Challenges for the Basis of Practice Response to Campbell: Is This a Case of Constriction?

The patient presented by Dr Patricia Campbell1 from the Advanced Heart Disease Section of Brigham and Women’s Hospital exemplifies challenges that surround the possible diagnosis of constrictive pericarditis. Constrictive pericarditis is a pericardial compressive syndrome due to fibrosis, scarring, and occasionally calcification of the pericardium. The primary pathophysiological consequence is impairment of ventricular filling. The hemodynamic abnormalities are characterized by elevation of both right and left ventricular filling pressures and equalization of right and left ventricular diastolic pressures. It should be appreciated, however, that there are a number of pathological conditions that can be associated with equalization of ventricular diastolic pressures (Table).