Constrictive pericarditis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor in Chief: M.Umer Tariq [2]

Overview

Pericardial constriction is a progressive disease without spontaneous reversal of the pericardial thickening. Some patients can be medically managed for several years. Edema can be controlled with diuretics and slowing of the heart rate can maximize the diastolic filling time. Most patients eventually develop significant debility from impaired cardiac output and elevated right and left sided filling pressures.

Medical Therapy

A few case series since 1987 have mentioned transient constrictive pericarditis that appears to be associated with pericardial inflammation. The use of cardiac MRI has made it possible to identify pericardial inflammation with the use of late gadolinium enhancement. This particular type of constrictive pericarditis can be treated with anti-inflammatory therapy and prevent its progression to irreversible disease requiring pericardiectomy

Transient pericarditis can be treated medically by:

• NSAIDS
• Steroids
• Heart failure management
• Chemotherapy

If medical therapy fails, transient pericarditis can be treated by pericardiectomy

Chronic constrictive pericarditis:

• Complete pericardiectomy
• Pericardiectomy is associated with 5-10% peri-operative mortality

2015 ESC Guidelines for the management of pericardial diseases: (DO NOT EDIT)

Recommendations for therapy of constrictive pericarditis:

Class I

"1. The mainstay of treatment of chronic permanent constriction is pericardiectomy" "1. (Level of Evidence: C)"

"2. Medical therapy of specific pericarditis (i.e tuberculous pericarditis) is recommended to prevent the progression of constriction (Level of Evidence: C)"

Class IIb

"1. Empiric anti-inflammatory therapy may be considered in cases with transient or new diagnosis of constriction with concomitant evidence of pericardial inflammation (i.e. CRP elevation or pericardial inflammation (i.e. CRP elevation or pericardial enhancement on CT/CMR) (Level of Evidence: C )"

Sources

• 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS)