The pericardium is the saclike membrane that surrounds the heart. Jul 29, 2014 constrictive pericarditis arises from a stiffening of the pericardium, which prevents complete or satisfactory diastolic filling of the heart. Pathophysiology, diagnosis, echocardiography and treatment are being explained a presentation with images and videos of the. Multiple echo windows should be obtained to verify the diffuse or localized nature of the pericarditis. Constrictive pericarditis is longterm, or chronic, inflammation of the pericardium. This disorder must be considered in the differential diagnosis for unexplained heart failure, particularly when the left ventricular ejection fraction is preserved. Constrictive pericarditis requires surgical treatment and is usually curable, while restrictive cardiomyopathy, short of cardiac transplantation, is treatable only by medical means and often responds unsatisfactorily. In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause. Gersh, mbchb, dphil abstract differentiation of constrictive pericarditis cp from restrictive cardiomyopathy rcm is a complex and often challenging process.
Between september 1992 and may 2014, 47 patients who underwent pericardiectomy for constrictive pericarditis were retrospectively examined. Constrictive pericarditis cp is characterized by impaired diastolic cardiac filling and elevated ventricular filling pressures figure 1 due to a rigid pericardium with. However, despite these similarities there are important. Constrictive pericarditis is a surgical disease, except in cases of very early constriction or in severe, advanced disease. Constrictive pericarditis traditional imaging and hemodynamic features pericardial calcification cxr and ct increased pericardial thickness echo, ct, and mri hemodynamics by cath increased ra pressure with rapid y descent equalization of lvrv enddiastolic pressures. Constrictive pericarditis versus restrictive cardiomyopathy.
This leads to impairment of ventricular filling in mid and late diastole. A case study cardiology volume 9, part 2 3 cause of cp in developed countries, composing up to 42% of cases in some series. Constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. American society of echocardiography, 2100 gateway centre.
Constrictive pericarditis is a potentially curable condition caused by a variety of situations which result in inflamed, scarred, thickened, or calcified pericardium. Since echocardiography is usually an initial diagnostic test to evaluate such patients, the following features can aid in the diagnosis of constrictive pericarditis. Up to 50% of patients presenting with congestive heart failure chf have preserved ejection fraction, the majority of whom have hypertension, coronary disease, or other wellknown substrates. Cardiac tamponade is a lifethreatening condition characterized by slow or rapid compression of the heart due to the accumulation of fluid in the pericardial space and rarely presents mainly as a. Restrictive constrictive pericarditis restrictive cardiomyopathy doppler echo respiratory variation in ventricular inflow velocities increase in respiratory variation of the ventricular inflow velocities in patients with compared to a in patients normal. The mechanism of effusiveconstrictive pericarditis is thought to be visceral pericardial constriction. Table 1 diagnostic features of restrictive cardiomyopathies and constrictive pericarditis clinical findings biomarkers ecg xrayct echodoppler cmr biopsy primary rcm skeletal myopathy atrial enlargement diffuse. Pericarditis that develops as the result of a viral, bacterial, fungal or. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Patient case studies focusing on constrictive pericarditis. The purpose of this study was to evaluate the longterm outcomes following treatment of constrictive pericarditis by pericardiectomy. Effusiveconstrictive pericarditis is a rare clinical syndrome characterized by concurrent pericardial effusion and pericardial constriction, with constrictive hemodynamics being persistent after the pericardial effusion is removed. Effusiveconstrictive pericarditis is a clinical hemodynamic syndrome in which constriction of the heart by the visceral pericardium occurs in the presence of tense. This swelling may be a symptom of constrictive pericarditis, a serious type of pericarditis. Nov 27, 2015 constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. Jan 02, 2020 effusive constrictive pericarditis is a rare clinical syndrome characterized by concurrent pericardial effusion and pericardial constriction, with constrictive hemodynamics being persistent after the pericardial effusion is removed. The scarred, and noncompliant pericardium causes restraint to early diastolic ventricular filling, resulting in the equalisation of intracardiac diastolic filling pressures, producing the socalled single diastolic chamber. Abstract constrictive pericarditis can result from a stiff pericardium that prevents satisfactory diastolic filling. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and definite diagnostic criteria are needed.
Apr 29, 2016 up to 50% of patients presenting with congestive heart failure chf have preserved ejection fraction, the majority of whom have hypertension, coronary disease, or other wellknown substrates. Effusiveconstrictive pericarditis is an uncommon syndrome in which individuals with pericardial effusion and tamponade show clinical and hemodynamic evidence of pericardial constriction after normalization of intrapericardial pressure by drainage of the effusion. Diagnosing constrictive pericarditis cardiac ultrasound examination pericarditis is an inflammation of the pericardium and can occur as the result of multiple pathologies. Constrictive pericarditis an overview sciencedirect topics. Constrictive pericarditis constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. Echocardiographic manifestations of constrictive pericarditis. A twodimensional echocardiogram revealed biatrial enlarge ment, inferior vena cava, and hepatic.
