Cardiovascular magnetic resonance in pericardial diseases. Orthostatic hypotension may occur as an adverse effect from excessive diuresis in patients with constrictive pericarditis, as seen in this patient, who was being treated with a. Pdf surgical treatment of constrictive pericarditis. Echocardiography allows differentiation of constrictive pericarditis. Constrictive pericarditis is usually caused by chronic fibrous thickening and scarring of the pericardium with consequent loss of its normal elasticity and compliance that impedes diastolic cardiac filling. Role of echocardiography in the diagnosis of constrictive. Case reports, studies performed exclusively in children age free. Constrictive pericarditis occurs when scarring and calcification of the pericardium result in loss of normal elasticity. Pericardial constriction is typically chronic, but variants include subacute, transient, and occult constrictive pericarditis.
Constrictive pericarditis, echocardiography, doppler tissue imaging. Since echocardiography is usually an initial diagnostic test to evaluate such patients, the following features can aid in the diagnosis of constrictive pericarditis. For this reason, the echocardiographic diagnosis of constrictive pericarditis has. Pdf the diagnosis of constrictive pericarditis should be considered in any patient with. Clinical presentation is dominated by restricted diastolic. In the developing world tuberculosis is a common cause of constrictive pericarditis. No single demographic is affected as there are numerous causes of constrictive pericarditis. Background ecp is characterized by the coexistence of tense pericardial effusion and constriction of the heart by the visceral pericardium. Both constrictive pericarditis and pericardial thickening can results from tuberculosis, radiation, viral pericarditis, or prior surgery. Constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. The symptoms and signs of constrictive pericarditis cp are often elusive at onset, with a long symptom free period that may take weeks to decades to develop after an episode of cp or pericardial injury, leading to a misdiagnosis or a delayed diagnosis. Constrictive pericarditis is a medical condition characterized by a thickened, fibrotic pericardium, limiting the hearts ability to function normally. In this respect, constrictive pericarditis differs from acute pericarditis, in which the use of nonsteroidal antiinflammatory agents nsaids, cyclooxygenase cox2 inhibitors, colchicine, corticosteroids, or a combination thereof may provide benefit. Coxsackie b, adenovirus and influenza a and b are most common.
Constrictive pericarditis radiology reference article. Constrictive pericarditis in constrictive pericarditis the upper limit of cardiac. 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. Echocardiographic is often seen in the pericardium pericardial effusion. In constrictive pericarditis cp, the thickened, dense pericardium imposes a restraint on ventricular filling. Jan 01, 2020 in the vast majority of cases, medical management is ineffective unless a prominent inflammatory component is present. The subcos tal view was used to identify tethering of the right ventricular free wall at its interface with. Physical findings usually observed with tuberculous pericarditis include fever, echocardiography is an accurate and noninvasive tool for establishing the presence of a pericardial effusion and to detect signs of tamponade.
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. The accumulated fluid can be serous, fibrinous, purulent, or hemorrhagic. The causes of constrictive pericarditis have changed over time. Occult constrictive pericarditis chest pain, dyspnea fatigue reported in 1977 described 19 patients with a syndrome called occult constrictive pericardial disease 10. Etiology of constrictive pericarditis 10 changing aetiologies 11 differential. 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. Constrictive pericarditis is a potentially reversible cause of heart failure that may be difficult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Pathology pericardium thickened 5mm by ct scarred loss of elasticity 3.
It develops insidiously, and in many cases, no etiology is ever determined. The pathophysiology of constrictive pericarditis is restriction of diastolic ventricular filling due to a noncompliant pericardium which is often adhered to the epicardium. Most deaths are due to myocardial infarction, and the remainder are due to heart failure, constrictive. Constrictive pericarditis symptoms and ecg medical library. Constrictive pericarditis is a potentially curable condition caused by a variety of situations which result in inflamed, scarred, thickened, or calcified pericardium. Constrictive pericarditis and pericardial thickening. Specific echo exam for constriction neither sensitive nor specific must diagnose via a combination of.
