Background: Constrictive pericarditis is a rare complication of pericarditis and is difficult to diagnose due to non-specific presentation. It mostly presents with right-sided heart failure as a consequence of a rigid pericardium that encases the heart causing impaired diastolic filling.
Case summary: We present the case of a patient with signs and symptoms of dyspnoea and right-sided heart failure who was initially diagnosed with heart failure with preserved ejection fraction (HFpEF) but remained symptomatic despite being euvolaemic after treatment. A septal bounce and shudder on echocardiogram prompted further investigation. Eventually, cardiac magnetic resonance (CMR) imaging and invasive biventricular pressure measurements led to the diagnosis of constrictive pericarditis. A pericardiectomy was performed after which the patient was relieved of symptoms.
Discussion: Constrictive pericarditis can mimic HFpEF. Due to its potentially curable character, timely recognition is of cardinal importance. In patients with symptoms of severe right-sided heart failure not resolving after diuretic therapy, a septal shudder on echocardiography should trigger further investigation, with e.g. CMR and cardiac catheterization.
Keywords: Cardiac catheterization; Cardiac magnetic resonance imaging; Case report; Constrictive pericarditis; Diastolic heart failure; Pericardiectomy.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.