Constrictive Pericarditis

Question 1

Definition

Answer 1

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

Question 2

Aetiology/risk factors

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:
o Idiopathic
o Virus
o TB
o Mediastinal irradiation
o Post-surgical
o 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

Presenting symptoms

Answer 4

· Gradual-onset of symptoms

· EARLY - symptoms and signs may be very subtle

· ADVANCED - jaundice, cachexia, muscle wasting

Question 5

Signs on physical examination

Answer 5

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

Question 6

Investigations

Answer 6

· 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)