Effusive constrictive pericarditis ecp is defined by concurrent pericardial effusion and pericardial constriction. A severe form of pericarditis in which the inflamed layers of the pericardium stiffen, develop scar tissue, thicken and stick together. Constrictive pericarditisa curable diastolic heart failure. Mar 19, 2020 constrictive pericarditis is often iatrogenic following openheart surgery or radiation therapy for the treatment of mastocarcinoma and other cancers. Constrictive pericarditis cp is typically chronic and can occur after any pericardial disease process. Request pdf role of echocardiography in the diagnosis of constrictive pericarditis the clinical recognition of constrictive pericarditis cp is important but. Constrictive pericarditis diagnosis, echocardiography and. Echocardiogram of patient with familial restrictive cardiomyopathy in the. As a result, the majority of ventricular filling occurs rapidly in early diastole and the ventricular volume does not increase after the end of the.
Role of echocardiography in the diagnosis of constrictive pericarditis. Longterm outcomes of pericardiectomy for constrictive. When the abnormal pericardium limits diastolic filling, there are a series of hemodynamic consequences. In constrictive pericarditis cp, the thickened, dense pericardium imposes a restraint on ventricular filling.
This limits diastolic relaxation of the heart and causes congestive heart. Constrictive pericarditis is a medical condition characterized by a thickened, fibrotic pericardium, limiting the hearts ability to function normally. Effusiveconstrictive pericarditis ecp is defined by concurrent pericardial effusion and pericardial constriction. Thickened pericardium was observed in 88% of patients with proved constrictive pericarditis. In summary, constrictive pericarditis should be considered in patients presenting with heart failure symptoms and preserved ejection fraction. Pericardial constriction is typically chronic, but variants include subacute, transient, and occult constrictive pericarditis.
Constrictive pericarditis radiology reference article. Whereas the pericardial cavity is typically obliterated in patients with constrictive. Pdf advances in the differentiation of constrictive pericarditis and. The diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics.
Constrictive pericarditis cp is a recognised, but unusual cause of chronic ascites. Constrictive pericarditis cp is defined as impedance to diastolic filling caused by a fibrotic pericardium. This usually involves the parietal pericardium, although it can involve the visceral pericardium see constrictive effusive pericarditis. Pdf chronic constrictive pericarditis researchgate. Constrictive pericarditisa curable diastolic heart. The hemodynamic alteration in effusiveconstrictive pericarditis is the result of combined effect of fluid accumulation and pericardial constriction and therefore the hemodynamic changes are also intermediate. Constrictive pericarditis, still a diagnostic challenge. Echocardiographic diagnosis of constrictive pericarditis.
May, 2015 the hemodynamic alteration in effusiveconstrictive pericarditis is the result of combined effect of fluid accumulation and pericardial constriction and therefore the hemodynamic changes are also intermediate. Effusive constrictive pericarditis is an uncommon syndrome in which individuals with pericardial effusion and tamponade show clinical and hemodynamic evidence of pericardial constriction after normalization of intrapericardial pressure by drainage of the effusion. Risk factors for the development of cp include prior cardiac surgery and radiation therapy. Various diagnostic advances over the years enable us to differentiate between these two conditions.
Constrictive pericarditis versus cardiac tamponade both constrictive pericarditis cp and cardiac tamponade restrict or impede ventricular diastolic filling resulting in accentuated respiratory changes in right and left heart filling as well as increased ventricular interaction. Although the etiology of hfpef is most commonly related to longstanding hypertension and atherosclerosis, a signif. Constrictive pericarditis curable paradoxical diastolic. Jan 01, 2020 constrictive pericarditis occurs when a thickened fibrotic pericardium, of whatever cause, impedes normal diastolic filling. Constrictive pericarditis is often iatrogenic following openheart surgery or radiation therapy for the treatment of mastocarcinoma and other cancers. Extreme respiratory variation in the depth of the a wave of the pulmonic valve echo was demonstrated in a patient with constrictive pericarditis. Although the primary cause of constrictive pericarditis is entirely different to that of restrictive cardi. Echocardiography diagnostic criteria for constriction american. Apr 18, 2014 restrictive constrictive pericarditis restrictive cardiomyopathy doppler echo respiratory variation in ventricular inflow velocities increase in respiratory variation of the ventricular inflow velocities in patients with compared to a in patients normal pattern hepatic venous flow reversal usually reverses during expiration in constrictive. Constrictive pericarditis is a form of pericarditis in which the pericardium is thickened and it were a hard shell that forms around the heart. Constrictive pericarditis interferes with the normal function of the heart. Constrictive pericarditis was verified by means of surgery andor catheterization in 17 patients. Constrictive pericarditis is a potentially curable condition caused by a variety of situations which result in inflamed, scarred, thickened. Real time two dimensional echocardiography in constrictive.
