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Full Version: Malaise, weight gain, increasing abdominal girth, and edema
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A 35-year-old woman is admitted to the hospital with malaise, weight gain, increasing abdominal girth, and edema. The symptoms began about 3 months ago and gradually progressed. The patient reports an increase in waist size of approximately 15 cm. The swelling in her legs has gotten increasingly worse such that she now feels her thighs are swollen as well. She has dyspnea on exertion and two-pillow orthopnea. She has a past history of Hodgkin’s disease diagnosed at age 18. She was treated at that time with chemotherapy and mediastinal irradiation. On physical examination, she has temporal wasting and appears chronically ill. Her current weight is 96 kg, which reflects an increase of 11 kg over the past 3 months. Her vital signs are normal. Her jugular venous pressure is approximately 16 cm, and the neck veins do not collapse on inspiration. Heart sounds are distant. There is a third heart sound heard shortly after aortic valve closure. The sound is short and abrupt and is heard best at the apex. The liver is enlarged and pulsatile. Ascites is present. There is pitting edema extending throughout the lower extremities and onto the abdominal wall. Echocardiogram shows pericardial thickening, dilatation of the inferior vena cava and hepatic veins, and abrupt cessation of ventricular filling in early diastole. Ejection fraction is 65%.

What is the best approach for treatment of this patient?

A. Aggressive diuresis only
B. Cardiac transplantation
C. Mitral valve replacement
D. Pericardial resection
E. Pericardiocentesis

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Members may check the correct answer file posted below Arrow d (2)
the answer is d
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