Pericarditis; constrictive

Causes and Risks:
Constrictive pericarditis is a chronic form of pericarditis . It may result from no apparent cause, or it may be the result of chronic inflammation caused by tuberculosis , radiation therapy to the chest, cardiac surgery, or an infection.

The inflamed pericardium causes pain when it rubs against the heart. Because the pericardium becomes thickened and scarred, it becomes less elastic. This prevents the pericardium from stretching and results in reduced filling of the chambers of the heart. This reduces cardiac output (the amount of blood pumped by the heart) and causes blood to back up behind the heart, resulting in symptoms of right-sided heart failure .

Constrictive pericarditis is relatively uncommon in children.

Prevention:
Constrictive pericarditis in many cases is not preventable.

Symptoms:

Symptoms of acute (but not chronic) pericarditis also include:

  • chest pain (less than that seen with acute pericarditis)
    • radiating to the neck, shoulder, back or abdomen
    • described as sharp, stabbing
    • increases with breathing

  • splinting of ribs with deep breathing (bends over or holds chest when breathing deeply)
  • the preferred position is upright, standing, or sitting
  • fever
  • sweating
  • chills
  • dry cough
  • anxiety



Signs and Tests:
Heart sounds may be weak or distant. There may be signs of hepatic (liver) congestion, such as enlargement of the liver and fluid in the abdomen ( ascites ). Neck veins may be prominent, and may not decrease when inhaling (related to increased pressure in the veins). The spleen may be examined by touch. Constrictive pericarditis may resemble restrictive cardiomyopathy or cardiac tamponade .

Pericardial thickening, scarring, or calcification (mineral deposits) may be verified by the results of the following tests:

An ECG may show changes. Atrial fibrillation is present about one-third of the time.

Treatment:
The goal of treatment is to improve heart function. The cause must be identified and treated. This may include antibiotics, antituberculosis medications, or other treatments.

Diuretics are commonly prescribed in small doses to gradually decrease excess fluid. Analgesics may be needed to control pain. Decreased activity may be recommended for some cases, and a low sodium diet may be recommended.

Surgical pericardiectomy (cutting or removal of part of the pericardium) is the definitive treatment and may be recommended if scarring is severe.

Prognosis:
Constrictive pericarditis may be life threatening if untreated. A pericardiectomy may have a relatively high death rate and is usually reserved for severely symptomatic cases.

Complications:



Call Your Healthcare Provider:
Call the health care provider if symptoms indicate constrictive pericarditis may be present.