CONSTRICTIVE PERICARDITIS

Question 1

Cause

Answer 1

Idiopathic; any cause of pericarditis can result in sufficient calcification and fibrosis to prevent filling esp. if chronic e.g. TB

Question 2

Pathology

Answer 2

Heart is enclosed by a rigid fibrous pericardial sac —> reduced diastolic filling of ventricles —> reduced SV and CO

Question 3

Presentation (5)

Answer 3

1- Resemble RHF (peripheral edema, distended JVP, ascites, hepatomegaly)
2- Kussmaul sign —> JVP increases paradoxically on inspiration (normally decreases)
3- Pulsus paradoxus
4- Atrial fibrillation
5- O/E pericardial knock (extra heart sound in diastole from ventricular filling)

Question 4

Diagnosis (2)

Answer 4

1- Chest X-ray —> normal sized heart with pericardial calcifications
2- CT/MRI —> pericardial thickening and calcifications

Question 5

Treatment (2)

Answer 5

1- Diuretics used first to decompress the filling of the heart and relieve edema and organomegaly
2- Surgical excision of pericardium