Don't blindly trust in BNP concentration: A case of constrictive pericarditis

Monitoring of the jugular venous pressure response to diuretics in constrictive pericarditis

“…When the jugular venous pressure (JVP) is markedly raised in patients with suspected right-sided heart failure [1], the diagnostic potential of this parameter should be optimised by monitoring its response to diuretics [2], given the fact that monitoring might raise the index of suspicion for constrictive pericarditis (CP) as the alternative diagnosis. In a series of 11 patients with CP (including nine with unequivocal elevation of JVP), despite rest and diuresis, "the jugular veins remained distended and the pressure elevated in all instances of constrictive pericarditis" [2].…”

“…In a series of 11 patients with CP (including nine with unequivocal elevation of JVP), despite rest and diuresis, "the jugular veins remained distended and the pressure elevated in all instances of constrictive pericarditis" [2]. Although brain natriuretic peptide (BNP) levels may be normal in CP [1,3], BNP levels in 43 patients reported by Oreto et al ranged from 114 to 782 ng/ml [4].…”