A 58-year-old man was seen with progressive breathlessness in the outpatient clinic. He had undergone coronary artery bypass grafting 3 years previously and this had been complicated by a resternotomy for tamponade. He recovered well but had started to feel breathless and fatigued over the past 12 months. His past medical history included type 2 diabetes mellitus and hypertension. He was a current smoker.
A diagnosis of constrictive pericarditis was made.
What is the most common physical finding seen in this group of patients?
B: finger clubbing
D: pericardial knock
E: pleural effusion
Correct answer: C Explanation C is the best answer. Hepatomegaly is the earliest and most consistent feature of pericardial constriction of the options here.
A: ascites (a later phenomenon than hepatomegaly) and D: pericardial knock (recognised in around 50% of cases) are also features of pericardial constriction, making this a true “best-of” question.
B: Finger clubbing is not a feature of constriction, however, and E: pleural effusion is uncommon.