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Constrictive pericarditis is the chronic inflammation of the pericardial sac surrounding the heart. This causes thickening, scarring and contraction of the pericardium and impedes the heart’s ability to dilate before it pumps out blood.
What Happens In Constrictive Pericarditis?
The fibrotic pericardium that develops in constrictive pericarditis impedes the diastolic function of the heart. In this condition, the easily distended pericardial lining becomes stiff and hard to expand. Usually the parietal pericardium is affected, but the visceral layer may also be affected.
The layers become thickened, fibrous and fused together. The available space between them is reduced and the ventricle will lose its distending capacity.
The venous return to the heart will be affected and the filling is reduced so the heart has less blood to pump forward.
Acute and chronic pericarditis deposits fibrin which may evoke a response that can lead to fluid collection in the sac called pericardial effusion.
Causes Of Constrictive Pericarditis
This disease may have multiple causes and in many cases no etiology can be determined. 10% of the cases may be acute in nature but in other cases the condition is preceded by a sub-clinical or occult form of pericarditis. 46% of the cases are due to idiopathic causes (presumably viral), 37% follow a cardio-thoracic surgery and 9% may occur after radiation therapy. Other causes include:
- Infection: Tuberculosis in developing countries and purulent pericarditis due to pneumococcal infection can cause pericarditis. Many gram-positive organisms like staphylococci and Group A and B streptococci and gram-negative rods like Pseudomonas species, Escherichia coli, and Klebsiella species can also be the cause.
- Neoplasms: Malignant involvement may manifest as pericardial effusion. Breast cancer, lung carcinomas and lymphomas are the metastatic malignancies most associated with this disease.
- Connective tissue disorders: Autoimmune disorders may manifest as episodes of acute pericarditis. Rheumatoid arthritis, Systemic lupus erythematosus and scleroderma may also present with this condition.
- Drugs: These include procainamide, hydralazine and methysergide.
- Myocardial infarction: Dressler syndrome
Symptoms of Constrictive Pericarditis
Symptoms of constrictive pericarditis can mimic a lot of other diseases such as myocardial infarction, aortic dissection, influenza and many connective tissue disorders. The major clinical confusion arises when differentiating this condition from restrictive pericarditis of the heart.
Symptoms develop that will be consistent with a congestive heart failure, usually right sided. This will reduce the cardiac output over time. Symptoms will initially be present upon exercising, and then, when the disease worsens, you may experience symptoms at rest.
These symptoms can help narrow down the diagnosis of constrictive pericarditis: Click here for general pericarditis symptoms
- Difficulty breathing that gets worse initially on exertion and later on even at rest
- Edema of the legs and ankle
- Swollen abdomen
- Dry cough
- Sharp stabbing pain when heart rubs against a stiff pericardium
- Pain increases with coughing, swallowing, deep breathing and lying flat.
- Pain relieved on sitting up and leaning forward
Constrictive Pericarditis Diagnosis and Treatment
Constrictive pericarditis is a potentially curable disease if diagnosed early and can be fatal if diagnosed too late. Long term survival depends on the severity of the underlying causes with the idiopathic type having the best prognosis.
A chest Xray, ECG, Echocardiography and even a cardiac CT or MRI may be used to detect cardiac stiffening, reduced filling and ventricular output.
Treatment for an acute attack of pericarditis involves pain medications such as non-steroidal anti-inflammatory that helps alleviate the pain and inflammation associated with the condition. If there is an infectious cause for the condition, antibiotics or anti-fungal drugs may be prescribed by your doctor.
The goal of the therapy is to improve heart function once the underlying cause has been treated. Your doctor may prescribe diuretics (water pills) which remove excess water. This should be accompanied with lifestyle changes like a low sodium diet and bed rest.
A definitive treatment for constrictive pericarditis is a type of surgery called pericardiectomy that involves cutting and removing the scarred tissue.