Constrictive Pericarditis

Question 1

What is constrictive pericarditis?

Answer 1

Chronic inflammation of the pericardium with thickening + scarring of the pericardial layers.
Limits ability of the heart to function normally, as is encased in a rigid pericardium

Question 2

Describe the aetiology of constrictive pericarditis

Answer 2

Can occur after any pericardial disease process

Question 3

Why is constrictive pericarditis often under diagnosed?

Answer 3

Difficult to distinguish it from restrictive cardiomyopathy + other causes of RHF

Question 4

List 9 causes of constrictive pericarditis

Answer 4

Idiopathic 
Viral infections  
TB 
Mediastinal irradiation  
Post-surgical  
Connective tissue diseases  
AI diseases  
Untreated pericarditis 
Trauma

Question 5

Describe the epidemiology of constrictive pericarditis

Answer 5

RARE
All ages
9% of patients with acute pericarditis develop constrictive pericarditis
TB has the HIGHEST TOTAL INCIDENCE out of all causes
M > F

Question 6

Describe nature of symptoms of constrictive pericarditis

Answer 6

Gradual-onset of symptoms

EARLY: symptoms + signs may be very subtle

Question 7

List 6 signs of right heart failure in constrictive pericarditis

Answer 7

Dyspnoea   
Raised JVP + Kussmaul's sign 
Pulsatile hepatomegaly  
Splenomegaly 
Ascites 
Peripheral oedema

Question 8

What investigations are used for constrictive pericarditis?

Answer 8

CXR: small heart +/- calcification of the pericardium
Echo: dx + helps distinguish from restrictive cardiomyopathy
MRI/ CT: allows assessment of thickness of pericardium
Pericardial biopsy: esp. if suspected infective cause

Question 9

Give 2 signs of advanced constrictive pericarditis

Answer 9

Jaundice

Cachexia

Question 10

What is Kussmauls sign?

Answer 10

paradoxical rise in JVP on inspiration