Constrictive Pericarditis

Question 1

What causes constrictive pericarditis?

Answer 1

In UK often unknown cause, TB elsewhere.

Can follow any case of pericarditis

Question 2

What are the clinical features of constrictive pericarditis?

Answer 2

Symptoms of RHF with raised JVP which has prominent x and y descents
Kussmaul’s sign, which is paradoxical rising of the JVP on inspiration
Quiet heart sounds with a soft, diffuse apex beat
S3 or ventricular gallop
Hepatosplenomegaly
Ascites and oedema

Question 3

What is Kussmaul’s sign?

Answer 3

Paradoxical rising of the JVP on inspiration

Question 4

What investigations would you carry out if suspected constrictive pericarditis?

Answer 4

CXR, Echo, cardiac catheterisation

Also a CT/MRI to differentiate form restrictive cardiomyopathy

Question 5

What is the management of constrictive pericarditis?

Answer 5

Surgical excision +/- medical management of underlying cause

Question 6

What are the x and y descents of the JVP?

Answer 6

The x descent is a drop in the JVP due to a relaxed RA filling post contraction
The y descent is due to the tricuspid opening and allowing blood to flow from the RA to the RV allowing blood to flow to the RA