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Constrictive Pericarditis

Title               

Ñ    Constrictive Pericarditis

Definition

Ñ    Thickening, fibrosis and calcification of the pericardium

Ñ    Results in the heart being surrounded by a solid case

Ñ    Does not allow the heart to fill adequately

Pathogenesis

Causes

Internal Factors

Ñ    Post-Purulent Pericarditis

Ñ    Tuberculous pericarditis

Mural Factors

Ñ    Post haemorrhagic:

Following surgery

Ñ    Neoplastic infiltration:

Primary or secondary

External Factors

Ñ    Radiation therapy

Systemic Factors

LMS

Ñ    Connective tissue disorders:

Rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, polyarteritis nodosa, giant cell arteritis, rheumatic fever

KUS

Ñ    Uraemia

RS

Ñ    Churg-Strauss syndrome

Pathological Process

Ñ    Pericardium becomes thick, fibrous calcified

Ñ    Pericardium becomes inelastic and interferes with diastolic filling of the heart

Clinical Features

History

CVS

Ñ    Fatigue

Ñ    Poor exercise tolerance

Examination

IS

Ñ    Dependent oedema

CVS

Ñ    Tachycardia

Ñ    Atrial fibrillation

Ñ    Pulsus paradoxus

Ñ    Elevated JVP

Ñ    Kussmaul’s sign

Ñ    Pericardial knock

GIT

Ñ    Hepatomegaly

Ñ    Ascites

Investigations

Imaging

Chest X-ray

Ñ    Small heart

Ñ    Pericardial calcification

Echocardiography

Ñ    Thickened pericardium

Ñ    Relative immobility of the heart

Ñ    Ventricular cavities small

Ñ    Normal wall thickness

Ñ    Dilated atria

MRI

Ñ    Useful for difficult cases

Electrophysiology

ECG

Ñ    Low voltage QRS complexes

Ñ    Inverted T waves

Physiological studies

Cardiac catheterisation

Ñ    End-diastolic pressures equal in all four chambers

Management

Control

Surgery

Ñ    Pericardiectomy

Prognosis

Ñ    Surgery results in improvement in approximately 50%

Ñ    In others full recovery does not occur because of:

Persistent constriction

Myocardial fibrosis

Atrial fibrillation

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