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July 19, 1976

Constrictive Pericarditis

Author Affiliations

Lemuel Shattuck Hospital Boston

JAMA. 1976;236(3):251. doi:10.1001/jama.1976.03270030011007

To the Editor.—  The well-written, editorial "think pieces" by JAMA's senior editors are always a joy to read, as well as valuable—and painless—learning experiences. I was distressed, therefore, to find a slight, but vital, lapse in Dr Hussey's otherwise delightful "Diagnosis by Deduction From a Few Observations" (235:1884, 1976). The "small, quiet heart" is not, and probably was not despite its promulgation in one of Beck's Triads, characteristic of constrictive pericarditis. Almost without exception, the heart size in constriction is normal or enlarged.1 Of course, for the degree of circulatory congestion, the heart may appear relatively small, but the roentgenographic silhouette is enlarged in at least 50% of cases.The perhaps apocryphal tale of Friedel Pick's last illness may be apposite to this discussion. Pick described constrictive pericarditis as manifesting itself as apparent hepatic cirrhosis ("Pick disease") and was said to have died of constriction. The renowned grosser