The pericardium is a two-layered outer sac that encircles the heart. A thin film of fluid (about 50 ml) slightly separates the two layers and decreases friction between them. Constrictive Pericarditis is present when the pericardium turns fibrotic, thickened, and adherent restricting the filling of the heart. It is most commonly a sequel of an inflammatory condition of pericardium.
Causes of Constrictive Pericarditis
- Idiopathic – with unknown cause
- Post Viral Pericarditis
- Prior Radiation Therapy
- Chronic Renal Failure Treated with Hemodialysis
- Cancerous Pericardial Infiltration
- Fungal and Parasitic Infections
- Associated with Acute Myocardial Infarction
Symptoms of Constrictive Pericarditis
The common presentations of constrictive pericarditis are fatigue, hypotension, tachycardia, edema, breathing difficulty on exertion and lying down and cough. Chest pain – sharp or stabbing , sudden, worse on breathing in or with movement , radiating to neck, back, shoulders, or abdomen, reduced by sitting up or leaning forward.
Diagnosis of Constrictive Pericarditis
Diagnosis can be made by Chest X-ray, Electrocardiography and Echocardiography. CT and MRI imaging are superior in assessment of pericardial anatomy and thickness. The confirmatory diagnosis can be made by Cardiac catheterization.
Chronic constrictive pericarditis is a progressive disease without spontaneous reversal of pericardial abnormalities, symptoms or hemodynamics.
Treatment for Constrictive Pericarditis
Treatment for constrictive pericarditis is complete resection of the pericardium – Pericardiectomy. A minority of patients may survive for many years with modest signs and symptoms, that is controlled by the judicious use of diet and diuretics. The underlying condition that resulted in constrictive pericarditis should also be addressed.