Constrictive pericarditis: Difference between revisions
Elcatracho (talk | contribs) |
|||
| (12 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
==Background<ref>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.</ref> | ==Background== | ||
[[File:2004 Heart Wall.jpg|thumb|Anatomy of the pericardium.]] | |||
*Can be infectious, post-cardiac surgery, inflammatory, idiopathic or related to radiation exposure | *Occurs when normally elastic pericardium becomes thickened and fibrotic (i.e., loss of elasticiticty)<ref>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.</ref> | ||
*Can be infectious, post-cardiac surgery, inflammatory, idiopathic or related to radiation exposure<ref>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.</ref> | |||
*Impairs diastolic filling of heart | *Impairs diastolic filling of heart | ||
*Must distinguish from [[restrictive cardiomyopathy]] | *Must distinguish from [[restrictive cardiomyopathy]] | ||
*Typically chronic complication of [[pericarditis]] | |||
==Clinical Features== | ==Clinical Features== | ||
*Pleuritic chest pain | |||
*Malaise | |||
*Symptoms similar to [[congestive heart failure]], especially right sided | *Symptoms similar to [[congestive heart failure]], especially right sided | ||
**Dyspnea | **[[Dyspnea]] | ||
**Lower extremity edema | **Lower extremity edema | ||
**Jugular venous distention | **Jugular venous distention | ||
*Characteristic symptoms of [[pericarditis]] less frequent in recurrent presentations | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Cardiomyopathy DDX}} | {{Cardiomyopathy DDX}} | ||
{{CHF}} | |||
==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
''Initial evaluation:'' | |||
*CBC | *CBC | ||
*Chemistry | *Chemistry | ||
*[[ECG]] | *[[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]] | *[[CXR]] | ||
**Ring of calcification around the heart, however the majority of patients will not have this | |||
*[[Troponin]]/CK | *[[Troponin]]/CK | ||
*BNP | *BNP | ||
*[[Ultrasound]] | *[[Ultrasound]] | ||
**Formal TTE/TEE | **Formal [[echocardiography|TTE/TEE]] | ||
''Advanced evaluation'' | |||
*Cardiac CT/MR | |||
*Invasive hemodynamic evaluation | |||
===Diagnosis=== | ===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== | ==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> | |||
*Definitive treatment is surgical pericardiectomy | *Definitive treatment is surgical pericardiectomy | ||
==Disposition== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
| Line 58: | Line 55: | ||
*[[Cardiomyopathy]] | *[[Cardiomyopathy]] | ||
*[[Congestive heart failure]] | *[[Congestive heart failure]] | ||
*[[Pericarditis]] | |||
*[[Pulsus paradoxus]] | |||
==External Links== | ==External Links== | ||
| Line 64: | Line 63: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Cardiology]] | |||
Latest revision as of 18:41, 14 December 2022
Background
- Occurs when normally elastic pericardium becomes thickened and fibrotic (i.e., loss of elasticiticty)[1]
- Can be infectious, post-cardiac surgery, inflammatory, idiopathic or related to radiation exposure[2]
- Impairs diastolic filling of heart
- Must distinguish from restrictive cardiomyopathy
- Typically chronic complication of pericarditis
Clinical Features
- Pleuritic chest pain
- Malaise
- Symptoms similar to congestive heart failure, especially right sided
- Dyspnea
- Lower extremity edema
- Jugular venous distention
- Characteristic symptoms of pericarditis less frequent in recurrent presentations
Differential Diagnosis
Cardiomyopathy
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Peripartum cardiomyopathy
- Takotsubo cardiomyopathy
- Arrhythmogenic right ventricular dysplasia
Congestive heart failure
- Cardiovascular
- Pulmonary
- Other
- Pure volume overload
- Renal failure
- Post-Transfusion
- Sepsis
- Anaphylaxis
- Pure volume overload
Evaluation
Workup
Initial evaluation:
- CBC
- Chemistry
- ECG
- No pathognomonic findings, however may be associated with nonspecific ST and T wave changes, atrial fibrillation, and low voltage [3]
- CXR
- Ring of calcification around the heart, however the majority of patients will not have this
- Troponin/CK
- BNP
- Ultrasound
- Formal TTE/TEE
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 [4]
- Definitive treatment is surgical pericardiectomy
Disposition
- Admit
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.
- ↑ 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.
- ↑ 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.