Constrictive pericarditis
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Constrictive pericarditis is a condition characterized by a thickened, fibrotic pericardium, limiting the heart's ability to function normally.<ref name="NIH2015">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause.<ref>Template:Cite journal</ref>
Signs and symptomsEdit
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.<ref name=NIH2015/>
CausesEdit
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.<ref>Template:Cite book</ref> Causes of constrictive pericarditis include:
- Tuberculosis<ref name="eMED2015">{{#invoke:citation/CS1|citation
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- Incomplete drainage of purulent pericarditis<ref name=eMED2015/>
- Fungal and parasitic infections<ref name=eMED2015/>
- Chronic pericarditis<ref name=eMED2015/>
- Postviral pericarditis<ref name=eMED2015/>
- Postsurgical<ref name=eMED2015/>
- Following MI, post-myocardial infarction<ref name=eMED2015/>
- In association with pulmonary asbestos<ref>Template:Cite book</ref>
PathophysiologyEdit
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. <ref>Yadav NK, Siddique MS. Constrictive Pericarditis. [Updated 2022 May 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459314/ Template:Webarchive</ref> This results in significant respiratory variation in blood flow in the chambers of the heart.<ref>Template:Cite book</ref>
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.<ref>Template:Cite book</ref>
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.<ref name="Welch 2017" />
DiagnosisEdit
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.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
- Chest X-Ray - pericardial calcification (common but not specific), pleural effusions are common findings.<ref name="peri2015">{{#invoke:citation/CS1|citation
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- Echocardiography - the principal echographic finding is changes in cardiac chamber volume.<ref name=peri2015/>
- CT and MRI - CT scan is useful in assessing the thickness of pericardium, calcification, and ventricular contour. Cardiac MRI may find pericardial thickening and pericardial-myocardial adherence. Ventricular septum shift during breathing can also be found using cardiac MRI. Late gadolinium enhancement can show enhancement of the pericardium due to fibroblast proliferation and neovascularization.<ref name="Welch 2017">Template:Cite journal</ref>
- BNP blood test - tests for the existence of the cardiac hormone brain natriuretic peptide, which is only present in restrictive cardiomyopathy but not in constrictive pericarditis<ref>Template:Cite book</ref>
- Conventional cardiac catheterization<ref name=Khandaker2010/>
- Physical examination - can reveal clinical features including Kussmaul's sign and a pericardial knock.<ref name="Khandaker2010">Template:Cite journal</ref>
TreatmentEdit
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,<ref name="Cinar-2006">Template:Cite journal</ref> with mortality rates of 6% or higher in major referral centers.<ref name="Chowdhury-2006">Template:Cite journal</ref>
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.<ref>Template:Cite book</ref>
ReferencesEdit
Further readingEdit
External linksEdit
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