Today we discussed a great case with concern for constrictive pericarditis post XRT.
In patients who receive 50 Gy to the chest about 30% will acquire pericardial disease which includes pericarditis, pericardial effusion and constrictive pericarditis.
Constrictive Pericarditis presents with signs of volume overload, elevated JVP, Kussmaul’s sign, pericardial knock, and congestive hepatopathy. On CXR, pericardial calcifications can sometimes be seen. Diagnosis is confirmed by RHC.
Anthracycline chemotherapy can cause cardiotoxicity. If using doxorubicin or daunorubicin at a cumulative dose of less than 400mg/m2 there is less than a 1% risk of cardiotoxicity. However, if the cumulative dose is greater than 550 mg/m2 then the risk of cardiotoxicity increases to 26%. Cardiotoxicity usually manifests as systolic or diastolic heart failure. Thus prior to initiation and serial echocardiograms are recommended.