This prevents the pericardium from stretching and results in. Echocardiographic diagnosis of constrictive pericarditis. Pericardial mesotheliomas are rare tumors which often present with features of constrictive pericarditis. Constrictive pericarditis is longterm, or chronic, inflammation of the pericardium. Constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. 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. Constrictive pericarditis cp is a rare clinical entity that can pose diagnostic problems. Chronic constrictive pericarditis chronic constrictive. Constrictive pericarditis cause, symptoms, diagnosis. 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. Constrictive pericarditis and pericardial thickening. 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. It is typically better sitting up and worse when lying down or breathing deeply. Severe complications, such as cardiac tamponade and constrictive pericarditis, are unusual in idiopathic cases, which remain the largest proportion of patients in.
For this reason, it is most often done in people who have severe symptoms. Chronic constrictive pericarditis physiology britannica. Between september 1992 and may 2014, 47 patients who underwent pericardiectomy for constrictive pericarditis were retrospectively. Backgroundpericardial thickening is an uncommon complication of cardiac surgery. Chronic or recurrent pericarditis, on the other hand, usually lasts six months or longer source. We present clinical, imaging, histological, and immunohistochemical findings of three cases presenting with chronic constrictive pericarditis. Symptoms typically include sudden onset of sharp chest pain.
Constrictive pericarditis may be life threatening if untreated. In constrictive pericarditis the pericardium is rigid meaning it cant move inward or outward. Acute pericarditis makes up the vast majority of reported cases, and usually lasts less than a few weeks. Mayo clinic pericarditis generally results from heart attacks, infections or immunological disorders. In the vast majority of cases, medical management is ineffective unless a prominent inflammatory component is present. Longterm outcomes of pericardiectomy for constrictive. Pericarditis is inflammation of the pericardium the fibrous sac surrounding the heart.
Jvp in constrictive pericarditis student doctor network. Most deaths are due to myocardial infarction, and the remainder are due to heart failure, constrictive. In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause. The pain may also be felt in the shoulders, neck, or back. 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. Constrictive pericarditis is often iatrogenic following openheart surgery or radiation therapy for the treatment of mastocarcinoma and other cancers. Constrictive pericarditis radiology reference article. The compression prevents the heart from filling normally and causes a form of heart failure. 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.
Guidelines on the diagnosis and management of pericardial. This condition, called chronic constrictive pericarditis, is corrected by surgical removal of the pericardium. The constriction occurs slowly over time and causes shortness of breath on exertion and a decreased ability to exercise. 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. 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 is a medical condition characterized by a thickened, fibrotic pericardium, limiting the hearts ability to function normally. In the normal heart, the pericardium is a flexible in nature but does not stretch very much. Both constrictive pericarditis and pericardial thickening can results from tuberculosis, radiation, viral pericarditis, or prior surgery. 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.
However, surgery to treat the condition has a high risk for complications. Constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. Invasive hemodynamics of constrictive pericarditis. The differentiation of restrictive cardiomyopathy and constrictive pericarditis has been a perennial problem in clinical cardiology. Constrictive pericarditis constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac.
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. We present the case of a 14yearold boy with a previous history of tuberculosis and right heart failure, in whom constrictive pericarditis was diagnosed. The pericardium is the saclike membrane that surrounds the heart. Transient constrictive pericarditis due to postpericardiotomy syndrome, tuberculous, or viral pericarditis may respond to antiinflammatory therapy. Patients with restrictive cardiomyopathies and constrictive pericarditis are often excluded or underrepresented in large randomized clinical trials.
Constrictive pericarditis arises from a stiffening of the pericardium, which prevents complete or satisfactory diastolic filling of the heart. This leads to impairment of ventricular filling in mid and late diastole. However, because of the compression, the heart does not enlarge as it does in most types of heart. With the advent of newer imaging tools, there has been a shift to noninvasive imaging particularly when chronic constrictive pericarditis ccp is suspected.
Constrictive pericarditis an overview sciencedirect topics. In the developing world where tuberculosis is still common, it remains the major cause of constrictive pericarditis. Constrictive pericarditisa curable diastolic heart. Constrictive pericarditis is a disorder caused by inflammation of the pericardium, the saclike covering of the heart. The diagnosis of cp requires a high degree of clinical suspicion. Constrictive pericarditis cp is a recognised, but unusual cause of chronic ascites. 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. Chronic constrictive pericarditis, which is rare, usually results when scarlike fibrous tissue forms throughout the pericardium.
Constrictive pericarditis versus restrictive cardiomyopathy. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high and, in end diastole, equal in all chambers. In early diastole, the pressure inside the pericardium is lowest leading to rapid ventricular. 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 in 26 patients with histologically normal pericardial thickness. 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. 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.
Other symptoms may include fever, weakness, palpitations, and shortness of breath. Chronic constrictive pericarditis linkedin slideshare. In the developing world tuberculosis is a common cause of constrictive pericarditis. When the abnormal pericardium limits diastolic filling, there are a series of hemodynamic consequences which manifest as fatigue, dyspnea, abdominal bloating, peripheral edema, or. Pericardial constriction is typically chronic, but variants include subacute, transient, and occult constrictive pericarditis. 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. Pdf chronic constrictive pericarditis researchgate. Constrictive pericarditis is a potentially curable condition caused by a variety of situations which result in inflamed, scarred, thickened, or calcified pericardium. Constrictive pericarditis is a wellknown complication of chest irradiation therapy and may occur 10 to 15 years after exposure.
Mediastinal radiation therapy results in approximately a threefold increase in the risk of cardiac death. One of those complications is chronic constrictive pericarditis. Diagnosing constrictive pericarditis remains challenging, and the most effective tools are designed. The purpose of this study was to evaluate the longterm outcomes following treatment of constrictive pericarditis by pericardiectomy. Echocardiography diagnostic criteria for constriction. Swelling in the legs and the abdomen may exist because. Objectivesto study pericardial thickening as the cause of severe postoperative venous congestion. 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. 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. Eventual thickening, scarring and contracture of the pericardium occurs causing it to be less elastic.
Constrictive pericarditis article pdf available in british medical journal 15592. Pericarditis cases fall into one of two large categories. Constrictive pericarditis is an uncommon disease in children, usually difficult to diagnose. I traveled a good distance to find the best surgeon for this condition. Definition of constrictive pericarditis medicinenet. Chronic pericarditis heart and blood vessel disorders. The case highlights the need to integrate all information, including clinical data, noninvasive cardiac imaging, and even invasive hemodynamic. Constrictive pericarditis is a disorder of cardiac filling caused by an inelastic pericardium. Radiationinduced constrictive pericarditis usually presents 10 years after therapy. The fibrous tissue tends to contract over the years, compressing the heart.