What Is Constrictive Pericarditis?

Constrictive pericarditis is caused by chronic pericardial inflammation caused by thickening, adhesion and even calcification of the pericardium, which causes the heart to relax and contract, restricts heart function, and causes diseases that cause systemic blood circulation disorders. About 10% of patients with acute suppurative pericarditis do not heal. Others can be caused by rheumatism, trauma, and mediastinal radiotherapy. Early pericardial resection can avoid the development of cardiogenic cachexia, severe liver dysfunction, and myocardial atrophy. Active prevention and treatment of acute pericarditis can prevent the development of pericardial constriction.

Basic Information

English name: constrictive pericarditis
Visiting department: Cardiology

Common causes: Mostly caused by tuberculous pericarditis
Common symptoms: Fever, chest pain, progressive fatigue, abdominal distension, lower limb edema, etc.

Causes of constrictive pericarditis

Constrictive pericarditis is secondary to acute pericarditis, and its etiology is still most common in China, followed by purulent and traumatic pericarditis. A few are related to pericardial tumors, acute non-specific pericarditis, and radiation pericarditis. There are also some patients whose etiology is unknown.

Clinical manifestations of constrictive pericarditis

Pericardial constriction

The length of time of formation varies. Usually, those who develop pericardial constriction within one year after the occurrence of acute pericarditis are called acute constriction, and those who are more than one year old are called chronic constriction. The evolution process has three forms:

(1) Systemic reactions and symptoms such as fever, chest pain, etc. can be gradually relieved or even completely disappeared within a few days after treatment of persistent acute pericarditis. However, signs of venous congestion such as hepatomegaly and jugular vein irritation have worsened, so in It is difficult to determine the boundaries between the acute and chronic phases in this group of patients, which is related to the pericardial thickening and narrowing of the pericardium that occur at the same time as the exudate is absorbed.

(2) The symptoms and signs of intermittent pericarditis in the acute phase can completely resolve within a certain period of time. The patient thinks that the lesions have healed, but the symptoms and signs of pericardial constriction reappear after a few months. This has a slower response to the pericardium. Formation is related to narrowing within time.

(3) Slow- onset type The clinical manifestations of acute pericarditis in these patients are relatively mild or have no history, but they have symptoms such as progressive fatigue, abdominal distension, and lower limb edema, and pericardial constriction occurs within 1 to 2 years.

2. Signs

(1) Low blood pressure, fast pulse, 1/3 odd pulses, 30% with atrial fibrillation.

(2) The venous pressure is significantly increased, even after diuresis, the venous pressure remains high, the jugular veins are swollen, and they are more obvious when inhaled, and the dilated jugular veins are suddenly collapsed at an early stage, which are non-specific signs.

(3) In the cardiac inspection, systolic apical retraction, early systolic apical pulsation, palpation with diastolic pulsating impact, percussive heart dullness circle is normal or enlarged, and pericardial throbbing sounds are heard in the 3 to 4 intercostal space of the left margin of the sternum. No noise.

(4) Other signs: such as jaundice, wet base snoring, liver enlargement, peritoneal effusion is more obvious than lower limb edema, and it is similar to liver cirrhosis.

Constrictive pericarditis

1. X-ray inspection

It shows that the size of the heart shadow is normal, the left and right heart edges are straightened, the aortic arch is small or difficult to recognize; the superior vena cava is often dilated, and sometimes pericardial calcification can be seen; the electrocardiogram has QRS low voltage, T wave flat or inverted. The diagnostic value of echocardiography for constrictive pericarditis is much lower than for pericardial effusion. Ultrasound examination showed thickening of the pericardium and weakening of wall activity, but they were not specific and constant signs.

2. Right heart catheterization

Characteristic manifestations are pulmonary capillary pressure, pulmonary arterial diastolic pressure, right ventricular end-diastolic pressure, and right atrial pressure are all elevated and at the same high level; the right atrial pressure curve shows an M or W waveform, and the right ventricular systolic pressure slightly increases , Showing a plateau-shaped curve of early diastolic depression.

Diagnosis of constrictive pericarditis

Typical constrictive pericarditis is not difficult to diagnose based on clinical manifestations and laboratory tests. Clinically, it is often necessary to distinguish it from cirrhosis, congestive heart failure, and tuberculous peritonitis. The clinical manifestations and hemodynamic changes of restricted cardiomyopathy are very similar to this disease, and the identification of the two may be very difficult. If necessary, diagnosis must be made by endocardial myocardial biopsy.

Constrictive pericarditis treatment

Early pericardial resection is performed to avoid the development of cardiogenic cachexia, severe liver dysfunction, and myocardial atrophy. Surgery should usually be performed after pericardial infection is controlled, tuberculosis activity has stopped, and medication is continued for 1 year after surgery. Known or suspected tuberculous constrictive pericarditis, antituberculosis treatment should be performed for 1 to 4 weeks before surgery. If the diagnosis is positive, medication should be continued for 6 to 12 months after pericardial resection. Some scholars believe that digitalis application before surgery can reduce arrhythmia and heart failure, and reduce mortality. For those who cannot be treated surgically, they are mainly diuretic and supportive treatment. If necessary, pleural and abdominal effusions are removed.

Constrictive pericarditis prognosis

Constrictive pericarditis is a chronic disease that is progressively exacerbated. It is often disabled or died due to failure, peritoneal effusion and peripheral edema or serious cardiac complications. If a thorough pericardial dissection can be performed early, most patients Achieved satisfactory results. A small number of patients have a poor prognosis because of a long course of disease, obvious myocardial atrophy and cardiogenic cirrhosis.

Constrictive pericarditis prevention

Active prevention and treatment of acute pericarditis can avoid the development of pericardial constriction, such as early incision and drainage of purulent pericarditis, regular antituberculosis treatment of tuberculous pericarditis, and strengthening of heart protection during radiotherapy. Once the development of constrictive pericarditis, we should strive for early surgery on the basis of active treatment of the primary disease.