Diagnosis of constrictive pericarditis obscured by hypertrophic cardiomyopathy: Back to basics

In this report, we describe the case of a 41-year-old man with hypertrophic cardiomyopathy presenting with right-sided congestive heart failure symptoms. Noninvasive testing was suggestive, but non-diagnostic for constrictive pericarditis (CP) and thus invasive hemodynamic catheterization was performed. The unique presence of both hypertrophic cardiomyopathy and constriction in this case led to lack of "modern" echocardiographic and invasive criteria for CP, based upon findings of enhanced ventricular dependence. However, classic hemodynamic criteria of early rapid filling with elevation and end-equalization of diastolic pressures were present, and the patient ultimately received pericardiectomy with dramatic clinical improvement.