Echocardiographic diagnosis of constrictive pericarditis. Chronic constrictive pericarditis, which is rare, usually results when scarlike fibrous tissue forms throughout the pericardium. Constrictive pericarditis arises from a stiffening of the pericardium, which prevents complete or satisfactory diastolic filling of the heart. Constrictive pericarditis or perhaps better termed pericardial constriction is a type of pericarditis which leads to diastolic dysfunction and potentially symptoms of right heart failure. Constrictive pericarditis requires surgical treatment and is usually curable, while restrictive cardiomyopathy, short of cardiac transplantation, is treatable only by medical means and often responds unsatisfactorily. Chronic or recurrent pericarditis, on the other hand, usually lasts six months or longer source. Subjectstwo men, one with severe aortic stenosis and single coronary artery disease, and one with coronary artery disease after an old inferior infarction. Constrictive pericarditis is a disorder caused by inflammation of the pericardium, the saclike covering of the heart.
In constrictive pericarditis the pericardium is rigid meaning it cant move inward or outward. Objectivesto study pericardial thickening as the cause of severe postoperative venous congestion. A recent study reported that response to antiinflammatory therapy is more likely to occur in patients with evidence of significant pericardial late enhancement and increased creactive protein. Chronic constrictive pericarditis chronic constrictive. Constrictive pericarditis cp is a recognised, but unusual cause of chronic ascites.
This condition, called chronic constrictive pericarditis, is corrected by surgical removal of the pericardium. Mediastinal radiation therapy results in approximately a threefold increase in the risk of cardiac death. However, surgery to treat the condition has a high risk for complications. The fibrous tissue tends to contract over the years, compressing the heart. In this video we will be learning what is constructive pericarditis, constrictive pericarditis cause, signs and symptoms of constrictive pericarditis, how to diagnose constrictive pericarditis and. Constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. Bleeding into the pericardium from trauma or from a heart operation is the most common cause of constrictive pericarditis, but tumors or infections can also be the cause. The purpose of this study was to evaluate the longterm outcomes following treatment of constrictive pericarditis by pericardiectomy.
This treatable cause of heart failure should be considered in all patients with unexplained right heart failure symptoms or signs, especially when the left ventricular ejection fraction is preserved. Other symptoms may include fever, weakness, palpitations, and shortness of breath. In the developing world where tuberculosis is still common, it remains the major cause of constrictive pericarditis. Guidelines on the diagnosis and management of pericardial. Constrictive pericarditis is often iatrogenic following openheart surgery or radiation therapy for the treatment of mastocarcinoma and other cancers. Constrictive pericarditis constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. The differentiation of restrictive cardiomyopathy and constrictive pericarditis has been a perennial problem in clinical cardiology. Transient constrictive pericarditis due to postpericardiotomy syndrome, tuberculous, or viral pericarditis may respond to antiinflammatory therapy. In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause. Jvp in constrictive pericarditis student doctor network. Chronic constrictive pericarditis linkedin slideshare. Effusiveconstrictive pericarditis is an uncommon syndrome in which individuals with pericardial effusion and tamponade show clinical and hemodynamic evidence of pericardial constriction after normalization of intrapericardial pressure by drainage of the effusion. Constrictive pericarditis is a wellknown complication of chest irradiation therapy and may occur 10 to 15 years after exposure.
Most deaths are due to myocardial infarction, and the remainder are due to heart failure, constrictive. Constrictive pericarditis article pdf available in british medical journal 15592. This leads to impairment of ventricular filling in mid and late diastole. Constrictive pericarditis etiology idiopathic or viral 42 to 49 % post cardiac surgery 11 to 37 % post radiation therapy 9 to 31 % connective tissue disorder 3 to 7 % postinfectious tuberculous or purulent pericarditis 3 to 6 % miscellaneous causes malignancy, trauma, druginduced, asbestosis, sarcoidosis, uremic. Chronic pericarditis heart and blood vessel disorders. In early diastole, the pressure inside the pericardium is lowest leading to rapid ventricular.
Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. However, because of the compression, the heart does not enlarge as it does in most types of heart. The pericardium is the saclike membrane that surrounds the heart. Longterm outcomes of pericardiectomy for constrictive. For this reason, it is most often done in people who have severe symptoms. The diagnosis of cp requires a high degree of clinical suspicion. Constrictive pericarditis may be life threatening if untreated. Constrictive pericarditis cause, symptoms, diagnosis. Mayo clinic pericarditis generally results from heart attacks, infections or immunological disorders. Constrictive pericarditisa curable diastolic heart. Chronic constrictive pericarditis physiology britannica. Diagnosing constrictive pericarditis remains challenging, and the most effective tools are designed. Constrictive pericarditis an overview sciencedirect topics. With the advent of newer imaging tools, there has been a shift to noninvasive imaging particularly when chronic constrictive pericarditis ccp is suspected.