Constrictive pericarditis definition of constrictive. Echocardiography is currently the main diagnostic tool in the assessment of. Pathophysiology and diagnosis of constrictive pericarditis. Dec 06, 2016 2d echocardiography of constrictive pericarditis features in this video. The superior resolution achieved with transesophageal echocardiography should allow better pericardial definition. 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. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Ventricular filling pressures and diastolic waveform were unaltered in the subjects free from. Identified causes include metallic foreign bodies, actinomycosis, and coccidioidomycosis.
In summary, constrictive pericarditis should be considered in patients presenting with heart failure symptoms and preserved ejection fraction. About onehalf of the patients with congestive heart failure have preserved left ventricular ejection fraction hfpef. A contemporary spectrum of constrictive pericarditis in 5 patients evaluated at the mayo clinic from 1985 through 1995 was compared with that of a historic cohort of 231 patients from 1936 through 1982. Chronic pericarditis often causes tiredness, coughing, and shortness of breath. Pdf advances in the differentiation of constrictive pericarditis and. Constrictive pericarditis cp is a recognised, but unusual cause of chronic ascites. Pericardial thickness measured with transesophageal. Echocardiography in evaluation of pericardial disease japi. The final diagnosis of constrictive pericarditis still remains a challenge, because it is a rare disease, with a long symptom free period that can make it difficult to establish the correlation between etiology and first clinical presentation. In severe cases, it can lead to swelling in the stomach and legs and hypotension low blood pressure. 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. Pericarditis is an inflammation of the pericardium heart sac usually caused by a virus. The diagnosis of cp had to be confirmed based on surgical findings and pathology in all patients.
Constrictive pericarditis cp is a potentially curable cause of diastolic heart failure. Misdiagnosis of constrictive pericarditis presenting with. Besides acting as a protective barrier, it also affects cardiac hemodynamics. Value of dynamic respiratory changes in left and right ventricular pressures for diagnosis of constrictive pericarditis. Constrictive pericarditis constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. Diagnosis may be challenging because the presentation can be similar to that of restrictive myocardial disease, severe tricuspid regurgitation, and some noncardiac conditions. Pericardial calcification on echo normal pericardium is highly reflective bright pericardial echo cannot alone diagnose constrictive pericarditis 20.
The true population prevalence is unknown, but amongst those with viral pericarditis it has been estimated to occur in less than 0. Anterior echo free space without any echo free space posteriorly could be due to subepicardial fat3 and should be interpreted cautiously. 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. Echocardiographic diagnosis of constrictive pericarditis. Pericardial effusion is an accumulation of fluid in the pericardial sac beyond the normal physiologic amounts and results from a variety of causes including cardiac or renal failure, infection, neoplasm, trauma, radiation, and myocardial infarction 12. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and. Pmc free article mccaughan bc, schaff hv, piehler jm, danielson gk, orszulak ta, puga fj, pluth jr, connolly dc, mcgoon dc. Left pleural effusion can also produce an echo free space behind the heart. Shell like echogenic pericardium with mild pericardial effusion 4. Jan 01, 2020 chronic constrictive pericarditis is a disease that has multiple possible causes and is associated with variable clinical findings, depending on its severity.
Constrictive pericarditis is longterm, or chronic, inflammation of the pericardium. Recognizing these syndromes is important because early. Mmode echocardiography shows the persistence of an echofree space between the. The diagnosis of constrictive pericarditis cp continues to be a challenge in the modern era. Mediastinal radiation therapy results in approximately a threefold increase in the risk of cardiac death. It is usually a chronic condition however subacute, transient. Constrictive pericarditis patients with constrictive pericarditis frequently present with symptoms of heart failure, such as dyspnea, orthopnea, and fatigability, and occasionally may present with liver enlargement and ascites. Constrictive pericarditis is a condition in which granulation tissue formation in the pericardium results in loss of pericardial elasticity leading to restriction in the ventricular filling. At times, a calcified pericardium is seen with encasement of the heart impeding diastolic filling 1. A correct diagnosis is difficult to establish on clinical grounds alone. Two serious complications of pericarditis are cardiac tamponade and chronic constrictive pericarditis. However, despite these similarities there are important. Early and late results of pericardiectomy for constrictive pericarditis. Clinically, it is important to distinguish constrictive pericarditis from restrictive cardiomyopathy each of which have similar clinical presentations and hemodynamic alterations.
