Constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter

Abstract Background Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium. This case demonstrates that mixed martial arts (MMA) is a previously unrecognized risk factor for CP, diagnosis of which is supported by cardiac imaging, right and left heart ca...

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Autores principales:	Meganne N. Ferrel, Sentia Iriana, I. Raymond Thomason, Christy L. Ma, Katsiaryna Tsarova, Brent D. Wilson, Stephen H. McKellar, John J. Ryan
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Case report Constrictive Diastolic heart failure Hemodynamics Imaging Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/4613c91f452c4a17893aaf069e7ec6df
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spelling	oai:doaj.org-article:4613c91f452c4a17893aaf069e7ec6df2021-11-28T12:05:24ZConstrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter10.1186/s12872-021-02378-81471-2261https://doaj.org/article/4613c91f452c4a17893aaf069e7ec6df2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12872-021-02378-8https://doaj.org/toc/1471-2261Abstract Background Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium. This case demonstrates that mixed martial arts (MMA) is a previously unrecognized risk factor for CP, diagnosis of which is supported by cardiac imaging, right and left heart catheterization, and histological findings of dense fibrous tissue without chronic inflammation. Case presentation A 47-year-old Caucasian male former mixed martial arts (MMA) fighter from the Western United States presented to liver clinic for elevated liver injury tests (LIT) and a 35-pound weight loss with associated diarrhea, lower extremity edema, dyspnea on exertion, and worsening fatigue over a period of 6 months. Past medical history includes concussion, right bundle branch block, migraine headache, hypertension, chronic pain related to musculoskeletal injuries and fractures secondary to MMA competition. Involvement in MMA was extensive with an 8-year history of professional MMA competition and 13-year history of MMA fighting with recurrent trauma to the chest wall. The patient also reported a 20-year history of performance enhancing drugs including testosterone. Physical exam was notable for elevated jugular venous pressure, hepatomegaly, and trace peripheral edema. An extensive workup was performed including laboratory studies, abdominal computerized tomography, liver biopsy, echocardiogram, and cardiac magnetic resonance imaging. Finally, right and left heart catheterization—the gold standard—confirmed discordance of the right ventricle-left ventricle, consistent with constrictive physiology. Pericardiectomy was performed with histologic evidence of chronic pericarditis. The patient’s hospital course was uncomplicated and he returned to NYHA functional class I. Conclusions CP can be a sequela of recurrent pericarditis or hemorrhagic effusions and may have a delayed presentation. In cases of recurrent trauma, CP may be managed with pericardiectomy with apparent good outcome. Further studies are warranted to analyze the occurrence of CP in MMA so as to better define the risk in such adults.Meganne N. FerrelSentia IrianaI. Raymond ThomasonChristy L. MaKatsiaryna TsarovaBrent D. WilsonStephen H. McKellarJohn J. RyanBMCarticleCase reportConstrictiveDiastolic heart failureHemodynamicsImagingDiseases of the circulatory (Cardiovascular) systemRC666-701ENBMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Case report Constrictive Diastolic heart failure Hemodynamics Imaging Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Case report Constrictive Diastolic heart failure Hemodynamics Imaging Diseases of the circulatory (Cardiovascular) system RC666-701 Meganne N. Ferrel Sentia Iriana I. Raymond Thomason Christy L. Ma Katsiaryna Tsarova Brent D. Wilson Stephen H. McKellar John J. Ryan Constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter
description	Abstract Background Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium. This case demonstrates that mixed martial arts (MMA) is a previously unrecognized risk factor for CP, diagnosis of which is supported by cardiac imaging, right and left heart catheterization, and histological findings of dense fibrous tissue without chronic inflammation. Case presentation A 47-year-old Caucasian male former mixed martial arts (MMA) fighter from the Western United States presented to liver clinic for elevated liver injury tests (LIT) and a 35-pound weight loss with associated diarrhea, lower extremity edema, dyspnea on exertion, and worsening fatigue over a period of 6 months. Past medical history includes concussion, right bundle branch block, migraine headache, hypertension, chronic pain related to musculoskeletal injuries and fractures secondary to MMA competition. Involvement in MMA was extensive with an 8-year history of professional MMA competition and 13-year history of MMA fighting with recurrent trauma to the chest wall. The patient also reported a 20-year history of performance enhancing drugs including testosterone. Physical exam was notable for elevated jugular venous pressure, hepatomegaly, and trace peripheral edema. An extensive workup was performed including laboratory studies, abdominal computerized tomography, liver biopsy, echocardiogram, and cardiac magnetic resonance imaging. Finally, right and left heart catheterization—the gold standard—confirmed discordance of the right ventricle-left ventricle, consistent with constrictive physiology. Pericardiectomy was performed with histologic evidence of chronic pericarditis. The patient’s hospital course was uncomplicated and he returned to NYHA functional class I. Conclusions CP can be a sequela of recurrent pericarditis or hemorrhagic effusions and may have a delayed presentation. In cases of recurrent trauma, CP may be managed with pericardiectomy with apparent good outcome. Further studies are warranted to analyze the occurrence of CP in MMA so as to better define the risk in such adults.
format	article
author	Meganne N. Ferrel Sentia Iriana I. Raymond Thomason Christy L. Ma Katsiaryna Tsarova Brent D. Wilson Stephen H. McKellar John J. Ryan
author_facet	Meganne N. Ferrel Sentia Iriana I. Raymond Thomason Christy L. Ma Katsiaryna Tsarova Brent D. Wilson Stephen H. McKellar John J. Ryan
author_sort	Meganne N. Ferrel
title	Constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter
title_short	Constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter
title_full	Constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter
title_fullStr	Constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter
title_full_unstemmed	Constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter
title_sort	constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter
publisher	BMC
publishDate	2021
url	https://doaj.org/article/4613c91f452c4a17893aaf069e7ec6df
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Constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter

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