Final The Echo Manual DIGITAL

The Echo Manual

27

CHAPTER 12 PERICARDIAL DISEASES

WHQW LV SURKLELWHG

FIGURE 12-32 A: 2-D echocardiography and continuous wave Doppler show low gradient severe aortic stenosis. LV , left ventricle; RV , right ventricle. B: Tissue Doppler of the mitral annulus ( top ) and strain imaging and hepatic vein Doppler indicate coexisting constrictive pericarditis. :RO WH U V . O X Z H U , Q F 8 QDXWKR U L] H G UH S U R G X FWL RQ R I W KH F R Q

Q14

pericarditis (51). As with chronic constrictive pericarditis, patients present with dyspnea, peripheral edema, increased jugular venous pressure, and, occasionally, ascites. The transient constrictive phase may last 2 to 3 months before it either resolves spontaneously or progresses to chronic constriction. The latter outcome is potentially avoidable if anti-inflammatory agents are initiated within 3 months of disease onset and can be predicted by elevated inflam- matory markers, greater baseline pericardial thickness, and more intense pericardial enhancement on cardiac MRI (Fig. 12-34A). Initial treatment with a nonsteroidal anti-inflam- matory drug like indomethacin, with or without colchicine, is recommended for 2 to 3 weeks. If there is no response, Q16

vein Doppler velocity pattern are more like those seen in patients with constrictive pericarditis (W. Miranda et al. Unpublished) (Fig. 12-33). TRANSIENT CONSTRICTIVE PERICARDITIS About 7% to 10% of patients with acute pericarditis have a transient constrictive phase. These patients usually have a moderate amount of pericardial effusion, and as the peri- cardial effusion resolves, the pericardium remains inflamed, thickened, and noncompliant, resulting in constrictive hemodynamics. Except for radiotherapy, all potential causes of pericarditis have been implicated in transient constrictive &RS\ULJKW ‹

32