Constrictive pericarditis

Question 1

Define:

Answer 1

Chronic inflammation of the pericardium with thickening and scarring of the pericardial layers. Will impair the cardiac function

Question 2

Aetiology/risk factors:

Answer 2

Often under-diagnosed as present very similar to restrictive cardiomyopathy.

Can occur after any disease and common causes are:

• post operative
• TB
• Viral
• connective tissue disorders
• idiopathic
• mediastinal radiation

Question 3

Epidemiology:

Answer 3

Rare

more common in males

9% of those with pericarditis will develop constrictive pericarditis

TB has the highest incidence

Question 4

Symptoms and signs:

Answer 4

gradual onset

advanced - jaundice, cachexia and muscle wasting

signs of right heart failure:

• kussmaul’s sign - paradoxical rise in JVP on inspiration
• raised JVP
• ascites
• peripheral oedema
• pulsatile hepatomegaly
• splenomegaly
• soft heart sounds, s3
• diastolic pericardial knock
• dyspnoea
• soft, diffuse apex beath

Question 5

Investigations:

Answer 5

CXR - will show a small heart +/- calcification of the pericardium

Echo- diagnostic and can distinguish between restrictive cardiomyopathy

MRI and CT - look at pericardial thickness

Biopsy - if an infective cause is suspected