Overview
The pericardium is a sac that surrounds the heart which is elastic. Constrictive pericarditis describes the thickening and fibrosis of the pericardium, leading to a loss of pericardial elasticity and a restriction in ventricular filling. It is mostly chronic in nature and difficult to differentiate from restrictive cardiomyopathy and other causes of right heart failure.
Causes
- Idiopathic
- Viral infections
- Tuberculosis
- Radiation to the mediastinum
- Surgery
- Any cause of pericarditis
Presentation
- Shortness of breath
- Features of right-sided heart failure:
- Elevated jugular venous pressure (JVP)
- Peripheral oedema
- Hepatomegaly – this may be pulsatile
- Pericardial ‘knock’ sound – a loud S3
- Kussmaul’s sign positive – elevated JVP does not fall with inspiration
Investigations
- Chest x-ray:
- Shows pericardial calcification
- Echocardiogram:
- Diagnostic and helps distinguish from restrictive cardiomyopathy
Management
Overview
Treatment may involve pericardiectomy, which involves removing as much of the pericardium as possible. Mortality is relatively high, ranging from 10-50%.
