Transthoracic Echocardiogram Showing Signs of Constrictive Physiology

A patient with recurrent pericarditis presented with constrictive physiology on transthoracic echocardiography (TTE). The apical 4-chamber view of the TTE demonstrates the abrupt displacement of the interventricular septum in early diastole during each cardiac cycle, which is called septal bounce or septal shudder. This is seen in constriction because of ventricular interdependence. The early diastolic filling of the right ventricle leads to the leftward deviation of the interventricular septum followed by a bounce back towards the right ventricle in late diastole. This results from increases in early diastolic pressure in the right ventricle that exceeds left ventricular diastolic pressures during the cardiac cycle. This is different from the respirophasic shift of the septum, which changes with inspiration. These findings can be associated with acute or recurrent pericarditis causing pericardial inflammation and increased pericardial thickness, which can lead to such imaging findings without true heart failure. Click the Related Article link for a review of echocardiographic findings of constrictive physiology and the Related Video links to watch multimodality imaging findings of constrictive physiology.