Myocardial Disease V

Cardiovascular System


{"ops":[{"insert":"A 58-year-old man comes to the physician because of a 3-month history of shortness of breath. He has had orthopnea, paroxysmal nocturnal dyspnea and peripheral edema. He has a history of sarcoidosis. His pulse is 100\/min and regular, respirations are 20\/min, and blood pressure is 130\/75 mm Hg. There are jugular venous pulsations 6 cm above the sternal angle with a prominent y descent. Crackles are heard at both lung bases. Cardiac examination shows an S3. There is 2+ pretibial edema bilaterally. An echocardiogram shows thickening of both ventricles and septum with normal pericardial thickness. Which of the following is the most likely diagnosis?"},{"insert":"\n"}]}

Background

{"ops":[{"insert":"Restrictive cardiomyopathy and constrictive pericarditis present with similar clinical findings. Cardiac catheterization may be required for differentiation, with enhanced ventricular interdependence being seen in the latter."},{"insert":"\n"}]}

(A)

Restrictive cardiomyopathy
{"ops":[{"insert":"Restrictive cardiomyopathy is an important complication of sarcoidosis. This presents with symptoms of heart failure along with elevated jugular venous pressure (JVP), a prominent y descent, kussmaul\u0027s sign, pulmonary edema, pleural effusions, and peripheral edema. Echocardiography may show thickening of both ventricles and septum. This is the most likely diagnosis."}]}

(B)

Constrictive pericarditis
{"ops":[{"insert":"Constrictive pericarditis presents with signs and symptoms that are similar to those of restrictive cardiomyopathy. However, the normal pericardial thickness on echocardiography makes this less likely. This is not the most likely diagnosis."}]}

(C)

Pulmonary embolism
{"ops":[{"insert":"Pulmonary embolism can cause right sided heart failure with an elevated JVP and peripheral edema. However, this does not explain the clinical findings such as a prominent y descent or pulmonary edema; or the echocardiogram findings. This is not the most likely diagnosis."}]}

(D)

Left ventricular thrombus
{"ops":[{"insert":"Left ventricular thrombus can occur in the setting of heart failure, although it is a consequence rather than a cause. However, it does not present with volume overload and cannot explain the other clinical findings. This is not the most likely diagnosis."}]}

(E)

Dilated cardiomyopathy
{"ops":[{"insert":"Dilated cardiomyopathy can present with symptoms of heart failure and signs of volume overload. However, the history of sarcoidosis and thickened ventricular wall on echocardiogram favor the latter. This is not the most likely diagnosis."}]}

References

{"ops":[{"insert":"KUSHWAHA SS, FALLON JT, FUSTER V. Restrictive cardiomyopathy. N Engl J Med [online] 1997 Jan 23, 336(4):267-76 [viewed 20 July 2019] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8995091"},{"insert":"\n","attributes":{"list":"ordered"}},{"insert":"GARCIA MJ. Constrictive Pericarditis Versus Restrictive\u00a0Cardiomyopathy? J Am Coll Cardiol [online] 2016 May 3, 67(17):2061-76 [viewed 20 July 2019] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27126534"},{"insert":"\n","attributes":{"list":"ordered"}}]}

Want to continue playing?

Open your Clinical Odyssey account today.


Enjoy unlimited access to 600+ simulations.
Safely improve your skills, anytime and anywhere.
Get answers to your follow-up questions from practicing physicians.