Constrictive pericarditis

Question 1

Define constrictive pericarditis

Answer 1

Chronic inflammation of the pericardium with thickening and scarring. It limits the ability of the heart to function normally.

fibrotic pericardium = reduced ventricular filling

Question 2

Explain the aetiology/risk factors of constrictive pericarditis

Answer 2

NOTE: it is often underdiagnosed because it is difficult to distinguish it from restrictive cardiomyopathy and other causes of right heart failure.

Can occur after any pericardial disease process
Most common causes:

infective (TB, idiopathic), connective tissue diseases

Question 3

Explain the aetiology/risk factors of constrictive pericarditis

Answer 3

RARE
Documented in all ages
9% of patients with acute pericarditis will develop constrictive pericarditis
TB has the HIGHEST TOTAL INCIDENCE out of all causes
More common in MALES

Question 4

Recognise the presenting symptoms and signs of constrictive pericarditis

Answer 4

Gradual-onset of symptoms

Symptoms;
May be very subtle
Severe RETROSTERNAL chest pain, radiates to the back; made worse by lying down or coughing, better by sitting and leaning forward.

Signs; Kussmauls and pericardial friction rub

Right Heart Failure Signs;
Dyspnoea - SOB
Peripheral oedema  
Raised JVP 
Kussmaul's sign (rise in JVP on inspiration) 
Pulsatile hepatomegaly  
ascites
3rd HS - pericardial knock

sinus tachycardia/AF

ADVANCED - jaundice, cachexia, muscle wasting

Question 5

Identify appropriate investigations for constrictive pericarditis

Answer 5

CXR - calcification of the pericardium
they will have kussmaul respiration

Echo
MRI - thickness of pericardium
CT - “
Pericardial biopsy - if suspecting infective cause

Question 6

Why is a pericardial rub heard on auscultation in constrictive pericarditis?

Answer 6

Inflammation of thickened layers of pericardium rub together!

Question 7

mx?

Answer 7

complete pericardectomy