new_n_lost
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A 62yrs old Breast Ca pt comes to u becos of weakness, fatiigue,fever n weight gain in the last 5yrs following her radiation therapy. She also complains of Abdominal Discomfort n exertional dyspnea. PE shoiws Hepatomegaly n a raised JVP with no change on inspiration, there is no evidence of Hyptension or Pulsus Paradoxus. CXR n Echo show a normal sized heart with no apparent hypertrophy.
Which of the Following is the Most likely Dx?
A) Cardiac Tamponade
B) Congestive Heart Failure
C) Constrictive PEricarditis
D) Recurrence of Breast Cancer
E) Restrictive Cardiomyopathy
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| vradojc1
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C - Hx of radiation Tx with signs of CHF without echo changes + duration
A/D would show more acute presentation
B/E would have signs of impaired heart "mobility" on echo
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| silver
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C
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| tompat
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i think tamponade and heart failur are out, as shown by normal echo findings and blood pressur.
pericarditis would give some what similar picture but i think radiaton will have effect on whole heart rather than just pericardium.
so i m left with restrictive cardiomyopathy
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| keepgoing
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WT GAIN/abd pain-->ascites ,hepatomegaly and inc jvp---congestion-->heart failure and in oxford clinical book its written--cardiac tamponade ass. with lung/breast ca and radiation therapy..but S/S not--cardiac tamp
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| new_n_lost
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The Correct Answer C.
Constrictive Pericarditis interferes with the filling of the ventricles because of granulation tissue formation in the pericardium. It can follow purulent viral infections, trauma, neoplastic diseases, medinastinal irradiation and other chronic diseases. Pericardial thickening and calcification are sometimes apparent on CT scan and MRI.
Choice A. Cardiac Tamponade is very similar in presentation to constrictive pericarditis. One definig characteristic of cardiac tamponade is the absence of Kussmaul's sign (failure of cervical venous distention to subside on inspiration). In addition, Pulsus paradoxus (decrease in systolic pressure by +/- 10mm Hg during inspiration) is ususally present. CXR should reveal an enlarged cardiac silhouette with pericardial effusion.
Choice B. Congestive Heart Failure produces signs and symptoms similar to those of Constrictive Pericarditis. Howeever, in CHF there would be significant enlargement and hypertrophy of the ventricles.
Choice D Breast and Lung carcinomas, lymphomas and melanomas are the most common metastases to the pericardium and shud therefore be considered in this case, However, metastases causing constrictive pathology is much less common then pericarditis.
Choice E. The CT scan and MRI would reveal the hypertrophied ventricular walls that occur in restrictive cardiomyopathies.
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| lq2006
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C
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