Constrictive pericarditis | |
---|---|
Other names | Pericarditis - constrictive[1] |
Constrictive pericarditis is defined by a fibrotic (thickened) pericardium. | |
Specialty | Cardiology |
Symptoms | Fatigue[1] |
Causes | Tuberculosis, Heart surgery[1] |
Diagnostic method | CT scan, MRI[1] |
Treatment | Diuretic, Antibiotics[1] |
Constrictive pericarditis is a condition characterized by a thickened, fibrotic pericardium, limiting the heart's ability to function normally.[1] In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause.[2]
Signs and symptoms of constrictive pericarditis are consistent with the following: fatigue, swollen abdomen, difficulty breathing (dyspnea), swelling of legs and general weakness. Related conditions are bacterial pericarditis, pericarditis and pericarditis after a heart attack.[1]
The cause of constrictive pericarditis in the developing world are idiopathic in origin, though likely infectious in nature. In regions where tuberculosis is common, it is the cause in a large portion of cases.[3] Causes of constrictive pericarditis include:
The pathophysiological characteristics of constrictive pericarditis are due to a thickened, fibrotic pericardium that forms a non-compliant shell around the heart. This shell prevents the heart from expanding when blood enters it. As pressure on the heart increases, the stroke volume decreases as a result of a reduction in the diastolic expansion in the chambers. [6] This results in significant respiratory variation in blood flow in the chambers of the heart.[7]
During inspiration, pressure in the thoracic cavity decreases but is not relayed to the left atrium, subsequently a reduction in flow to the left atrium and ventricle happens. During diastole, less blood flow in left ventricle allows for more room for filling in right ventricle and therefore a septal shift occurs.[8]
During expiration, the amount of blood entering the left ventricle will increase, allowing the interventricular septum to bulge towards the right ventricle, decreasing the right heart ventricular filing.[9]
The diagnosis of constrictive pericarditis is often difficult to make. In particular, restrictive cardiomyopathy has many similar clinical features to constrictive pericarditis, and differentiating them in a particular individual is often a diagnostic dilemma.[10]
The definitive treatment for constrictive pericarditis is pericardial stripping, which is a surgical procedure where the entire pericardium is peeled away from the heart. This procedure has significant risk involved,[14] with mortality rates of 6% or higher in major referral centers.[15]
A poor outcome is almost always the result after a pericardiectomy is performed for constrictive pericarditis whose origin was radiation-induced, further some patients may develop heart failure post-operatively.[16]