Constrictive pericarditis: Difference between revisions
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[[Category:Cardiology]] | [[Category:Cardiology]] | ||
==Background== | |||
*Result of scarring and loss of elasticity of the pericardial sac | |||
*Typically chronic complication of [[pericarditis]] | |||
==Clinical Features== | |||
*Pleuritic chest pain | |||
*Dyspnea | |||
*Malaise | |||
*Characteristic symptoms of [[pericarditis]] less frequent in recurrent presentations | |||
==Differential Diagnosis== | |||
==Evaluation== | |||
===Workup=== | |||
*Initial evaluation: | |||
**ECG: No pathognomonic findings, however may be associated with nonspecific ST and T wave changes, atrial fibrillation, and low voltage <ref> Talreja DR, Edwards WD, Danielson GK, Schaff HV, Tajik AJ, Tazelaar HD, Breen JF, Oh JK. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation. 2003 Oct 14;108(15):1852-7. doi: 10.1161/01.CIR.0000087606.18453.FD. Epub 2003 Sep 29. PMID: 14517161.</ref> | |||
**CXR: Ring of calcification around the heart, however the majority of patients will not have this | |||
**TTE | |||
*Advanced evaluation: | |||
**Cardiac CT/MR | |||
**Invasive hemodynamic evaluation | |||
===Diagnosis=== | |||
*No single diagnostic imaging/evaluation parameter | |||
*Must be differentiated from [[tamponade]] and disorders such as [[restrictive cardiomyopathy]] as management is different for each of these pathologies | |||
==Management== | |||
*If no signs of chronic process: Medical management (Colchicine, NSAIDs for 2-3 months) | |||
**Chronic signs: Anasarca, cachexia, [[atrial fibrillation]], hepatic dysfunction, pericardial calcification | |||
*If chronic process: Pericardiectomy <ref> Welch TD. Constrictive pericarditis: diagnosis, management and clinical outcomes. Heart. 2018 May;104(9):725-731. doi: 10.1136/heartjnl-2017-311683. Epub 2017 Nov 25. PMID: 29175978.</ref> | |||
==Disposition== | |||
*Admit | |||
==See Also== | |||
==External Links== | |||
==References== | |||
<references/> | |||
Revision as of 17:58, 14 December 2022
Background[1]
- Occurs when normally elastic pericardium becomes thickened and fibrotic
- Can be infectious, post-cardiac surgery, inflammatory, idiopathic or related to radiation exposure
- Impairs diastolic filling of heart
- Must distinguish from restrictive cardiomyopathy
Clinical Features
- Symptoms similar to congestive heart failure, especially right sided
- Dyspnea
- Lower extremity edema
- Jugular venous distention
Differential Diagnosis
Cardiomyopathy
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Peripartum cardiomyopathy
- Takotsubo cardiomyopathy
- Arrhythmogenic right ventricular dysplasia
- Cardiovascular
- Pulmonary
- Other
- Pure volume overload
- Renal Failure
- Post-Transfusion
- Sepsis
- Anaphylaxis
- Pure volume overload
Evaluation
Workup
- CBC
- Chemistry
- ECG
- CXR
- Troponin/CK
- BNP
- Ultrasound
- Formal TTE/TEE
Diagnosis
Management
- Definitive treatment is surgical pericardiectomy
Disposition
See Also
External Links
References
- ↑ Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.
Background
- Result of scarring and loss of elasticity of the pericardial sac
- Typically chronic complication of pericarditis
Clinical Features
- Pleuritic chest pain
- Dyspnea
- Malaise
- Characteristic symptoms of pericarditis less frequent in recurrent presentations
Differential Diagnosis
Evaluation
Workup
- Initial evaluation:
- ECG: No pathognomonic findings, however may be associated with nonspecific ST and T wave changes, atrial fibrillation, and low voltage [1]
- CXR: Ring of calcification around the heart, however the majority of patients will not have this
- TTE
- Advanced evaluation:
- Cardiac CT/MR
- Invasive hemodynamic evaluation
Diagnosis
- No single diagnostic imaging/evaluation parameter
- Must be differentiated from tamponade and disorders such as restrictive cardiomyopathy as management is different for each of these pathologies
Management
- If no signs of chronic process: Medical management (Colchicine, NSAIDs for 2-3 months)
- Chronic signs: Anasarca, cachexia, atrial fibrillation, hepatic dysfunction, pericardial calcification
- If chronic process: Pericardiectomy [2]
Disposition
- Admit
See Also
External Links
References
- ↑ Talreja DR, Edwards WD, Danielson GK, Schaff HV, Tajik AJ, Tazelaar HD, Breen JF, Oh JK. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation. 2003 Oct 14;108(15):1852-7. doi: 10.1161/01.CIR.0000087606.18453.FD. Epub 2003 Sep 29. PMID: 14517161.
- ↑ Welch TD. Constrictive pericarditis: diagnosis, management and clinical outcomes. Heart. 2018 May;104(9):725-731. doi: 10.1136/heartjnl-2017-311683. Epub 2017 Nov 25. PMID: 29175978.