Constrictive Pericarditis

Question 1

What is constructive pericarditis?

Answer 1

Inflammation, thickening, and/or calcification of the pericardium and fusion of the parietal and visceral layers of the serous pericardium

Question 2

What are the causes of constrictive pericarditis?

Answer 2

• Idiopathic
• Infectious
• Radiation induced
• Post surgical

Question 3

What is the pathophysiology of constrictive pericarditis?

Answer 3

Heart is encased within a rigid and noncompliant pericardial sack, leading to restricted diastolic filling due to fixed intrapericardial volume

Question 4

What is interventricular interdependence in constrictive pericarditis?

Answer 4

The septum bows with inspiration

Question 5

What is Kussmaul’s sign?

Answer 5

Paradoxical rise in venous pressure resulting in jugular venous distention during inspiration

Question 6

What is a pericardial knock?

Answer 6

High-pitched heart sound heard in early diastole due to abrupt halting of early filling

Question 7

What is the normal pulse wave Doppler finding of the mitral valve?

Answer 7

No significant changes greater than 25% in mitral E wave during expiration

Question 8

What is the normal pulse wave Doppler finding of the tricuspid valve?

Answer 8

Right heart filling changes with respiration, with less than 25% change in tricuspid E wave with respiration

Question 9

What does the TDI criteria for constrictive pericarditis indicate about annulus paradoxus?

Answer 9

TDI septal E prime velocity is normal or increased despite increased mean left atrial pressure; a low E/E prime ratio indicates high filling pressure

Question 10

What is indicated by annulus reversal in constrictive pericarditis?

Answer 10

Lateral wall motion is reduced, so lateral E prime is less than septal E prime