Transient constrictive pericarditis 2018 mfmer 371200334 an email from a junior staff 52 year old man waiting for heart transplantation had echo, cath, and mri medial e 20 cmsec diastolic reversal flow with expiration. Motion of pulmonic valve and constrictive pericarditis chest. Constrictive pericarditis arises from a stiffening of the pericardium, which prevents complete or satisfactory diastolic filling of the heart. Echocardiography is recommended for all patients with heart failure1 and, therefore, provides an important opportunity to evaluate for constrictive pericarditis. The differentiation of restrictive cardiomyopathy and constrictive pericarditis has been a perennial problem in clinical cardiology. The mechanism of effusive constrictive pericarditis is thought to be visceral pericardial constriction. Restrictive cardiomyopathy versus constrictive pericarditis oxford. Constrictive pericarditis or perhaps better termed pericardial constriction is a type of pericarditis which leads to diastolic dysfunction and potentially symptoms of right heart failure. Constrictive pericarditis cp is a form of diastolic heart failure that arises because an inelastic pericardium inhibits cardiac filling.
Constrictive pericarditis after cardiac surgery is a unique entity, which carries distinctive features than cp associated with other etiologies. The diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics mimic restrictive cardiomyopathy. As a result of loss of the normal elasticity of the pericardium, patients with cp exhibit exaggerated interventricular dependence and dissociation between intracardiac and intrathoracic pressures during respiration. Although the typical echocardiographic features of cp in spontaneously breathing patients have been extensively described, data on the hemodynamic and echocardiographic features of cp during positive pressure mechanical ventilation are incomplete. Invasive hemodynamics of constrictive pericarditis.
Constrictive pericarditis is a potentially reversible cause of heart failure. When the abnormal pericardium limits diastolic filling, there are a series of hemodynamic consequences which manifest as fatigue, dyspnea, abdominal bloating, peripheral edema, or. Constrictive pericarditis prevalence, causes and clinical. Constrictive pericarditis is a potentially reversible cause of heart failure that may be difficult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Transthoracic echocardiography revealed normal left ven. Constrictive pericarditis curable paradoxical diastolic heart. Effusiveconstrictive pericarditis is a clinical hemodynamic syndrome in which constriction of the heart by the visceral pericardium occurs in the presence of tense effusion in a free. Section of cardiology, department of medicine, west virginia university school of medicine, morgmtown, west virginia, usa summary. Pericarditis may present as either a chronic or acute process and is often associated with the development of a pericardial effusion. Constrictive pericarditis symptoms and ecg medical library. Echocardiography diagnostic criteria for constriction. Constrictive pericarditis occurs when scarring and calcification of the pericardium result in loss of normal elasticity.
Epidemiology no single demographic is affected as the. Constrictive pericarditis and restrictive cardiomyopathy. Role of echocardiography in the diagnosis of constrictive. In some people, pericarditis can cause swelling of the feet, legs or ankles. As many as 1015% have either restrictive cardiomyopathy or constrictive pericarditis. Constrictive pericarditis never confused with anything else. The sensitivity, specificity, and accuracy of mr imaging in the diagnosis of constrictive pericarditis were 88%, 100%, and 93%, respectively. Diagnosis may be challenging because the presentation can be similar to that of restrictive myocardial disease, severe tricuspid regurgitation, and some noncardiac conditions. The normal pericardium is a thin sac consisting of fibro elastic tissue and contains a small amount of fluid. Echocardiographic diagnosis of constrictive pericarditis the echocardiographic diagnosis of cp was originally based on mmode echocardiographic. Fischbein and colleagues relating constrictive pericardial physiology to calcified pericarditis associated with asbestos exposure chest 1988. Differentiation of constriction and restriction complex cardiovascular hemodynamics jeffrey b. Garcia, md abstract about onehalf of the patients with congestive heart failure have preserved left ventricular ejection fraction hfpef. Thus, the heart can not fill normally diastolic dysfunction.
Constrictive pericarditis cp is a potentially curable cause of diastolic heart failure. In the developing world tuberculosis is a common cause of constrictive pericarditis. Radiationinduced constrictive pericarditis usually presents 10 years after therapy. Constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and. Pdf the diagnosis of constrictive pericarditis should be considered in any patient.
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