Other additions to the clinical profile include the recognition of effusive constrictive pericarditis,5 occult constriction,6localised constriction,7 and reversible constriction. Constrictive pericarditis cp is a potentially curable cause of diastolic heart failure. Patients with symptomatic constrictive pericarditis eg, with dyspnea, unexplained weight gain, a new or increased pleural effusion, or ascites and those with markers of chronic constriction eg, cachexia, atrial fibrillation, hepatic dysfunction, pericardial calcification usually require pericardial resection. However, the incidence of chronic constrictive pericarditis. Although the etiology of hfpef is most commonly related to longstanding hypertension and atherosclerosis, a signif. Pericardial constriction is typically chronic, but variants include subacute, transient, and occult constrictive pericarditis. This disorder must be considered in the differential diagnosis for unexplained heart failure, particularly when the left ventricular ejection fraction is preserved. Chronic constrictive pericarditis information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis. Chronic constrictive pericarditis due to a foreign body. The most common symptom of chronic pericarditis is chest pain. The fibrous tissue tends to contract over the years, compressing the heart. In a study comprising 25 patients who underwent pericardiectomy due to symptomatic chronic constrictive pericarditis reduced exercise capacity and sleepdisordered breathing, there was improvement in peak rate of oxygen uptake, quality of life, and sleep, but no significant change in sleep disordered breathing. Constrictive pericarditis cp is diagnosed by symptoms and multimodality approach. Chronic constrictive pericarditis symptoms, diagnosis.
Symptoms of chronic constrictive pericarditis include. Constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. Other localizations are exceptional, even though asbestos. The cause of the constrictive pericarditis was believed to be either the needle in. Patients with pericardial constriction may present with two types of complaints. The only possible cure for chronic constrictive pericarditis is surgical removal of the pericardium.
Pericardiectomy is the only definitive treatment option for patients with chronic symptomatic constrictive pericarditis. The cause of the constrictive pericarditis was believed to be either the needle in the perieardium or the original trauma, i. Differentiating constrictive pericarditis and restrictive. Effusiveconstrictive pericarditis is a clinical hemodynamic syndrome in which constriction of the heart by the visceral pericardium occurs in the presence of tense effusion in a free. Constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. With pericarditis, the amount of fluid increases and may contain pus. Chronic constrictive pericarditis is a term applied to the condition which results when fibrous thickening of the pericardium interferes mechanically with the normal movements of the heart and blood. Chronic constrictive pericarditis, which is rare, usually results when scarlike fibrous tissue forms throughout the pericardium.
These experimental findings indicate that chronic constrictive pericarditis may well be due to traumatic hemopericardium rather than to specific infection. Pericardiectomy for relapsing pericarditis and chronic constrictive pericarditis. These parallel those of antecedent acute pericarditis and hence are many and varied. Effusiveconstrictive pericarditis effusiveconstrictive pericarditis is characterized by underlying constrictive physiology with a coexisting pericardial effusion, often with cardiac tamponade. Acute pericarditis is more common than chronic pericarditis, and can occur as a complication of infections, immunologic conditions, or even as a result of a heart attack myocardial infarction, as dresslers syndrome. Constrictive pericarditisa curable diastolic heart failure. The compression prevents the heart from filling normally and causes a form of heart failure. Pericarditisconstrictive pericarditis mayo clinic connect. Nov 27, 2015 constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium.
The treatment of acute infectious pericarditis and chronic. Nov 02, 2016 chronic constrictive pericarditis aetiology. Constrictive pericarditis is the final stage of a chronic inflammatory process characterized by fibrous thickening and calcification of the pericardium that impairs diastolic filling, reduces cardiac output, and ultimately leads to heart failure. This leads to impairment of ventricular filling in mid and late diastole. On histopathological examination of pericardiectomy specimens, 1 patient 11. Pericardial involvement in endstage renal disease esrd is manifested most commonly as acute uremic or dialysis pericarditis and infrequently as chronic constrictive pericarditis ccp. Depending on the type, signs and symptoms of pericarditis may include some or all of the following. All patients with chronic constriction had a surgically confirmed diagnosis of constrictive pericarditis. Constrictive pericarditis cp is a recognised, but unusual cause of chronic ascites. Constrictive pericarditis is a chronic inflammatory lesion of the pericardium accompanied by extensive fibrous proliferation and eventual formation of fibrous adhesions between the surfaces of the visceral and parietal pericardium.