Pericardial constriction is typically chronic, but variants include subacute, transient, and occult constrictive pericarditis. In the vast majority of cases, medical management is ineffective unless a prominent inflammatory component is present. Constrictive pericarditis is a pretty rare condition you want to find a surgeon at a major heart center that has had a lot of experience dealing with it. As a result, the majority of ventricular filling occurs rapidly in early diastole and the ventricular volume does not increase after the end of the. The compression prevents the heart from filling normally and causes a form of heart failure. Echocardiography diagnostic criteria for constriction. Constrictive pericarditis and pericardial thickening. It is typically better sitting up and worse when lying down or breathing deeply. Methods and resultspatients with surgically confrmed constrictive pericarditis n at mayo clinic 20082010 were compared with patients n36 diagnosed with restrictive myocardial disease or severe tricuspid regurgitation after constrictive pericarditis was considered but ruled out. In the developing world tuberculosis is a common cause of constrictive pericarditis.
Pericarditis cases fall into one of two large categories. Acute pericarditis makes up the vast majority of reported cases, and usually lasts less than a few weeks. The pathophysiology of constrictive pericarditis is restriction of diastolic ventricular filling due to a noncompliant pericardium which is often adhered to the epicardium. Constrictive pericarditis symptoms and ecg medical library. Constrictive pericarditis versus restrictive cardiomyopathy. Eventual thickening, scarring and contracture of the pericardium occurs causing it to be less elastic. In the normal heart, the pericardium is a flexible in nature but does not stretch very much. We present the case of a 14yearold boy with a previous history of tuberculosis and right heart failure, in whom constrictive pericarditis was diagnosed. Constrictive pericarditis is an uncommon disease in children, usually difficult to diagnose. We present a patient with unexplained dyspnea, recurrent rightside. Constrictive pericarditis is a medical condition characterized by a thickened, fibrotic pericardium, limiting the hearts ability to function normally. When the abnormal pericardium limits diastolic filling, there are a series of hemodynamic consequences which manifest as fatigue, dyspnea, abdominal bloating, peripheral edema, or. Pdf chronic constrictive pericarditis researchgate.
One of those complications is chronic constrictive pericarditis. Pericardial mesotheliomas are rare tumors which often present with features of constrictive pericarditis. Between september 1992 and may 2014, 47 patients who underwent pericardiectomy for constrictive pericarditis were retrospectively. We present clinical, imaging, histological, and immunohistochemical findings of three cases presenting with chronic constrictive pericarditis. Constrictive pericarditis radiology reference article. Both constrictive pericarditis and pericardial thickening can results from tuberculosis, radiation, viral pericarditis, or prior surgery. Constrictive pericarditis is a potentially curable condition caused by a variety of situations which result in inflamed, scarred, thickened, or calcified pericardium.
Radiationinduced constrictive pericarditis usually presents 10 years after therapy. The constriction occurs slowly over time and causes shortness of breath on exertion and a decreased ability to exercise. Patients with restrictive cardiomyopathies and constrictive pericarditis are often excluded or underrepresented in large randomized clinical trials. Swelling in the legs and the abdomen may exist because. Pericarditis is inflammation of the pericardium the fibrous sac surrounding the heart.
In this respect, constrictive pericarditis differs from acute pericarditis, in which the use of nonsteroidal antiinflammatory agents nsaids, cyclooxygenase cox2 inhibitors, colchicine, corticosteroids, or a combination thereof may provide benefit. Invasive hemodynamics of constrictive pericarditis. The pain may also be felt in the shoulders, neck, or back. If chronic pericarditis is left untreated over a prolonged period or it is not properly treated, it may lead to other serious heart disorders. This prevents the pericardium from stretching and results in. Definition chronic constrictive pericarditis is a chronic inflammatory process that involves both fibrous and serous layers of the pericardium, and that leads to pericardial thickening and compression constriction of the ventricles. The hemodynamic alteration in effusiveconstrictive pericarditis is the result of combined effect of fluid accumulation and pericardial constriction and therefore the hemodynamic changes are also intermediate. Constrictive pericarditis cp is a rare clinical entity that can pose diagnostic problems.
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