Constrictive pericarditis

Constrictive pericarditis Prolonged (chronic) inflammation of the sac-like covering of the heart (the pericardium) with thickening, scarring, and muscle stiffness (contracture).

Summary

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  • 1 Description
  • 2 Symptoms
  • 3 Signs and tests
  • 4 Treatment
  • 5 Expectations (prognosis)
  • 6 Complications
  • 7 Situations requiring medical assistance
  • 8 Prevention
  • 9 Alternative names
  • 10 References
  • 11 See also
  • 12 Sources

Description

Constrictive pericarditis is most often caused by conditions or procedures that cause inflammation to develop around the heart, such as:

  • Cardiosurgery
  • Radiation therapy tothe chest
  • Tuberculosis

Less common causes include:

  • Abnormal accumulation of fluid in the covering of the heart due to bacterial or viral infection or surgical complications
  • Mesothelioma

Constrictive pericarditis can also develop without apparent cause.

The inflammation causes the covering of the heart to become thick and stiff, causing the organ to have difficulty expanding properly when it beats. As a result, the heart chambers are not filled with enough blood. Blood is dammed behind the heart, causing heart swelling and other symptoms of heart failure.

The condition is relatively rare in children.

Symptoms

Symptoms of chronic constrictive pericarditis include:

  • Shortness of breath (dyspnea) that develops slowly and gets worse
  • Fatigue, excessive tiredness
  • Long-term swelling (edema) of the legsand ankles
  • Distended abdomen
  • Weakness

Signs and tests

Constrictive pericarditis is very difficult to diagnose. The signs and symptoms are similar to restrictive cardiomyopathy and cardiac tamponade . The doctor needs to rule out these conditions when making a diagnosis.

A physical examination may show that the neck veins protrude, suggesting an increase in blood pressure in the area, which is called the Kussmaul sign . The doctor may notice distant or faint heart sounds when auscultating the chest with a stethoscope .

Physical examination may also reveal swelling of the liver and fluid in the ventral area. The following exams can be ordered:

  • Magnetic resonance imaging of the chest
  • CT scan of the chest
  • Chest x-ray
  • Coronary angiographyor cardiac catheterization
  • ECG
  • Echocardiography

Treatment

The goal of treatment is to improve heart function. The cause must be identified and treated, which may include antibiotics, anti-tuberculosis drugs, or other treatments.

Diuretics are often prescribed in small doses to help the body flush out excess fluid. The painkillers may be needed to control pain.

Decreased activity may be recommended for some patients. A low-sodium diet can also be recommended .

Definitive treatment is a type of surgery, called pericardiectomy, that involves cutting or removing the scar and part of the sac-like covering of the heart.

Expectations (prognosis)

Constrictive pericarditis can be life threatening if left untreated. However, surgery to treat the condition is associated with a high rate of complications and is generally reserved for patients with severe symptoms.

Complications

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

Situations requiring medical assistance

Call your doctor if you have symptoms of constrictive pericarditis.

Prevention

In some cases, constrictive pericarditis cannot be prevented. However, conditions that can lead to constrictive pericarditis must be treated appropriately.

Alternative names

Pericarditis due to cardiac constriction

 

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