Question

A 26-year-old man complains of abdominal distension, swelling of the legs, and easy fatigability. His blood pressure is 90/70 mm Hg and the pulse becomes difficult to feel on inspiration. He has pedal oedema, ascites, and tender hepatomegaly. The precordium is quiet, with a loud and somewhat early apical third heart sound. The probable diagnosis is

• A. Cor pulmonale
• B. Tricuspid stenosis
• C. Constrictive pericarditis
• D. Pulmonary stenosis

Hint:

Think about what happens to ventricular filling when the pericardium itself becomes thick and rigid.

Answer 1

The Correct Option is C

This question tests recognition of constrictive pericarditis from its classic bedside triad of a quiet precordium, an early loud apical sound (pericardial knock), and systemic venous congestion.

1. Cor pulmonale: caused by chronic lung disease; expect a loud pulmonary component of the second sound and evidence of respiratory illness, not a pericardial knock.
2. Tricuspid stenosis: gives a diastolic murmur with an opening snap, not an early loud systolic-timed knock, and rarely occurs alone.
3. Constrictive pericarditis: a rigid, thickened pericardium halts diastolic filling abruptly, producing the pericardial knock, muffling the precordium, causing pulsus paradoxus, and backing up pressure to cause ascites, hepatomegaly, and oedema - matching every detail given.
4. Pulmonary stenosis: produces an ejection systolic murmur at the pulmonary area, not this constellation of right heart failure with a knock.

Correct answer: Constrictive pericarditis.