Constrictive Pericarditis

Question 1

Define

Answer 1

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

Question 2

Causes

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

Epidemiology

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

Symptoms / Signs

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

Investigation

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)