Constrictive pericarditis is an uncommon condition that occurs in varied forms. Errors and uncertainties in diagnosis are frequent. Constrictive pericarditis after coronary artery bypass grafting cabg is rare and can present as unexplained dyspnea. Diagnosis and treatment of constrictive pericarditis. Mitral inflow variation mitral inflow e 10 cmsec 2018 mfmer 371200314 a 27 yowoman with dyspnea pulsusparadoxuswith asthma ivc hv mitral inflow e 10 cmsec. Echocardiographic guidance of pericardiocentesis is technically less demanding and can be. Designthe volume of pericardial fluid removed by surgical drainage or. Constrictive pericarditis cp is characterized by impaired diastolic cardiac filling and elevated ventricular filling pressures figure 1 due to a rigid pericardium with. A new cross sectional echocardiographic method for estimating the. Echocardiographic diagnosis of constrictive pericarditis the echocardiographic diagnosis of cp was originally based on mmode echocardiographic. Multimodality imaging of pericardial diseases jacc. Constrictive pericarditis, still a diagnostic challenge.
However, despite these similarities there are important. Normal pericardium is visible on spinecho cmr as a thin, smooth. Constrictive pericarditis bijoy k khandheria, md, fase, facc, fesc director, echocardiography services, aurora health care no conflict, no off label use echo diagnostic criteria septal motion abnormality mv flow velocity restrictive ea 1 hepatic vein diastolic. Constrictive pericarditis after coronary artery bypass. 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. Constrictive pericarditis is a disorder of cardiac filling caused by an inelastic pericardium. Guidelines on the diagnosis and management of pericardial diseases. Pericarditis knowledge for medical students and physicians. However, im now left with the diagnosis of chronic constrictive pericarditis which they are thinking may have begun to develop back in 2006 when i had pneumonia after losing my dad suddenly. Constrictive pericarditis is a potentially reversible cause of heart failure that may be difficult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Igg4related effusive constrictive pericarditis european.
An unresectable pleomorphic liposarcoma arising from the pericardium was found at thoracotomy. Inflammatory diseases of the pericardium constitute a spectrum ranging from acute pericarditis to chronic constrictive pericarditis. Constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. Medical therapy of constrictive pericarditis plays a small but important role. Acute pericarditis is most commonly caused by viral infection. Pericardial disease is an important cause of morbidity and mortality in patients with cardiovascular disease. A severe form of pericarditis in which the inflamed layers of the pericardium stiffen, develop scar tissue, thicken and stick together. Constrictive pericarditis apical 4 chamber view youtube. Constrictive pericarditis cp is a recognised, but unusual cause of chronic ascites.
Acute inflammation typically manifests with fever, pleuritic chest pain, and a pericardial friction rub on auscultation. Constrictive pericarditis is a medical condition characterized by a thickened, fibrotic pericardium, limiting the hearts ability to function normally. 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. Pericarditis may present as either a chronic or acute process and is often associated with the development of a pericardial effusion. Pericardial constriction is typically chronic, but variants include subacute, transient, and occult constrictive pericarditis. Constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. Role of echocardiography in the diagnosis of constrictive. At pericarditis or tamponade, there is an obstacle for intake from the atria to the ventricles. Full text full text is available as a scanned copy of the original print version. Diagnosis may be challenging because the presentation can be similar to that of restrictive myocardial disease, severe tricuspid regurgitation, and some noncardiac conditions. Pericarditis that develops as the result of a viral, bacterial, fungal or. Pericarditis accounts for pericarditis syndromes such as acute, chronic, recurrent, constrictive, effusive constrictive.
Effusive constrictive pericarditis constrictive pericarditis cardiac tamponade jvp remain elevated despite lowering of the pericardial pressure to near zero with peri cardiocentesis rapid y descent appears no inspiratory decline in rap thickened,scarred and consequent loss of the normal elasticity of the pericardial sac typically chronic. Effective imageguided medical management in effusive. Constrictive pericarditis constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. Constrictive pericarditis arises from a stiffening of the pericardium, which prevents complete or satisfactory diastolic filling of the heart. 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. The study compared echocardiograms in patients with constrictive pericarditis with those of 36 patients with either of the other two conditions. Constrictive pericarditis versus restrictive cardiomyopathy. Effusive constrictive pericarditis is characterized by the presence of pericardial effusion and constriction secondary to an inflammatory process of the pericardium. The pericardial friction rub can be transient, mono, bi or triphasic. A 30 year old man presented with symptoms of constrictive pericarditis.
Moderate pericardial effusion with signs of cardiac. Pericardiectomy might be necessary in case of failure of medical treatment, a very common scenario in this kind of. Between september 1992 and may 2014, 47 patients who underwent pericardiectomy for constrictive pericarditis were retrospectively. The purpose of this study was to evaluate the longterm outcomes following treatment of constrictive pericarditis by pericardiectomy. Characteristic clinical findings in pericarditis include pleuritic chest pain and a pericardial friction. Constrictive pericarditis cp is defined as impedance to diastolic filling caused by a fibrotic pericardium.
