THE CONTEXT
The target passage lists clinical features of constrictive pericarditis, illustrates pericardial calcification and continues the discussion of diagnosing and treating tuberculous pericarditis.
Pulse, venous pressure and heart sounds
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Features include fatigue and a rapid, low-volume pulse.
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Jugular venous pressure is elevated with a rapid y descent; Kussmaul sign and pulsus paradoxus are also listed.
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A loud early third heart sound, termed a ‘pericardial knock’, may be heard.
Congestion and radiographic findings
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Hepatomegaly, ascites and peripheral oedema are listed clinical features.
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The illustrated lateral chest X-ray in chronic constrictive pericarditis with severe heart failure shows heavy pericardial calcification.
Diagnosis and treatment of tuberculous pericarditis
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Diagnosis may be confirmed by aspiration of pericardial fluid followed by direct examination or culture for tubercle bacilli.
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Treatment requires specific antituberculous chemotherapy.
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An additional course of prednisolone, beginning at 60 mg daily and gradually tapering over 3 months, improves outcome.