Timothy J. Barreiro, DO

February 01, 2007

abstract: In the past, constrictive pericarditis was most often caused by tuberculosis. Today, however, it is more likely to be preceded by injury or trauma, infection, or previous cardiac surgery. Most patients with constrictive pericarditis present with dyspnea and have elevated jugular venous pressure. Other potential symptoms and signs include peripheral edema, abdominal fullness, hepatomegaly, ascites, and chest pain. Electrocardiography demonstrates nonspecific ST-segment and T-wave changes and generalized T-wave inversion or flattening. In many cases, chest radiography and CT reveal pericardial calcification, and echocardiography shows increased pericardial thickness and calcification. Treatment may include NSAIDs, corticosteroids, antibiotics, angiotensin-converting enzyme inhibitors, and diuretics. Surgery is the treatment of choice for chronic disease, and pericardiectomy is typically effective. (J Respir Dis. 2007;28(2):49-56)

April 15, 2006

A 51-year-old woman with chronic obstructive pulmonary disease presents with nonproductive cough and slowly progressive dyspnea of 3 months' duration. She denies fever, chills, and night sweats. Over the past 3 months, she has received several different courses of treatment; the latest was cefixime, a 2-week tapering dose of prednisone, and bronchodilators. These treatments have failed to alleviate her symptoms.