Pediatric pericarditis american college of cardiology. Constrictive pericarditis interferes with the normal function of the heart. Get a printable copy pdf file of the complete article 2. Echocardiographic evaluation of pericardial effusion and cardiac. In constrictive pericarditis cp, the thickened, dense pericardium imposes a restraint on ventricular filling. Pdf surgical treatment of constrictive pericarditis. Major symptoms are retrosternal or left precordial chest pain radiates to the trapezius ridge, can be pleuritic or simulate ischae mia, and varies with posture, nonproductive cough, and shortness of breath. Get a printable copy pdf file of the complete article 915k, or click on a page.
Constrictive pericarditis is a surgical disease, except in cases of very early constriction or in severe, advanced disease. Echocardiography and computed tomography showed a mass extending from the pericardium to surround the heart and penetrating the left ventricular apex. This treatable cause of heart failure should be considered in all patients with unexplained right heart failure symptoms or signs, especially when the left ventricular ejection fraction is preserved. The role of echocardiography in the evaluation of the patient with pericarditis is to chracterize the presence, size, location, and hemodynamic impact of a pericardial effusion. Guidelines and expert consensus documents aim to pres ent all the relevant evidence. Cardiovascular magnetic resonance in pericardial diseases.
Constrictive pericarditis is a potentially reversible cause of heart failure. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and. Echocardiography is not needed to diagnose pericarditis. Diagnosing constrictive pericarditis cardiac ultrasound examination pericarditis is an inflammation of the pericardium and can occur as the result of multiple pathologies. Igg4related disease is a systemic fibroinflammatory disease with tissue infiltration of igg4positive plasma cells. Constrictive pericarditis is a potentially curable condition caused by a variety of situations which result in inflamed, scarred, thickened, or calcified pericardium. Differentiating constrictive pericarditis and restrictive. Garcia, md abstract about onehalf of the patients with congestive heart failure have preserved left ventricular ejection fraction hfpef.
Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Constrictive pericarditis caused by primary liposarcoma. American society of echocardiography, 2100 gateway centre. Although the etiology of hfpef is most commonly related to longstanding hypertension and atherosclerosis, a signif. In the african context, however, where cp is more prevalent, preventable diagnostic delay is inexcusable. Echocardiography diagnostic criteria for constriction. Pericardial disease, echocardiography, cardiovascular magnetic resonance, cardiac computed. Pericardial effusion appears as an echofree space between the two layers of the pericardium. Role of echocardiography in the diagnosis of constrictive pericarditis. The mechanism of effusive constrictive pericarditis is thought to be visceral pericardial constriction. Due to the obstruction from outside, eg by the pericardial fluid, the space in the heart becomes restricted and the filling of one ventricle becomes detrimental to the area of the other ventricle.
In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause. Herein, we present a case of a 70year old retired farmer whose symptoms of right heart failure were initially attributed to coexisting pneumonia and pulmonary embolism. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Constrictive pericarditisa curable diastolic heart. Other important entities that involve the pericardium include benign and malignant pericardial masses, pericardial cysts, and diverticula, as well. Echocardiographic diagnosis of constrictive pericarditis. Invasive studies and even exploratory thoracotomy are considered to be the only sure methods of diagnosis. Note the conical deformity of the right ventricle, tubular deformity of the left ventricle, biatrial dilation, and diastol. Pdf chronic constrictive pericarditis researchgate. This leads to impairment of ventricular filling in mid and late diastole. Pericarditis is inflammation of the pericardium that may be acute or chronic. This is a rare case of successful diagnosis for igg4related effusive constrictive pericarditis by characteristic cmr images and pathological findings.
A study by welch et al indicated that echocardiography can be used to differentiate constrictive pericarditis from restrictive myocardial disease and severe tricuspid regurgitation. Ppt constrictive pericarditis powerpoint presentation. The normal pericardium is a thin sac consisting of fibro elastic tissue and contains a small amount of fluid. Longterm outcomes of pericardiectomy for constrictive. Appearance of constrictive pericarditis on static ct pericardial thickening pericardial calcification small tubular shaped ventricles particularly rt v atrial enlargement. Links to pubmed are also available for selected references. Ibuprofen 600mg every 8 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and definite diagnostic criteria are needed. 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. Constrictive pericarditis never confused with anything else. Constrictive pericarditis cp is typically chronic and can occur after any pericardial disease process. Cabg constrictive pericarditis seen within a period of 17 months at our institution.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. The diagnosis of constrictive pericarditis requires a high degree of clinical suspicion, for the signs and symptoms of this disease can be falsely attributed to other causes. Constrictive pericarditis an overview sciencedirect topics. I have now been discharged from hospital for a 6 week period to allow me to regain a normal level of fitness after spending the past 7 weeks there. 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. Guidelines on the diagnosis and management of pericardial. Careful observation and correct interpretation of a. Constrictive pericarditis bijoy k khandheria, md, fase, facc, fesc director, echocardiography services, aurora health care no conflict, no off label use echo diagnostic criteria septal motion abnormality mv flow velocity restrictive ea 1 hepatic vein diastolic reversal with expiration sensitivity 87 % specificity 91 %. A difficult diagnosis constrictive pericarditis and its.
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