The abdominal aorta and constrictive pericarditis: Abdominal aortic respiratory variation as an echocardiographic finding in constrictive pericarditis

A 68-year-old man with a history of pericarditis was referred for evaluation of dyspnea and 6 months of recurrent paroxysmal atrial fibrillation. He initially presented with sweating, fatigue, chest tightness, and abdominal bloating. At the time, an electrocardiogram revealed atrial fibrillation with rapid ventricular response (190/ min). He was rate controlled and then underwent successful electrical cardioversion to sinus rhythm. An echocardiogram demonstrated a moderate pericardial effusion. Two months later, with recurrent similar symptoms, an electrocardiogram demonstrated atrial flutter. A transesophageal echocardiogram was performed to rule out atrial thrombi. It demonstrated a thickened pericardium, a tiny pericardial effusion, and no thrombus. He again underwent successful electrical cardioversion to sinus rhythm. His medical history was significant for a cerebrovascular accident 3 years prior with residual left-sided paresthesias. His medications included furosemide, metoprolol, diltiazem, propafenone, spironolactone, atorvastatin, rofecoxib, aspirin, and clonazepam.