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BMJ Case Rep ; 14(1)2021 Jan 25.
Article in English | MEDLINE | ID: mdl-33495174

ABSTRACT

Constrictive pericarditis is a relatively uncommon form of cardiac failure and presents due to scarring and consequent loss of the normal elasticity of the pericardial sac. This results in abnormal/limited ventricular filling and symptoms of heart failure. The aetiology is varied, from infective causes to idiopathic causes, or can manifest after cardiothoracic surgery. This case involves a 46-year-old man presenting with acute group A beta haemolytic streptococcus infection, and over the subsequent 6 months develops constrictive pericarditis due to what is believed to be a rheumatic aetiology. The patient subsequently underwent pericardiectomy and had restoration of normal filling dynamics confirmed on follow-up echocardiography. This case provides a subject matter for the review of the features of constrictive pericarditis and its investigation and management. This case is that it highlights the fact that pericarditis is not a benign condition. Emerging evidence suggests that pericarditis is due to a failure in inflammatory regulatory mechanisms, and patients suffering this condition have a preponderance to 'autoinflammation'. Pericarditis should be recognised early and treated fully with anti-inflammatory agents.


Subject(s)
Bacteremia/diagnosis , Pericarditis, Constrictive/diagnosis , Rheumatic Heart Disease/diagnosis , Streptococcal Infections/diagnosis , Anti-Bacterial Agents/therapeutic use , Antistreptolysin/immunology , Bacteremia/complications , Bacteremia/drug therapy , Blood Culture , C-Reactive Protein/immunology , Cardiac Catheterization , Ceftriaxone/therapeutic use , Electrocardiography , Hospitalization , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Pericardiectomy , Pericarditis, Constrictive/etiology , Pericarditis, Constrictive/physiopathology , Pericarditis, Constrictive/surgery , Piperacillin, Tazobactam Drug Combination/therapeutic use , Rheumatic Heart Disease/etiology , Rheumatic Heart Disease/physiopathology , Rheumatic Heart Disease/surgery , Streptococcal Infections/complications , Streptococcal Infections/drug therapy , Streptococcus pyogenes , Ventricular Pressure
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