The subject of chronic pericardial disease must, of necessity, encompass considerations of multiple causative factors, remarkably variable clinical pictures, and systemic effects which may involve nearly every organ system. The differentiation of restrictive cardiomyopathy and constrictive pericarditis has been a perennial problem in clinical cardiology. Chronic cardiac compression chronic constrictive pericarditis. 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 cp is a chronic thickening of pericardium, caused by pericardial fibrosis, fused pericardial mem branes and eventually. Constrictive pericarditis is a chronic condition that is usually well tolerated by the patient until the disease is far advanced. Diagnoses of chronic constrictive pericarditis of traumatic origin7 with enlargement of the liver and ascites, class iii, and foreign body, metallic, right side of the chest were made. Jul 29, 2014 constrictive pericarditis arises from a stiffening of the pericardium, which prevents complete or satisfactory diastolic filling of the heart. 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. Chronic pericarditis is usually associated with chronic inflammation and may result in fluid around the heart pericardial effusion. Constrictive pericarditis cp is a chronic inflammatory process, often.
The management of pericardial diseases in esrd patients involves internists, cardiologists, and nephrologists. Nineteen patients with an undoubted diagnosis of constrictive pericarditis have been observed by us. We present a patient with unexplained dyspnea, recurrent rightside. Constrictive pericarditis european journal of internal medicine. The risk of constrictive pericarditis is higher following bacterial forms of pericarditis, intermediate for postpericardiotomy syndromes and systemic inflammatory diseases and low for viral and idiopathic cases of pericarditis. Garcia, md abstract about onehalf of the patients with congestive heart failure have preserved left ventricular ejection fraction hfpef. Surgical treatment of constrictive pericarditis texas. Constrictive pericarditis is chronic inflammation of the pericardium, which is a saclike membrane that surrounds the heart. Constrictive pericarditis prevalence, causes and clinical. Pdf surgical treatment of constrictive pericarditis. Constrictive pericarditis cp is the result of chronic scarring and eventual inelasticity of the pericardial sac, leading to heart failure.
Chronic constrictive pericarditis is a disease that has multiple possible causes and is associated with variable clinical findings, depending on its severity. Constrictive pericarditis cp is a rare clinical entity that can pose diagnostic problems. The pericardium is the thin sac that surrounds your heart. Acute cardiac tamponade, in contrast, is a syndrome in which the onset of restrictive symptoms is rapid and dramatic. Constrictive pericarditis versus restrictive cardiomyopathy. Dec 01, 2001 constrictive pericarditis was caused by tuberculosis in 22. Uremic pericarditis, pericardial effusion and constrictive. In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause. Chronic constrictive pericarditis chronic constrictive. Chronic constrictive tuberculous pericarditis report of a case with pericardiectomy felix a.
Constrictive pericarditis cp is a chronic inflammatory process, often characterised by chronic scarring, fibrosis and calcification of the pericardium associated with diastolic dysfunction, eventually leading to low cardiac output and heart failure. Inflammation of the pericardium that lasts for three months or longer constrictive pericarditis. Constrictive pericarditis an overview sciencedirect topics. Constrictive pericarditis is a medical condition characterized by a thickened, fibrotic pericardium, limiting the hearts ability to function normally. Although constrictive pericarditis has been recognized for many years, it was not until the advent of modern thoracic surgery and its meticulous attention to technic and anesthesia that surgical treatment of the disease has been possible, with gratifying results in small but important groups of cases, gathered especially in boston, 1 nashville, 2 and cleveland. Chronic pericarditis however is less common, a form of which is constrictive pericarditis. Pathologic basis of veterinary disease sixth edition, 2017. Between september 1992 and may 2014, 47 patients who underwent pericardiectomy for constrictive pericarditis were retrospectively examined. It develops insidiously, and in many cases, no etiology is ever determined. We report a 27yearold patient with a history of uncontrolled hypertension, endstagerenal disease on hemodialysis, who presented with recurrent ascites, dyspnea, and hypotension. Pathophysiology and diagnosis of constrictive pericarditis. 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.
However, im now left with the diagnosis of chronic constrictive pericarditis which they are thinking may have begun to develop back in 2006 when i had pneumonia after losing my dad suddenly. Jan 01, 2020 chronic constrictive pericarditis is a disease that has multiple possible causes and is associated with variable clinical findings, depending on its severity. Chronic pericarditis heart and blood vessel disorders. Impact of pericardiectomy on exercise capacity and sleep of patients with chronic constrictive pericarditis. Chronic constrictive pericarditis may be the end result in the healing of acute infectious pericarditis by the formation of granulation tissue in the pericardial cavity gradually contracting and forming a firm scar, encasing the heart and interfering with its filling. The normal pericardium minimally impedes ventricular distensibility at normal cardiac. As a result, the majority of ventricular filling occurs rapidly in early diastole and the ventricular. In addition, some cases occur without antecedent acute pericarditis. Cholesterol pericarditis is a rare disorder that may be associated with myxedema. Constrictive pericarditis constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. Spodick has written a companion volume for his excellent monograph acute pericarditis which was published in 1959. Family medicine and presently serves as associate editor of american family physician. Constrictive pericarditis is also well documented in this population, ultimately resulting in pericardiectomy for definitive treatment.
