Constrictive Pericarditis

Question 1

Constrictive Pericarditis Occur

Answer 1

❑Occur following
inflammatory sequela resulting in a thickened
(and often calcified) pericardium, which can then lead to
constrictive pericarditis

Question 2

Most common are

Answer 2

are viral/idiopathic, uremic, post
surgery, tuberculosis, or post-radiation therapy
→Other causes include neoplasms, autoimmune,
trauma, sarcoidosis, methysergide therapy, and
implantable cardioverter-defibrillator patches

Question 3

Symptoms:

Answer 3

• Abdominal fullness (caused by hepatic congestion and ascites) and peripheral edema
• Fatigue, weight loss, and muscle weakness
• Less common to have orthopnea, dyspnea, or cough

Question 4

Physical examination
:

Answer 4

Elevated jugular venous pressure
* Signs of passive liver congestion (icterus, ascites)
* Leg edema

Question 5

Kussmaul sign:

Answer 5

✓Increased jugular venous pressure with inspiration (normally decreases with inspiration)
✓Occurs during inspiration because the rigid pericardium prevents the increased venous
blood from fully filling the right cardiac chambers.

Question 6

Pericardial
knock
:

Answer 6

Extra heart sound heard in early diastole (mimics an S3), coinciding with abrupt cessation
in ventricular filling because of the rigid pericardium

Question 7

ECG
:

Answer 7

Nonspecific findings such as T-wave
flattening or inversions

Question 8

Chest radiography
:

Answer 8

May show a calcified pericardium
(rare)

Question 9

Echocardiogram
:

Answer 9

1 Abnormal diastolic ventricular septal motion
caused by interventricular interdependence
2 Marked respiratory variation in ventricular
size/filling (>25%)
3 Plethoric inferior vena cava, and at times, a
thickened pericardium (>4 mm

Question 10

CT or MRI

Answer 10

Most useful in identifying thickened (>4 mm)
and calcified pericardium

Question 11

TREATMENT Definitive treatment:

Answer 11

total peri-cardiectomy (surgical removal of
the pericardium)
➢90% of patients have symptomatic improvement; 50% with
complete relief
➢
Less effective when an underlying restrictive cardiomyopathy is
also present, as seen after radiation therapy
➢Surgical mortality is
5% to 19%

Question 12

Avoid

Answer 12

calcium channel blockers and β-blockers because sinus
tachycardia is a compensatory mechanism for impaired cardiac
filling