PDF(Pubmed)
Abstract：
An 80-year-old man presented to the cardiology outpatient clinic due to shortness of breath. His past medical history included alcohol intake, hypertension, inferior wall myocardial infarction (five years ago), an ischemic stroke, and permanent atrial fibrillation (diagnosed three years before the current examination). A physical exam revealed a decreased intensity of S1 and S2, irregular rate and rhythm, and no murmurs nor friction rub. X-rays, Computed Tomography, and echocardiography exhibited pericardial calcification, involving mostly the inferior wall and protruding into the left ventricle. A diagnosis of constrictive pericarditis due to pericardial calcification was established and considered idiopathic. Even when it may be related to ischemic heart disease, post-infarction pericarditis could explain how the calcification extended to adjacent territory perfused by the circumflex coronary artery. Combined imaging studies were crucial not only for identifying calcium deposits in the pericardium but also in assessing a patient inherently prone to co-existing and exacerbating conditions. Even though pericardiectomy allows for removal of the clinical manifestations of congestive pericarditis in the most symptomatic patients with pericardial calcification, among patients like ours, with tolerable symptoms, cardiologists should discuss the therapeutic options considering the patient\'s choices, potentially including a rehabilitation plan as part of non-pharmacological management.
摘要：
一名80岁的男子因呼吸急促而出现在心脏病学门诊。他过去的病史包括饮酒，高血压,下壁心肌梗死（五年前），缺血性中风,和永久性心房颤动（在当前检查前三年诊断）。体格检查显示S1和S2的强度降低，速率和节律不规则，没有杂音也没有摩擦摩擦。X光片,计算机断层扫描,超声心动图显示心包钙化，主要累及下壁并伸入左心室.确定了由于心包钙化引起的缩窄性心包炎的诊断，并认为是特发性的。即使它可能与缺血性心脏病有关，梗死后心包炎可以解释钙化如何扩展到回旋支冠状动脉灌注的邻近区域。联合成像研究不仅对于识别心包中的钙沉积物，而且对于评估固有地容易共存和恶化的患者至关重要。即使心包切除术允许在最有症状的心包钙化患者中去除充血性心包炎的临床表现，像我们这样的病人,有可以忍受的症状，心脏病学家应该考虑患者的选择来讨论治疗方案，可能包括康复计划作为非药物管理的一部分。
