Constrictive Pericarditis

Question 1

Causes

Answer 1

• Any cause of pericarditis
  Particularly TB

Question 2

Pathophysiology

Answer 2

• CHRONIC: if pericardium becomes so inelastic as to interfere with diastolic filling of the heart = CONSTRICTIVE PERICARDITIS -> hard for ventricles to compensate = decrease in SV and Increase in HR to compensate

Question 3

Features

Answer 3

• dyspnoea
• right heart failure: elevated JVP, ascites, oedema, hepatomegaly
• JVP shows prominent x and y descent
• pericardial knock - loud S3
• Kussmaul’s sign is positive

Question 4

Diagnosis

Answer 4

CXR - pericardial calcification
Echo: thickened pericardium (>3-4 cm)

Question 5

Difference between constrictive pericarditis and cardiac tamponade

Answer 5

JVP: X + Y descent Present in constrictive pericarditis but Y descent absent in tamponade
Absent Y descent in cardiac tamponade is TAMponade = TAMpaX
Pulsus Paradoxus: Absent in constrictive pericarditis, present in tamponade
Kussmauls signs: Present in constrictive pericarditis, rare in tamponade
a paradoxical rise in JVP during inspiration

Question 6

Treatment

Answer 6

Tx is limited
- Diuretics may relieve congestion but do not reverse constriction.
- GOLD STANDARD = Surgical pericardiectomy indicated in symptomatic patients with confirmed constriction.