OBSERVATIONS OF ANGINA AND MYOCARDIAL-INFARCTION IN CONSTRICTIVE PERICARDITIS

The common symptoms of constrictive pericarditis, i.e. dyspnea on exer tion, shortness of breath and cough, relate to impairment of ventricul ar filling and to a progressive rise in systemic and pulmonary venous pressures. Myocardial ischemia, angina and myocardial infarction are r arely associated with this disease. We have encountered two patients w ith constrictive pericarditis, one presenting with angina and the othe r with acute anterior wall infarction. Possible etiologies of constric tive pericarditis in the first case include cardiac surgery, chronic r enal failure and myocarditis; in the second case, Crohn's disease. The proposed mechanism of chest pain in the first patient was a reduced c ardiac output resulting in underperfusion of the coronary arteries, al though it is possible that the patient experienced angina due to the p resence of severe coronary artery disease. In the second patient an an terior wall infarction and post-infarction angina were attributed to o bliteration of the left anterior descending artery by constraint of a thickened pericardium. In both cases non-invasive imaging modalities w ere not of use in establishing the diagnosis of constrictive pericardi tis. Clinical awareness and accurate hemodynamic measurements continue to play a key role in the diagnostic process.