Chronic Pericarditis

Question 1

Chronic pericarditis refers to long-standing inflammation (>3 months) of the pericardium that usually follows an acute episode.
Pericarditis refers to inflammation of the pericardial sac. It may be acute, incessant, or chronic.

Answer 1

Acute: an episode of acute pericardial inflammation
Incessant: pericardial inflammation lasting > 4-6 weeks but < 3 months
Chronic: pericardial inflammation lasting > 3 months

Question 2

The main consequence of chronic inflammation of the pericardium is development of ..

Answer 2

The main consequence of chronic inflammation of the pericardium is development of constrictive pericarditis.

Question 3

The development of constrictive pericarditis can be categorised into three clinical phenotypes:

Answer 3

Transient constriction: reversible constriction with resolution spontaneously or with medical therapy
Effusion-constriction: constrictive pericarditis with evidence of a pericardial effusion (features of constriction persist even after removal of pericardial fluid)
Chronic constriction: constriction > 3-6 months duration

Question 4

Clinical features of chronic pericarditis

Answer 4

Patients characteristically present with features of right heart failure.

Question 5

Signs and symptoms of chronic percarditis

Answer 5

Symptoms

Shortness of breath
Leg swelling
Abdominal swelling
Exercise intolerance
Signs

Raised jugular venous pressure
Peripheral oedema
Ascites
Hepatomegaly

Question 6

Management of chronic pericarditis

Answer 6

The treatment of chronic pericarditis is specialist.

The decision to treat a patient with chronic pericarditis depends on the extent of fibrosis and pathological phenotype.

Pericardiectomy is generally considered for patients with chronic constrictive pericarditis and severe symptoms of heart failure. This involves surgically removing the pericardial sac.

Question 7

Diagnosis & investigations

The diagnosis of chronic constrictive pericarditis is made through imaging of the heart.

Answer 7

A variety of imaging modalities may be used to assess the heart including echocardiography, computed tomography, and magnetic resonance imaging.

These show impaired filling of the heart chambers during diastole and there may be features of chronicity including calcification.

Question 8

4 signs of chronic pericarditis?

Answer 8

Raised jugular venous pressure
Peripheral oedema
Ascites
Hepatomegaly