Constrictive pericarditis

Question 1

Define constrictive pericarditis

Answer 1

Chronic inflammation of the pericardium w/ thickening & scarring - limits ability of heart to function normally

Question 2

Aetiology of constrictive pericarditis

general + 6

Answer 2

Can occur after any pericardial disease process

Common causes of pericarditis:
Idiopathic
Virus
TB
Mediastinal irradiation
Post surgical 
Connective tissue disease

Question 3

Epidemiology of constrictive pericarditis

prevalence, age, disease x2, gender

Answer 3

RARE
Documented in all ages
9% patients w/ acute pericarditis develop constrictive pericarditis
TB has highest total incidence out of all causes
More common in MALES

Question 4

Presenting symptoms & signs of constrictive pericarditis

3 +1

Answer 4

Gradual onset of symptoms
EARLY - symptoms & signs may be very subtle
ADVANCED - jaundice, cachexia, muscle wasting

Right heart failure

Question 5

Presenting symptoms & signs of constrictive pericarditis - right heart failure
(5)

Answer 5

Dyspnoea
Peripheral oedema
Raised JVP
Kussmaul's sign
Pulsatile hepatomegaly

Question 6

Define Kussmaul’s sign

Answer 6

paradoxical rise in JVP on inspiration

Question 7

Investigations for constrictive pericarditis

5 types

Answer 7

CXR
Echocardiogram
MRI
CT
Pericardial biopsy

Question 8

Investigations for constrictive pericarditis - CXR

Answer 8

May show calcification of pericardium

Question 9

Investigations for constrictive pericarditis - echocardiogram

Answer 9

Usually diagnostic & helps distinguish from restrictive cardiomyopathy

Question 10

Investigations for constrictive pericarditis - MRI

Answer 10

Allows assessment of thickness of pericardium

Question 11

Investigations for constrictive pericarditis - CT

Answer 11

Same role as MRI

Question 12

Investigations for constrictive pericarditis - pericardial biopsy

Answer 12

May be indicated (especially if suspected infective cause)