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A 61-year-old lady with a medical history of hypertension and hyperlipidemia, presented with recurrent palpitation for 3 weeks. The palpitations were sudden in onset and gradual in offset.
Her electrocardiogram (ECG) showed paroxysmal atrial fibrillation. Her 2Dechocardiogram showed abnormally small right ventricular (RV) cavity size with extracardiac compression of RV, normal RV global systolic function (Figure 1). Stress echocardiogram was negative for inducible ischemia at low workload. CT thorax with contrast showed no mediastinal or pulmonary mass detected. Discontinuous pericardial calcification was identified (Figure 2).
Right and left heart catheterization showed features of constrictive pericarditis. Right atrial (RA) pressure was elevated with prominent x and y descends (Figure 4a). Elevated diastolic pressures of the left ventricle (LV) and RV with a difference of less than 5 mmHg, RV and LV waveform demonstrating dip and plateau pattern (Figure 4b) were also shown. Some discordance of RV and LV pressures with respiration was noted (Figure 4c). There was diastolic equalization of RA and LV pressure (Figure 4d).
She underwent pericardiectomy. Adhesions were found involving the whole of the pericardium with heavy calcification at the right AV groove and the inferior surface of the heart. Central venous pressure before an operation was more than 30 mmHg and was 18 mmHg post pericardiectomy. 2Dechocardiogram done 7 days postpericardiectomy showed no features of residual constriction.