Ascites After Pericarditis: Call the Cardiologist
A 57-year-old female with a past medical history of viral pericarditis, atrial flutter and hypothyroidism presents with a 3-month history of progressive dyspnea on exertion, abdominal fullness and bilateral lower extremity edema.
She was initially diagnosed with viral pericarditis in 1988, for which she was treated with prednisone and indomethacin. She presented to an outside facility in 2012 complaining of abdominal pain. A right upper quadrant ultrasound was performed and showed a "portal vein abnormality" associated with small-to-moderate volume ascites. She was started on spironolactone and hydrochlorothiazide. She subsequently presented to pericardial clinic recently with profound shortness of breath with minimal exertion and bilateral lower extremity edema. Her electrocardiogram (Figure 1), chest x-ray (Figure 2), chest computed tomography (CT) (Figure 3) and echocardiogram Doppler images (Figures 4-6) are shown below.
She underwent right heart catheterization which demonstrated the following: right atrial pressure 29 mmHg, right ventricular (RV) pressure 71/29 mmHg, pulmonary artery pressure 71/44 mmHg, pulmonary capillary wedge pressure of 30 mmHg, left ventricular (LV) pressure of 113/33 mmHg. Cardiac output was 2.8 L/min by Fick and 3.73 L/min by thermodilution. Her mixed venous oxygen saturation was 58%.
Which of the following findings on right heart catheterization would be the most specific for constrictive pericarditis?