Constrictive Pericarditis

Question 1

What causes constrictive pericarditis?

Answer 1

Often Unknown, TB elsewhere, chronic pericarditis, fungal/parasitic infection

Question 2

What are the main signs on examination?

Answer 2

Raised JVP, symptoms of right HF (fatigue, ascites, leg swelling), kussmauls sign (JVP rises paradoxically with inspiration), diffuse apex beat, s3, quiet HS’s, hepatosplenomegaly, ascites

Question 3

What investigations should be done?

Answer 3

CXR, echo

Question 4

What might CXR reveal?

Answer 4

Small heart +/- calcified heart

Question 5

What is the management?

Answer 5

Surgical excision of the pericardium (pericardial stripping)

Question 6

Explain kussmauls sign pathophysiology?

Answer 6

The fibrotic pericardium prevents blood from expanding the heart. When a person inspires the reduction in thoracic pressure should allow the heart to fill more and increase venous drainage but in ConPeri this isn’t translated so there is a reduction in emptying resulting in paradoxical rise in JVP on inspiration

Question 7

Prognosis?

Answer 7

Extremely poor, pericardial stripping itself carries a 6% or greater mortality rate with many developing HF post op highlighting the importance of the pericardium

Question 8

What is constrictive pericarditis?

Answer 8

Where the heart is encased in a rigid pericardium