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

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

More common causes of pericarditis:
Idiopathic
Virus
TB
Mediastinal irradiation
Post-surgical
Connective tissue disease

Question 3

Summarise the epidemiology of constrictive pericarditis

Answer 3

RARE
Documented in all ages
9% of patients with acute peric
arditis 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

EARLY - symptoms and signs may
be very subtle

ADVANCED - jaundice, cachexia, muscle wasting

Right Heart Failure Signs
Dyspnoea
Peripheral oedema
Raised JVP
Kussmaul's sign (paradoxical rise in JVP on inspiration)
Pulsatile hepatomegaly

Question 5

Identify appropriate investigations 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)