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A 34-year-old amateur triathlete presenting with dyspnoea

Sabiha Gati, Sports Cardiology Quiz Section Editor

Differentiating between restrictive cardiomyopathy and constrictive pericarditis remains a challenge despite advances in imaging techniques and invasive physiological assessment.

Athletes with these diagnoses are advised to discontinue exercise in the short-term. Expedited surgery for pericardial constriction has a prognostic value and thus a clear understanding of the investigation is important to facilitate timely treatment. These athletes may be able to return to sport if they achieve symptomatic and functional resolution, whereas restrictive cardiomyopathy cannot be cured.

Therefore, distinguishing between the two can have significant long-term lifestyle implications.

Rehabilitation and Sports Cardiology


The case

A 34-year old triathlete was admitted under the cardiology team after self-presenting with one month of progressive shortness of breath now occurring at rest.

  • He participated in several international sporting competitions.
  • Blood tests showed an equivocal CRP and troponin level.
  • Electrocardiogram (ECG) demonstrated sinus rhythm at 99bpm with inferolateral T-wave inversion.
  • An echo demonstrated a non-dilated left ventricle (LV) with normal LV wall thickness and mildly reduced systolic function.
  • An echogenic, thickened pericardium, a 12mm pericardial effusion and a large right sided pleural effusion were also seen.

The athlete was advised to stop all forms of exercise and further investigations were expedited. 

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Note: The views and opinions expressed on this page are those of the author and may not be accepted by others. While every attempt is made to keep the information up to date, there is always going to be a lag in updating information. The reader is encouraged to read this in conjunction with appropriate ESC Guidelines. The material on this page is for educational purposes and is not for use as a definitive management strategy in the care of patients. Quiz material in the site are only examples and do not guarantee outcomes from formal examinations.

References

1. Aquaro GD, Barison A, Cagnolo A, Todiere G, Lombardi M, Emdin M. Role of tissue characterization by Cardiac Magnetic Resonance in the diagnosis of constrictive pericarditis. Int J Cardiovasc Imaging. 2015 Jun;31(5):1021–31.

2. Garcia MJ. Constrictive Pericarditis Versus Restrictive Cardiomyopathy? J Am Coll Cardiol. 2016 May 3;67(17):2061–76.

3. Pelliccia A, Solberg EE, Papadakis M, Adami PE, Biffi A, Caselli S, et al. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). European Heart Journal. 2019 Jan 1;40(1):19–33.

4. Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NAM, et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation. Lippincott Williams & Wilkins Hagerstown, MD; 2015 Dec 1;132(22):e273–80.

Notes to editor

Author information:

Nikhil Ahluwalia, Cardiology Registrar, Bart’s Heart Centre, London, UK, Sports Cardiology MSc student, Cardiology Clinical Academic Group, St George’s University of London.

James C. Moon, Consultant Cardiologist, Bart’s Health Centre, London, UK. Professor of Cardiology, NIHR University College London Hospitals Biomedical Research Centre, London, UK.