Constrictive pericarditis: Difference between revisions
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==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]] | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Cardiomyopathy DDX}} | {{Cardiomyopathy DDX}} | ||
{{CHF}} | |||
==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
''Initial evaluation:'' | |||
*CBC | *CBC | ||
*Chemistry | *Chemistry | ||
| Line 53: | Line 33: | ||
*[[Ultrasound]] | *[[Ultrasound]] | ||
**Formal [[echocardiography|TTE/TEE]] | **Formal [[echocardiography|TTE/TEE]] | ||
''Advanced evaluation'' | |||
*Cardiac CT/MR | |||
*Invasive hemodynamic evaluation | |||
===Diagnosis=== | ===Diagnosis=== | ||
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.