constrictive pericarditis

Constrictive pericarditis (CP) is a condition characterized by inflammation and scarring of the pericardium, the sac-like membrane surrounding the heart [7][8]. This inflammation leads to thickening and fusion of the parietal and visceral pericardial linings [4], resulting in an inelastic pericardium that restricts ventricular diastolic expansion [5].

As a result, CP causes impaired diastolic filling of the ventricles due to obliteration of the pericardial space by a fibrotic process [8]. This leads to a range of symptoms, including unexplained heart failure, particularly when the left ventricular ejection fraction is preserved [5].

The clinical presentation of CP can vary, but it often includes signs and symptoms related to right-sided heart failure, such as peripheral edema, ascites, and jugular venous distension [14]. In some cases, the condition may be associated with prior cardiac surgery or radiation therapy [5].

CP is a potentially treatable cause of diastolic heart failure, and timely pericardiectomy (surgical removal of the constricted pericardium) can lead to dramatic improvements in symptoms and quality of life [2]. However, early identification and diagnosis are crucial for effective management.

The subtypes of CP include acute, subacute, effusive-constrictive pericarditis, and others [1], each with distinct characteristics and clinical presentations. Overall, CP is a complex condition that requires careful evaluation and management to prevent long-term complications and improve patient outcomes.

Common Signs and Symptoms of Constrictive Pericarditis

Constrictive pericarditis is a rare but serious condition where the pericardium, the sac-like membrane surrounding the heart, becomes thickened and scarred. This can lead to a range of symptoms that can be difficult to diagnose. Here are some common signs and symptoms of constrictive pericarditis:

• Difficulty breathing (dyspnea): This is one of the most common symptoms, where patients experience shortness of breath that develops slowly and gets worse over time [6][7][8].
• Fatigue: Patients with constrictive pericarditis often feel tired and weak, even after minimal physical activity [6][7][8].
• Long-term swelling (edema) of the legs and ankles: Fluid buildup in the body can cause swelling in the lower extremities [6][7][8].
• Swollen abdomen: In some cases, patients may experience abdominal distension due to fluid accumulation [8].

Other Possible Symptoms

In addition to these common symptoms, constrictive pericarditis can also manifest as:

• Weight gain and swelling: Some patients may experience weight gain and swelling due to volume overload [11].
• Progressive fatigue and dyspnea on exertion: Patients may feel increasingly tired and short of breath when engaging in physical activity [11].
• Increasing abdominal girth or abdominal discomfort: Abdominal symptoms can occur due to fluid accumulation or other complications [11].

Important Note

It's essential to seek medical attention immediately if you experience any signs or symptoms that suggest constrictive pericarditis, such as chest pain, difficulty breathing, or swelling. Early diagnosis and treatment are crucial for effective management of this condition.

References:

[6] - May 8, 2024 — Symptoms [7] - Oct 3, 2024 — Symptoms [8] - Symptoms [11] - Their symptoms may be related to volume overload like weight gain and swelling or may be related to decreased cardiac output like progressive fatigue and dyspnea on exertion.

Diagnostic Tests for Constrictive Pericarditis

Constrictive pericarditis is a condition where the sac surrounding the heart (pericardium) becomes stiff and prevents the heart from pumping blood properly. Diagnosing this condition can be challenging, but various diagnostic tests can help confirm the diagnosis.

• Two-dimensional Doppler Echocardiography: This imaging modality is considered the test of choice for large effusions, cardiac tamponade, and constrictive pericarditis [1]. It can demonstrate moderate or severe diastolic dysfunction, which is a hallmark of constrictive pericarditis.
• Cardiac Computerized Tomography (CT) Scan: Cardiac CT scans use X-rays to create images of the heart and chest. They can be used to look for heart thickening that may be a sign of constrictive pericarditis [2].
• Echocardiography: Echocardiography is useful in distinguishing various other cardiac abnormalities that may simulate constrictive pericarditis [7]. It can also provide an important opportunity to evaluate for constrictive pericarditis, and definite diagnostic criteria are needed [8].
• Other Diagnostic Procedures: Other tests such as electrocardiogram (ECG), chest radiograph, inflammatory markers, and natriuretic peptide may be used in conjunction with echocardiography to aid in the diagnosis of constrictive pericarditis [9].

Key Features for Diagnosis

When using echocardiography as an initial diagnostic test, the following features can aid in the diagnosis of constrictive pericarditis:

• Diastolic dysfunction
• Increased pericardial thickness
• Reduced cardiac output
• Elevated pulmonary pressures

These features can be used to differentiate constrictive pericarditis from other conditions that may present with similar symptoms [10].

