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

Question 2

What are the causes/risk factors of constrictive pericarditis?

Answer 2

• Idiopathic
• Infection e.g. coxsackie B, mumps, Streptococcus spp., Staphylococcus spp., TB
• Connective tissue disease e.g. sarcoidosis, SLE, scleroderma
• Post-MI (few days)
• Dressler’s syndrome (4-6 weeks)
• Malignancy
• Hypothyroidism
• Uraemia
• Radiotherapy
• Thoracic surgery
• Drugs e.g. hydralazine, isoniazid

Question 3

What are the symptoms of constrictive pericarditis?

Answer 3

• Pleuritic chest pain – worse on inspiration, lying back; relieved by sitting forward
• SOB
• Nausea

Question 4

What are the signs if constrictive pericarditis?

Answer 4

• Kussmaul’s sign (↑JVP with inspiration)
• Pulsus paradoxus
• Pulsatile hepatomegaly
• Ascites
• Peripheral oedema
• Pericardial knock
• Dyspnoea

Question 5

What investigations are carried out for constrictive pericarditis?

Answer 5

• CXR - may show calcification of the pericardium
• Echocardiogram - usually diagnostic and helps distinguish from restrictive cardiomyopathy
• MRI - allows assessment of thickness of pericardium
• CT - same role as MRI
• Pericardial biopsy - may be indicated (especially if suspected infective cause)