Acute pericarditis

Question 1

Cause of constrictive pericarditis?

Answer 1

In the early part of the 20th century, tuberculosis was the major cause of constrictive pericarditis.
The most frequent cause now is
“idiopathic” (i.e., months to years following presumed idiopathic or viral acute pericarditis).
However, any etiology of pericarditis can lead to this complication.

Question 2

Pathophysiology?

Answer 2

The pathophysiologic abnormalities in constrictive pericarditis occur during diastole; systolic
contraction of the ventricles is usually normal. In this condition, a rigid, scarred pericardium encircles
the heart and inhibits normal filling of the cardiac chambers. For example, as blood passes from the
right atrium into the right ventricle during diastole, the RV size expands and quickly reaches the limit
imposed by the constricting pericardium. At that point, further filling is suddenly arrested, and
venous return to the right heart ceases. Thus, systemic venous pressure rises, and signs of right-sided
heart failure ensue. In addition, the impaired filling of the left ventricle causes a reduction in stroke
volume and cardiac output, which leads to lower blood pressure.

Question 3

Clinical Features?

Answer 3

The symptoms and signs of constrictive pericarditis usually develop over months to years. They result
from
(1) reduced cardiac output (fatigue, hypotension, and reflex tachycardia) and
(2) elevated
systemic venous pressures (jugular venous distention, hepatomegaly with ascites, and peripheral
edema). Because the most impressive physical findings are often the insidious development of
hepatomegaly and ascites, patients may be mistakenly suspected of having hepatic cirrhosis or an
intraabdominal tumor. However, careful inspection of the elevated jugular veins can point to the
correct diagnosis of constrictive pericarditis