Constrictive Pericarditis

Question 1

Name 3 infective causes of constrictive pericarditis

Answer 1

TB, pneumococci, staphylcocci, coxsackie B, adenovirus

Question 2

Name 3 other possible causes

Answer 2

Radiation, post cardiac surgery, autoimmune (SLE, scleroderma, arthritis), uraemia (from long term dialysis) or drugs like hydralazine, idiopathic

Question 3

What is the most common cause in the developed world?

Answer 3

Idiopathic

Question 4

What is the most common cause world wide?

Answer 4

TB

Question 5

Name the most common clinical feature

Answer 5

Breathlessness

Question 6

Name 3 other clinical features

Answer 6

Fatigue, orthopnoea, elevated JVP, kussmaul’s sign (paradoxical rise in breathing rate), soft/ impalpable apex beat.

S3, hepatomegaly, ascites and peripheral oedema may also be present

Question 7

Investigations

Answer 7

CXR, CT/MRI, echocardiogram, cardiac catherization may be required to do a cardiac biopsy. Mantoux testing may be done to test for TB

Question 8

Management includes?

Answer 8

Treatment of cause, diuretics, some require resection of the pericardium which is curative but has a high complication rate

Question 9

What would you be looking for on a CXR?

Answer 9

Small heart, pericardial calcification, pleural effusion and dilated vena cava

Question 10

What is the difference between constrictive and normal pericarditis?

Answer 10

Constrictive pericarditis has reached a greater extent of fibrosis which actually constricts the heart impairing complete diastolic filling, elevates filling pressures and lowers CO