A 42-year-old woman has progressive right-sided heart failure with ascites, marked jugular venous distension, and a Kussmaul sign. Cardiac catheterisation shows equalization of end-diastolic pressures in all four chambers with a dip-and-plateau waveform. Which additional finding favours constrictive pericarditis over restrictive cardiomyopathy as the cause?
- A Biatrial enlargement with reduced longitudinal strain on speckle tracking
- B Markedly elevated serum NT-proBNP concentration
- C Elevated lateral mitral annular E/e' ratio above 15
- D Interventricular septal shift toward the left ventricle with inspiration (septal bounce) on echocardiography ✓
Explanation
In constrictive pericarditis the rigid pericardium uncouples the ventricles, so inspiration augments right ventricular filling and shifts the septum leftward, the septal bounce, reflecting enhanced ventricular interdependence; this is absent in restrictive cardiomyopathy where the myocardium itself is diseased. Restrictive cardiomyopathy instead shows high NT-proBNP, elevated E/e', biatrial enlargement, and reduced strain, all markers of intrinsic myocardial disease. Pericardial thickness greater than 4 mm on CT or MRI would be further supportive evidence of constriction.
Reference: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.