Constrictive Pericarditis

Epidemiology

  • Effusion is present in 28% of all pericardial disease cases (including constrictive pericarditis and acute pericarditis)

Physiology

  • Mechanism: elevated systemic capillary and PCWP pressures with transudation of fluid into pleural space
  • Development of “Cardiac Cirrhosis”: hepatic vein pressures are typically higher in constrictive pericarditis than those in right-sided congestive heart failure -> increasing probablity of developing hepatic necrosis (and ultimately cardiac cirrhosis)

Diagnosis

  • Echocardiogram: necessary
  • Swan: necessary
  • Cardiac Catheterization:

Clinical Manifestations

Cardiac Manifestations

  • General Features
    • Elevated Jugular Venous Pressure
    • Kussmaul’s Sign (see Kussmaul’s Sign, [[Kussmauls Sign]]): rise in the jugular venous pressure on inspiration
    • Pericardial Calcification on CXR
    • Pericardial Knock
  • Features Characteristic of Fluid Overload-Type Presentation
  • Features Characteristic of Low Cardiac Output-Type Presentation
    • Exertional Dyspnea (see Dyspnea, [[Dyspnea]])
    • Fatigue (see XXX)

Gastrointestinal Manifestations

  • “Cardiac Cirrhosis” (see Congestive Hepatopathy, [[Congestive Hepatopathy]])
  • Congestive Hepatopathy (Passive Hepatic Congestion) (see Congestive Hepatopathy, [[Congestive Hepatopathy]])
    • Absence of Jaundice/Hyperbiliruinemia: often absent in cases due to constrictive pericarditis (for unclear reasons)
    • Ascites
    • Hepatomegaly
    • Peripheral Edema
    • Pulsatile Liver

Pulmonary Manfestations

  • Pleural Effusion (See Pleural Effusion-Transudate, [[Pleural Effusion-Transudate]])
    • Pleural effusion is present in 28-60% of cases
    • Can be left, right, or bilateral
  • xxx

Treatment

  • xxx

References

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