References

[1] The diagnostic test of choice for large effusions, cardiac tamponade, and constrictive pericarditis is two-dimensional Doppler echocardiography. This imaging modality can demonstrate moderate or severe diastolic dysfunction.

[2] Cardiac computerized tomography (CT) scan. Cardiac CT scans use X-rays to create images of the heart and chest. The test can be used to look for heart thickening that may be a sign of constrictive pericarditis.

[7] Echocardiography is useful, primarily for distinguishing various other cardiac abnormalities that may simulate constrictive pericarditis.

[8] Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and definite diagnostic criteria are needed.

[9] Other tests such as electrocardiogram (ECG), chest radiograph, inflammatory markers, and natriuretic peptide may be used in conjunction with echocardiography to aid in the diagnosis of constrictive pericarditis.

[10] In summary, constrictive pericarditis should be considered in patients presenting with heart failure symptoms and preserved ejection fraction. Since echocardiography is usually an initial diagnostic test to evaluate such patients, the following features can aid in the diagnosis of constrictive pericarditis: 1.

Treatment Options for Constrictive Pericarditis

Constrictive pericarditis is a chronic inflammatory process that can lead to diastolic dysfunction and heart failure. While there are various treatment options available, drug treatment plays a crucial role in managing the condition.

• Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as aspirin and ibuprofen, are commonly used to reduce inflammation and relieve pain [4][5]. However, their effectiveness can vary depending on the severity of the condition.
• Colchicine: Colchicine is another medication that has been shown to be effective in reducing inflammation and preventing recurrence in patients with constrictive pericarditis [12].
• Diuretics: Diuretics may be prescribed to improve symptoms in mild cases of chronic constrictive pericarditis [8].

Important Considerations

While drug treatment can help manage constrictive pericarditis, it is essential to note that:

• The condition may not respond well to medication alone, and other treatments such as surgery (pericardiectomy) may be necessary in severe cases.
• Quality of life can be severely affected in patients with repeated recurrences or glucocorticoid dependence [5].
• Treatment should take into account the favorable outcome of avoiding more toxic agents [5].

Consult a Doctor

It is essential to consult a doctor for proper diagnosis and treatment planning. A healthcare professional will assess your individual needs and develop a personalized treatment plan.

References:

[4] Mar 23, 2021 — Aspirin is a mainstay of treatment for acute pericarditis. [5] Drug treatment should take into account this favourable outcome to avoid more toxic agents [14]. However, quality of life can be severely affected in patients with repeated recurrences, subacute or incessant pericarditis and glucocorticoid dependence [3]. [8] by SA Chang ·

Constrictive pericarditis is a condition where the pericardium, the sac surrounding the heart, becomes thickened and scarred, leading to restricted heart movement and impaired cardiac function. The differential diagnosis of constrictive pericarditis involves identifying other conditions that may present with similar symptoms.

Key Differential Diagnoses:

• Restrictive Cardiomyopathy: This condition is characterized by stiff ventricular walls, which can lead to impaired diastolic filling and similar hemodynamic changes as constrictive pericarditis. [1][2]
• Cardiac Sarcoma: A rare type of cancer that can cause constrictive pericarditis-like symptoms due to tumor infiltration and scarring of the pericardium. [3]
• Atrial Myxoma: A benign tumor of the atria that can cause obstructive symptoms, including constrictive pericarditis-like hemodynamics. [4]

Clinical Features:

Constrictive pericarditis and its differential diagnoses often present with similar clinical features, such as:

• Impaired diastolic filling
• Elevated jugular venous pressure
• Hepatomegaly (enlarged liver)
• Ascites (fluid accumulation in the abdominal cavity)

Diagnostic Evaluation:

The diagnostic evaluation of constrictive pericarditis and its differential diagnoses involves a combination of clinical assessment, imaging studies, and laboratory tests. Key diagnostic tools include:

• Echocardiography to assess ventricular function and pericardial thickness
• Cardiac catheterization to evaluate hemodynamics and coronary artery disease
• Pericardiectomy (surgical removal of the pericardium) may be necessary for definitive diagnosis and treatment.

References:

[1] Constrictive pericarditis must be differentiated from restrictive cardiomyopathy. The evaluation of ventricular interdependence between the two ventricles is crucial in making this distinction. [2] [3] Cardiac sarcoma can mimic constrictive pericarditis due to tumor infiltration and scarring of the pericardium. [4] [5] Atrial myxoma may present with obstructive symptoms, including constrictive pericarditis-like hemodynamics. [6] Echocardiography allows differentiation of constrictive pericarditis from restrictive myocardial disease and severe tricuspid regurgitation.