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Epidemiology of pericardial diseases in Africa: a systematic scoping review
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    How to mitigate diagnostic delay in constrictive pericarditis

    Given the fact that constrictive pericarditis is an eminently reversible cause of congestive heart failure(CHF) its timely clinical recognition deserved special mention in the recent review of epidemiology of pericardial diseases in Africa(1). Timely recognition and treatment might, arguably, mitigate the risk of perioperative mortality which is currently of the order of 12.5% to 14%, given the fact that this adverse statistic is principally generated by patients who come to operation in New York Heart Association functional class III and IV(2)(3). Accordingly, what needs to be done is to educate doctors and medical students to identify stigmata which differentiate CP from "run of the mill" CHF so as to expedite early referral of suspected CP to tertiary centres for definitive diagnosis and, hence, timely pericardiectomy.
    According to Little and Freeman, in the typical case of CP, "there will be marked jugular venous distension, hepatic congestion, ascites, and peripheral oedema, while the lungs remain clear"(3). Consequently, on the basis of their series of 30 patients, Evans and Jackson observed that "the presence of distended neck veins in a patient who is able to lie comfortably in the recumbent posture is characteristic of the disease"(4). The jugular venous pressure(JVP) response to a diagnostic trial of diuretic therapy may also be of diagnostic significance(5)(6). In CP, the typical response is that the JVP remains persisten...

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