Constrictive Pericarditis

Question 1

Define constrictive pericarditis

Answer 1

Inflammation of the pericardium that impedes normal diastolic filling as the heart is surrounded in a rigid pericardium

Question 2

Aetiology of constrictive pericarditis

Answer 2

Complication of acute pericarditis
Unknown, idiopathic
Infectious: TB, bacterial, viral
Prior cardiac surgery, radiotherapy

Pericardial effusion healing -> pericardial cavity may be replaced by granulation tissue -> dense scar/thickened fibrotic pericardium (non-compliant) that encases the heart which interferes with filling

Question 3

Risk factors for constrictive pericarditis

Answer 3

Male 
20-50
Transmural MI 
Cardiac surgery 
Neoplasm
Infection (esp. TB in developing countries)

Question 4

What us the pericarditis triad

Answer 4

Chest pain
Pericardial friction rub
Serial ECG changes

Question 5

Symptoms of Constrictive pericarditis

Answer 5

Chest pain (pleuritic - stabbing pain, central, worse on inspiration and lying down, relieved by sitting forward | radiates to neck, shoulder, trapezius ridge
Fever
Dyspnoea
Malaise

Question 6

Signs of Constrictive pericarditis on examination

Answer 6

Right heart failure: ascites, pitting oedema, hepatosplenomegaly, raised JVP
Kussmaul sign (differentiate from tamponate)
Pulsus paradoxus
Diastolic pericardial knock
Soft diffuse apex beat
Quiet heart sounds
Pericardial friction rub

Question 7

Investigations for Constrictive pericarditis

Answer 7

Echo - assess pericardial effusion + cardiac function

ECG - widespread saddle-shaped ST elevation

Bloods - Trops: rule out MI, FBC: infectious cause, Blood cultures: infectious cause

CXR - small heart, pericardial calficiation