edema. What's abnormal? What are we looking for?

#echofirst #FOAMed

1/

Echo shows normal biventricular size and systolic function, as well as ventricular septal motion abnormality from ventricular interdependence (not fully shown)

2/

Medial mitral annulus e’ velocity > 9 cm/sec

3/

Hepatic vein expiratory diastolic reversal ratio (not impressive here) and restrictive mitral inflow velocity.

4/

Respiratory variation in ventricular filling: 40% increase in tricuspid in velocities (shown) and 25% decrease in mitral inflow velocities with inspiration.

5/

Plethoric inferior vena cava

6/

Are there any other helpful tests?

7/

CT shows a thickened pericardium along the RV free wall. Anything more than 3-4 mm is abnormal.

8/

MRI shows ventricular interdependence and re-demonstrates the thickened pericardium.

9/

Left and right heart catheterization shows ventricular interdependence, and equalization of diastolic pressures.

10/

Coronary angiography shows fixation of the distal coronaries.

11/

A pericardiectomy is a big undertaking. Use multimodal imaging to ensure you have the right diagnosis and treatment for your patients.

12/

I hope you enjoyed my first Tweetorial!

@HarperLea1 @YasMoayedi @MDMichael13 @DrBerticMia @adamdavidthomas @ThinkingCC @HeartDocSharon @oscaar84 @IM_POCUS @NephroP @ArgaizR @carpefckndiem @korbinhay
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ping @NephroGuy @Wormsy10 @katiewiskar @RaynerHartleyMD @RyanTruant @JdBapttiste