Clinical and Hemodynamic Studies of Myocardial Fibrosis

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Abstract
Three patients are presented with intractable heart failure[long dash]myocardial fibrosis. Many clinical and hemodynamic features strongly suggested constrictive pericarditis, particularly the right ventricular and right atrial pressure contours, although the pericardium was normal at operation. Differentiation can sometimes be made on quantitative grounds. Severely disabled patients with right ventricular end-diastolic to systolic pressure ratios clearly less than 1/3, and with right atrial mean pressures well below 15 mm Hg, are unlikely to have constrictive pericarditis. Any considerable respiratory variation in right atrial pressure contour increases the likelihood that the diagnosis is myocardial fibrosis rather than constrictive pericarditis, as does the observation that the right ventricular early diastolic dip goes below the baseline.