# Pericardial Calcification: An Uncommon Case with Intraventricular Extension

## TL;DR

An 80-year-old man with a history of heart issues was diagnosed with pericardial calcification extending into the heart, managed through imaging and non-surgical options.

## Contribution

Highlights the importance of combined imaging in diagnosing pericardial calcification with intraventricular extension and its management in elderly patients.

## Key findings

- Pericardial calcification was found to extend into the left ventricle, likely due to post-infarction pericarditis.
- Imaging studies were essential for identifying calcification and assessing co-existing cardiac conditions.
- Non-surgical management, including rehabilitation, is a viable option for patients with tolerable symptoms.

## Abstract

An 80-year-old man presented to the cardiology outpatient clinic due to shortness of breath. His past medical history included alcohol intake, hypertension, inferior wall myocardial infarction (five years ago), an ischemic stroke, and permanent atrial fibrillation (diagnosed three years before the current examination). A physical exam revealed a decreased intensity of S1 and S2, irregular rate and rhythm, and no murmurs nor friction rub. X-rays, Computed Tomography, and echocardiography exhibited pericardial calcification, involving mostly the inferior wall and protruding into the left ventricle. A diagnosis of constrictive pericarditis due to pericardial calcification was established and considered idiopathic. Even when it may be related to ischemic heart disease, post-infarction pericarditis could explain how the calcification extended to adjacent territory perfused by the circumflex coronary artery. Combined imaging studies were crucial not only for identifying calcium deposits in the pericardium but also in assessing a patient inherently prone to co-existing and exacerbating conditions. Even though pericardiectomy allows for removal of the clinical manifestations of congestive pericarditis in the most symptomatic patients with pericardial calcification, among patients like ours, with tolerable symptoms, cardiologists should discuss the therapeutic options considering the patient’s choices, potentially including a rehabilitation plan as part of non-pharmacological management.