CONSTRICTIVE PERICARDITIS

Condition in which a rigid pericardium impairs cardiac filling, causing elevation of systemic and pulmonary venous pressures, and decreased cardiac output. Results from healing and scar formation in some pts with previous pericarditis. Viral, tuberculosis (mostly in developing nations), previous cardiac surgery, collagen vascular disorders, uremia, neoplastic and radiation-associated pericarditis are potential causes.



History 

Gradual onset of dyspnea, fatigue, pedal edema, abdominal swelling; symptoms of LV failure uncommon.

Physical Examination 

Tachycardia, jugular venous distention (with prominent y descent) that increases further on inspiration (Kussmaul sign); hepatomegaly, ascites, peripheral edema are common; sharp diastolic sound, “pericardial knock” following S2 sometimes present.

Laboratory ECG 

Low limb lead voltage; atrial arrhythmias are common.

CXR 

Rim of pericardial calcification is most common in tuberculous pericarditis.

Echocardiogram 

Thickened pericardium, normal ventricular contraction; abrupt halt in ventricular filling in early diastole. Dilatation of IVC is common. Dramatic effects of respiration are typical: During inspiration the ventricular septum shifts to the left with prominent reduction of blood flow velocity across mitral valve; pattern reverses during expiration .

CT or MRI 

More precise than echocardiogram for demonstrating thickened pericardium. Cardiac Catheterization Equalization of diastolic pressures in all chambers; ventricular pressure tracings show “dip and plateau” appearance. Differentiate from restrictive cardiomyopathy .

Constrictive Pericarditis TREATMENT

Surgical stripping of the pericardium. Progressive improvement ensues over several months.