# Lessons From a Complex Case of Calcific Constrictive Pericarditis: A Case Report

## TL;DR

This case report describes a complex instance of calcific constrictive pericarditis in a patient with multiple health issues, emphasizing the difficulty in diagnosis and treatment.

## Contribution

The paper contributes a detailed case study highlighting diagnostic and therapeutic challenges in calcific constrictive pericarditis with comorbidities.

## Key findings

- Calcific constrictive pericarditis can present with non-specific symptoms, leading to delayed diagnosis.
- Patients with multiple comorbidities face significant challenges in treatment options for calcific constrictive pericarditis.
- Conservative management and palliative care may be necessary when surgical intervention is not feasible.

## Abstract

Despite advances in imaging and diagnostics, calcific constrictive pericarditis (CCP) remains a rare and challenging entity, often masquerading as other cardiopulmonary conditions, leading to delayed diagnosis. We present a 70-year-old male with a history of heart failure, atrial fibrillation (AF), cirrhosis, chronic obstructive pulmonary disease (COPD), and prior pleural effusion, who was admitted with acute hypoxic respiratory failure and AF with rapid ventricular response (RVR). Imaging revealed extensive pericardial calcifications, leading to a diagnosis of CCP. The patient's clinical course was marked by refractory hypotension, altered mental status, and progressive cardiohepatic syndrome. Given his high surgical risk, he was managed conservatively and transitioned to palliative care. This case underscores the diagnostic and therapeutic challenges of CCP, particularly in patients with complex comorbidities where surgical intervention is not feasible. It highlights the need for early recognition and individualized management strategies to optimize outcomes in this challenging subset of patients.