Tuberculous chronic constrictive pericarditis associated with. Constrictive pericarditis cp is a form of diastolic heart failure that arises because an inelastic pericardium inhibits cardiac filling. The subject of chronic pericardial disease must, of necessity, encompass considerations. The purpose of this study was to evaluate the longterm outcomes following treatment of constrictive pericarditis by pericardiectomy. Constrictive pericarditis is a dense fibrous thickening of the pericardium that causes chronic cardiac compression.
Effusive constrictive pericarditis was recorded in 5 patients. Constrictive pericarditis arises from a stiffening of the pericardium, which prevents complete or satisfactory diastolic filling of the heart. Chronic pericarditis is inflammation of the pericardium the flexible twolayered sac that envelops the heart that begins gradually, is longlasting, and results in fluid accumulation in the pericardial space or thickening of the pericardium. Traumatic hemopericardium and chronic constrictive pericarditis.
New medicines may bring a halt to your recurrent pericarditis. Risk of constrictive pericarditis after acute pericarditis. Constrictive pericarditis cp is a disease characterized by the encasement of the heart by a rigid nonpliable pericardium due to dense fibrosis and adhesions. Pdf constrictive pericarditis cp is a rare clinical entity that can pose diagnostic problems.
A small amount of clear fluid between the heart and the sac allows the heart to beat easily. Traumatic hemopericardium and chronic constrictive. The pericardium is the saclike membrane that surrounds the heart. Constrictive pericarditisa curable diastolic heart. 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. In some patients approximately 10%, an antecedent acute pericarditis is present. However, because the risk of death from surgery is 5 to 15% and is higher in people who have severe heart failure, most people do not have surgery unless the disease substantially interferes with daily. Pdf chronic constrictive pericarditis researchgate. Chronic pericarditis is inflammation of the pericardium for longer than 3 months.
Get a printable copy pdf file of the complete article 4. Hypothyroidism may cause pericardial effusion and cholesterol pericarditis. The visceral pericardium is a mesothelial monolayer that is adherent to the epicardium, which is reflected back on itself at the level of the great vessels. Constrictive pericarditis cp is a relatively uncommon form of clinical heart failure. Chronic idiopathic pericardial effusion without tamponade. Aug 27, 2014 i have been tested for everything from cancer and tb to lupus, with all clear results. Sixtyone patients with chronic cardiac compression were studied critically, the largest series in the literature.
Pericardial physiology and pathophysiology in constriction. Signs and symptoms of constrictive pericarditis are. A 57 year old man with history of hypertension and atrial fibrillation presented with 2 years of chest pain and progressive dyspnea limiting his daily activities. Between september 1992 and may 2014, 47 patients who underwent pericardiectomy for constrictive pericarditis were retrospectively. Pdf radical pericardiectomy for chronic constrictive. If you have recurrent pericarditis, new medications may provide new treatment options that can end episodes of pericarditis. Constrictive pericarditis is a disorder of cardiac filling caused by an inelastic pericardium.
Difficulty breathing dyspnea that develops slowly and gets worse fatigue longterm swelling edema of the legs and ankles swollen abdomen weakness constrictive pericarditis is very hard to medlineplus. Mar, 2017 constrictive pericarditis cp is a relatively uncommon form of clinical heart failure. This re sults in restricted diastolic filling of the. Constrictive pericarditis interferes with the normal function of the heart. Constrictive pericarditis is longterm, or chronic, inflammation of the pericardium. Longterm outcomes of pericardiectomy for constrictive.
Chronic constrictive pericarditis in association with end. Chronic constrictive pericarditis associated with asbestosis. For patients with newly diagnosed constrictive pericarditis who are hemodynamically stable and do not have evidence of chronic constriction, a trial of conservative management rather than pericardiectomy is warranted. Risk factors for the development of cp include prior cardiac surgery and radiation therapy. Pericardial effusion was more often present in patients with an acute or subacute presentation compared with those with chronic presentation 48% and 35% vs 9. Constrictive pericarditis, a disease with particularly high morbidity and mortality, remains a challenging clinical diagnosis, and one that is frequently overlooked. Mephis,tennessee as its name implies, this disease is distinguished by an inflam. The scarred, and noncompliant pericardium causes restraint to early diastolic ventricular filling, resulting in the equalisation of intracardiac diastolic filling pressures, producing the socalled single diastolic chamber. The true population prevalence is unknown, but amongst those with viral pericarditis it has been estimated to occur in less than 0. It is a potentially curable cause of diastolic heart failure, antiinflammatory therapy being potentially effective in those with transient cp and pericardiectomy being the treatment in those with chronic disease. Chronic pericardial effusion or chronic constrictive pericarditis may follow acute pericarditis of almost any etiology. What is the treatment for constrictive pericarditis. The diagnosis of cp requires a high degree of clinical suspicion.
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