A 77-year-old man with progressive dyspnea on exertion

Our plain-English summary of A 77-year-old man with progressive dyspnea on exertion, by J.G. Weg (Chest, 1998).

The study

• Author: J.G. Weg
• Journal: Chest
• Published: 1998;113(2):521-2
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article was a board review teaching question, not a research study. It described one man with dyspnea (shortness of breath) on exertion that had worsened over 5 years. He had had surgery for angina about 38 years earlier, around 1960. The answer given was asbestos. The author explained that a chest X-ray and CT scan showed extensive calcification of the pericardium, the sac around the heart. The author called this a late complication of the Beck procedure, in which asbestos was put into the pericardial sac to try to develop collateral blood flow to the heart. The article did not name the fiber type. On examination the man had about 17 cm of jugular venous distention, a pericardial knock and leg swelling. A transesophageal echocardiogram showed findings the author described as consistent with pericardial constriction, and an estimated right ventricular systolic pressure of 38 mm Hg. Coronary angiography found no significant disease, and a stress thallium study was normal. The author noted that one other calcified constrictive pericarditis case after the Beck procedure, and a malignant mesothelioma, had been reported elsewhere.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Board review question of the month (teaching case describing a single patient)
• Who was studied: One man, described in the text as 75 years old (77 in the title), who had surgery for angina about 38 years earlier (approximately 1960); location not stated
• Exposure: Asbestos placed into the pericardial sac during the Beck procedure, an operation intended to develop collateral blood flow to the heart; fiber type not specified
• Main results:
  • The chest X-ray and CT scan of this patient showed extensive pericardial calcification
  • On examination the patient had approximately 17 cm of jugular venous distention, a pericardial knock, and lower extremity edema
  • The transesophageal echocardiogram gave an estimated right ventricular systolic pressure of 38 mm Hg
  • The echocardiogram showed decreased motion of the right atrium and left ventricular free wall, which the author described as consistent with pericardial constriction
  • Coronary angiography in this patient did not identify significant disease, and a stress thallium study was normal
• The authors' conclusion: The author gave asbestos as the answer, attributing the pericardial calcification to asbestos placed in the pericardial sac during the Beck procedure

Topics

Medical terms in this study, explained in our Lexicon: Dyspnea.

Related studies

• Chronic constrictive pericarditis associated with asbestosis — L. Fischbein, M. Namade, et al. (1988)
• Asbestos induced pericardial effusion and constrictive pericarditis — D. Davies, M.I. Andrews, et al. (1991)
• Pleural calcification associated with exposure to chrysotile asbestos in southeast Turkey — S. Yazicioglu (1976)
• A 70-year-old woman with dyspnea and chest pain — A. Ganesh, M. Flores, et al. (2014)
• Persistent Dyspnea in a 74-Year-Old Man With Normal Spirometry and Lung Volumes — W.H. Chong, B. Saha, et al. (2021)
• Pericardiectomy for treatment of neoplastic constrictive pericarditis — F. Buyukbayrak, E. Aksoy, et al. (2014)

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