Review Question - QID 100620

The patient described in the question stem has pericarditis, a common complication of rheumatoid arthritis. Constrictive pericarditis can restrict venous return to the right heart resulting in an increase in JVP on inspiration (Kussmaul's sign).

Pericarditis is inflammation of the pericardial sac. There are 4 types of pericarditis (serous, fibrinous, hemorrhagic, and constrictive) and each is associated with particular diseases (detailed in the topic "Pericarditis"). On inspiration, more blood returns to the heart as intrathoracic pressure becomes more negative. However, constrictive pericarditis impedes filling of the right ventricle, and blood is not as effectively removed from the jugular vein, increasing the pressure within it. This phenomenon can be observed at the bedside and is known as Kussmaul's sign.

Goyle et al. review the etiologies and diagnosis of pericarditis. They report that pericarditis is most often caused by viral infection, though it can be bacterial or fungal in rare cases. Non-infectious causes include autoimmune disease (as in this case), renal failure, injury to the mediastinal area, and certain drugs (notably hydralazine and procainamide).

Kass et al. review the differential diagnosis of pleuritic chest pain, which range from life-threatening to benign, self-limited conditions. Pulmonary embolism is the most common potentially life-threatening cause of pleuritic chest pain but other clinically significant conditions include pericarditis, pneumonia, myocardial infarction, and pneumothorax.

Illustration A shows an example of fibrinous pericarditis.

Incorrect answers:
Answer 2: This is the opposite of pulsus paradoxus, the DECREASE in systolic pressure on inspiration that can be seen in pericarditis among other conditions.
Answer 3: A pulsatile abdominal mass is seen in an abdominal aortic aneurysm.
Answer 4: A continuous machine-like murmur is observed in PDA.
Answer 5: S3 heart sound is observed in dilated cardiomyopathy.