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Pericarditis - constrictive

Constrictive pericarditis

 

Constrictive pericarditis is long-term (chronic) inflammation of the sac-like covering of the heart (the pericardium) with thickening and scarring.

Related conditions include:

  • Bacterial pericarditis
  • Pericarditis
  • Pericarditis after heart attack

Causes

 

Most of the time, constrictive pericarditis occurs due to things that cause inflammation to develop around the heart, such as:

  • Heart surgery
  • Radiation therapy to the chest
  • Tuberculosis

Less common causes include:

  • Abnormal fluid buildup in the covering of the heart. This may occur because of infection or as a complication of surgery.
  • Mesothelioma

The condition may also develop without a clear cause.

It is rare in children.

 

Symptoms

 

When you have constrictive pericarditis, the inflammation causes the covering of the heart to become thick and rigid. This makes it hard for the heart to stretch properly when it beats. As a result, the heart chambers don't fill up with enough blood. Blood backs up behind the heart, causing heart swelling and other symptoms of heart failure.

Symptoms of chronic constrictive pericarditis include:

  • Difficulty breathing (dyspnea) that develops slowly and gets worse
  • Fatigue
  • Long-term swelling (edema) of the legs and ankles
  • Swollen abdomen
  • Weakness

 

Exams and Tests

 

Constrictive pericarditis is very hard to diagnose. Signs and symptoms are similar to other conditions such as restrictive cardiomyopathy and cardiac tamponade. Your health care provider will need to rule out these conditions when making a diagnosis.

A physical exam may show that your neck veins stick out. This indicates increased pressure around the heart. When it happens due to constrictive pericarditis that is called Kussmaul's sign. The provider may note weak or distant heart sounds when listening to your chest with a stethoscope. A knocking sound may also be heard.

The physical exam may also reveal liver swelling and fluid in the belly area.

The following tests may be ordered:

  • Chest MRI
  • Chest CT scan
  • Chest x-ray
  • Coronary angiography or cardiac catheterization
  • ECG
  • Echocardiogram

 

Treatment

 

The goal of treatment is to improve heart function. The cause must be identified and treated. Depending on the source of the problem, treatment may include antibiotics, medicines for tuberculosis, or other treatments.

Diuretics ("water pills") are often used in small doses to help the body remove excess fluid. Pain medicines may be needed for discomfort.

Some people may need to cut down on their activity. A low-sodium diet may also be recommended.

If other methods DO NOT control the problem, surgery called a pericardiectomy may be needed. This involves cutting or removing the scarring and part of the sac-like covering of the heart.

 

Outlook (Prognosis)

 

Constrictive pericarditis may be life threatening if untreated.

However, surgery to treat the condition has a high risk for complications. For this reason, it is most often done in people who have severe symptoms.

 

Possible Complications

 

Complications may include:

  • Cardiac tamponade
  • Damage to the coronary arteries
  • Heart failure
  • Pulmonary edema
  • Scarring of the heart muscle

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of constrictive pericarditis.

 

Prevention

 

Constrictive pericarditis in some cases is not preventable.

However, conditions that can lead to constrictive pericarditis should be properly treated.

 

 

References

Jouriles NJ. Pericardial and Myocardial Disease. In Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 82.

LeWinter MM, Hopkins WE. Pericardial diseases. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap71.

Little WC, Oh JK. Pericardial diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 77.

 
  • Pericardium

    Pericardium - illustration

    The pericardium is a thin double-layered sac which encloses the heart. Fluid is contained within the layers and lubricates the constantly rubbing surfaces.

    Pericardium

    illustration

  • Constrictive pericarditis

    Constrictive pericarditis - illustration

    Constrictive pericarditis is a disorder caused by inflammation of the pericardium, the sac-like covering of the heart. Eventual thickening, scarring and contracture of the pericardium occurs causing it to be less elastic. This prevents the pericardium from stretching and results in reduced filling of the chambers of the heart. This reduces the amount of blood pumped by the heart and causes blood to back up behind the heart, resulting in symptoms of heart failure. Constrictive pericarditis may be life threatening if untreated.

    Constrictive pericarditis

    illustration

    • Pericardium

      Pericardium - illustration

      The pericardium is a thin double-layered sac which encloses the heart. Fluid is contained within the layers and lubricates the constantly rubbing surfaces.

      Pericardium

      illustration

    • Constrictive pericarditis

      Constrictive pericarditis - illustration

      Constrictive pericarditis is a disorder caused by inflammation of the pericardium, the sac-like covering of the heart. Eventual thickening, scarring and contracture of the pericardium occurs causing it to be less elastic. This prevents the pericardium from stretching and results in reduced filling of the chambers of the heart. This reduces the amount of blood pumped by the heart and causes blood to back up behind the heart, resulting in symptoms of heart failure. Constrictive pericarditis may be life threatening if untreated.

      Constrictive pericarditis

      illustration

    Tests for Pericarditis - constrictive

     

       

      Review Date: 5/5/2016

      Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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