Tightening up

A 28 year old woman presents with worsening exertional dyspnea for one month which has now progressed to dyspnea at rest. She denies orthopnea, paroxysmal nocturnal dyspnea or chest pain. She also gives a background of intermittent low grade fever and a non-productive cough for the preceding year.

Her medical history is otherwise unremarkable, and a full blood count is found to be normal. Her ESR is 110 mm/first hour.

Select Relevant Investigations
ECG

Performed

The ECG is positive for low voltage QRS complexes.
Chest X-ray

Performed

The right lung shows apical shadowing. The cardiac silhouette appears normal.
Echocardiography

Performed

Left and right ventricular diastolic filling is restricted, while early diastolic rapid filling is noted. An abnormal early diastolic septal bounce is present. A pericardial effusion is not seen. Systolic function is normal, with a left ventricular ejection fraction > 70%.
Sputum for AFB

Performed

3 early morning sputum samples are collected after nebulization with saline. The 3rd sample tests positive for acid-fast bacilli.

Select Relevant Management
Pericardiocentesis
Steroids
Thrombolysis
Pericardiectomy