Constrictive pericarditis versus restrictive cardiomyopathy. Constrictive pericarditis is a potentially reversible cause of heart failure. Constrictive pericarditis an overview sciencedirect topics. Echocardiography diagnostic criteria for constriction. Constrictive pericarditis statpearls ncbi bookshelf. This limits diastolic relaxation of the heart and causes congestive heart. Radiationinduced constrictive pericarditis usually presents 10 years after therapy. 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. Echocardiographic diagnosis of constrictive pericarditis the echocardiographic diagnosis of cp was originally based on mmode echocardiographic. The differentiation of restrictive cardiomyopathy and constrictive pericarditis has been a perennial problem in clinical cardiology. Constrictive pericarditis is a clinical syndrome consequent on compression of the heart by a rigid, chronically inflamed thickened pericardium table 1. Predictors of constrictive pericarditis after tuberculous pericarditis. Transthoracic echocardiography cannot reliably detect thickened pericardium. In some patients approximately 10%, an antecedent acute pericarditis is present.
Nov 18, 20 patient case studies focusing on constrictive pericarditis. Constrictive pericarditis prevalence, causes and clinical. A patient is sent to the echo lab with the diagnosis of constrictive pericarditis. 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. This leads to impairment of ventricular filling in mid and late diastole. Constrictive pericarditis is often iatrogenic following openheart surgery or radiation therapy for the treatment of mastocarcinoma and other cancers. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and definite diagnostic criteria are needed. Constrictive pericarditis is a wellknown complication of chest irradiation therapy and may occur 10 to 15 years after exposure. He presented with high crp, fever, chest pain, and tachycardia. Role of echocardiography in the diagnosis of constrictive pericarditis.
Understanding the pathophysiology and integrating the results of invasive and noninvasive techniques are important in the differential diagnosis of cp and e. S mm thick echofree space, suggesting thickened pericardium. In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause. A fatal complication of pericarditis is that an inflammation in the heart causes the pericardial fluid or blood to fill up when relaxed, this is called tamponade. Objectives the purpose of this study was to examine the prevalence and histopathologic correlates of pericardial delayed hyperenhancement dhe seen with cardiac magnetic resonance imaging cmr among patients with constrictive pericarditis cp undergoing pericardiectomy. Constrictive pericarditis article about constrictive. When the abnormal pericardium limits diastolic filling, there are a series of hemodynamic consequences which manifest as fatigue, dyspnea, abdominal bloating, peripheral edema, or. Echocardiogram of patient with familial restrictive cardiomyopathy in the setting of troponin t mutation. The pericardium is the saclike membrane that surrounds the heart. Mar, 2017 constrictive pericarditis cp is a relatively uncommon form of clinical heart failure.
This study assessed the reliability of transesophageal echocardiographic measurements of pericardial thickness and the potential diagnostic usefulness of this technique. Notable trends were an increasing frequency of cp due to cardiac surgery and mediastinal radiation patients who had received radiotherapy. Ppt constrictive pericarditis powerpoint presentation. 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 a relatively uncommon form of clinical heart failure.
Constrictive pericarditis, still a diagnostic challenge. The taoist approach to mental health and wellbeing. Echocardiography in evaluation of pericardial disease. Idiopathic hemorrhagic pericarditis can sometimes evolve into constrictive pericarditis. Pericardial delayed hyperenhancement with cmr imaging in. The pericardium is the fibroelastic sac that covers the heart. Ct and mri can differentiate between fat and fluid. Constrictive pericarditis is a rare condition in cats and dogs 2729.
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