Just a bit more pericarditis…
Definition: the heart is encased in a rigid pericardium due to chronic inflammation, preventing adequate diastolic filling of the ventricles
Aetiology/ risk factors:
-often unknown (UK)
-TB is the main cause in developing countries
-after any pericarditis
-intrapericardial haemorrhage during heart surgery
relatively rare complication of pericardial insult
-features of right heart failure: leg swelling, abdominal swelling, fatigue
-features of right heart failure:
-raised JVP (with prominent x and y descents)
-Kussmaul’s sign (JVP rises with inspiration)
-pulsus paradoxus (reduced systolic BP by > 10 mmHg on inspiration)
-soft, diffuse apex beat
-quiet heart sounds
-S3 heart sound
-diastolic pericardial knock (due to rapid ventricular filling)
-decreased pulse pressure
Clinically, constrictive pericarditis cannot be distinguished from restrictive cardiomyopathy.
CXR- small heart +/- pericardial calcification (calcification best seen on lateral CXR or CT)
-CXR may show a pleural effusion
CT/MRI- pericardial thickening and calcification
Echo- changes in cardiac chamber volume
Cardiac catheterisation-changes in ventricular pressures, pattern useful in differentiating from restrictive cardiomyopathy
–Surgical excision of the pericardium = pericardiectomy
-portal hypertension, ascites
-shock (restricted cardiac filling)
-pleural effusion (transudate)
Prognosis: potentially curable if diagnosed early, can be fatal if overlooked.
Longterm prognosis with medical therapy alone is poor.
Long-term survival after pericardiectomy depends on the underlying cause. Idiopathic constrictive pericarditis has the best prognosis (88% survival at 7 years). The worst postpericardiectomy prognosis occurs in postradiation constrictive pericarditis (27% survival at 7 years), probably as a reflection of confounding comorbidities.
References: Rapid Medicine, Cheese & Onion, Medscape