No single demographic is affected as there are numerous causes of constrictive pericarditis.
Clinical presentation is dominated by restricted diastolic ventricular filling resulting in an increase in diastolic pressure in all four cardiac chambers. Patients typically present with symptoms of both left and right sided heart failure including:
Characterised by fibrous or calcific constrictive thickening of the pericardium, which prevents normal diastolic filling of the heart. It may follow any type of pericardial effusion and may develop within a variable time frame ranging from two or three months to a number of years.
- idiopathic (most common) 6
- previous cardiac surgery (second most common) 6
- radiotherapy (third most common) 6
- tuberculosis (previously common) 7
- viral infection
- pyogenic infection
- chronic renal failure
- rheumatic fever (rare) 4
- systemic lupus erythematosus (rare) 5
In approximately 50% of cases there is visible pericardial calcification on chest radiographs.
Aside from pericardial thickening, echocardiography may show small tubular-shaped ventricles, distortion of the ventricular septum (e.g. flattened or sigmoid-shaped) and atypical septal movement (i.e. septal bounce).
CT chest - cardiac
CT is very sensitive in demonstrating calcification of the pericardium which is suggestive of the disease if found in the proper clinical setting. A thickened pericardium (more than 4 mm) on its own does not indicate constrictive pericarditis 8. Contrast-enhanced CT may also show signs of cardiac failure like septal flattening and retrograde flow of contrast into the dilated inferior vena cava and hepatic veins.
The pericardium is often thickened to more than 4 mm. MRI is better than CT at differentiating between pericardial fluid and thickened pericardium 8. Cine MRI may also demonstrate septal flattening and septal bounce.
Treatment and prognosis
- potentially curable by a pericardiectomy
Clinically, it is difficult to differentiate between constrictive pericarditis and restrictive cardiomyopathy. It is important to distinguish between constrictive pericarditis and restrictive cardiomyopathy as the former benefit from pericardial stripping.
- 1. Weissleder R, Wittenberg J, M.D. MG et-al. Primer of Diagnostic Imaging, Expert Consult- Online and Print. Mosby. (2011) ISBN:0323065384. Read it at Google Books - Find it at Amazon
- 2. Belloni E, De cobelli F, Esposito A et-al. MRI of cardiomyopathy. AJR Am J Roentgenol. 2008;191 (6): 1702-10. doi:10.2214/AJR.07.3997 - Pubmed citation
- 3. Anand SS, Saini VK, Wahi PL. CONSTRICTIVE PERICARDITIS. Dis Chest. 1965;47 (3): 291-5. doi:10.1378/chest.47.3.291 - Pubmed citation
- 4. Lindinger, A.; Schmaltz, A. A.; Hoffmann, W. Constrictive pericarditis due to acute rheumatic fever European Heart Journal. 8 (suppl J): 241. doi:10.1093/eurheartj/8.suppl_J.241
- 5. Tsokos G, Gordon C, FRCP JSSMD. Systemic lupus erythematosus. Mosby. ISBN:0323044344. Read it at Google Books - Find it at Amazon
- 6. Bertog SC, Thambidorai SK, Parakh K et-al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J. Am. Coll. Cardiol. 2004;43 (8): 1445-52. doi:10.1016/j.jacc.2003.11.048 - Pubmed citation
- 7. Lilly LS. Pathophysiology of Heart Disease:: A Collaborative Project of Medical Students and Faculty. LWW. ISBN:1605477230. Read it at Google Books - Find it at Amazon
- 8. O'Leary SM, Williams PL, Williams MP et-al. Imaging the pericardium: appearances on ECG-gated 64-detector row cardiac computed tomography. Br J Radiol. 2010;83 (987): 194-205. Br J Radiol (full text) - doi:10.1259/bjr/55699491 - Free text at pubmed - Pubmed citation