Constrictive pericarditis overview: Difference between revisions
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==Overview== | ==Overview== | ||
Pericardial constriction occurs when a fibrotic, adherent [[pericardium]] restricts diastolic filling of the heart. Variants of constrictive pericarditis have been described such as transient, subtle, effusive and chronic, depending on the course of the disease. The disease process typically begins with pericardial inflammation that progresses onto fibrosis. It may occasionally follow an episode of [[acute pericarditis]]. There is fibrous scarring of the [[pericardium]] and usually fusion of the visceral and parietal [[pericardium]]. <ref> Mehta A, Mehta M, Jain AC. Constrictive pericarditis. Clin Cardiol 1999; 22:334-44.</ref> <ref>Cameron J, Oesterle SN, Baldwin JC, Hancock EW. The etiologic spectrum of constrictive pericarditis. Am Heart J 1987; 113:354-60. </ref> <ref>Ling LH, Oh JK, Schaff HV, et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation 1999; 100:1380-6. </ref> | Pericardial constriction occurs when a fibrotic, adherent [[pericardium]] restricts diastolic filling of the heart. Variants of constrictive pericarditis have been described such as transient, subtle, effusive and chronic, depending on the course of the disease. The disease process typically begins with pericardial inflammation that progresses onto fibrosis. It may occasionally follow an episode of [[acute pericarditis]]. There is fibrous scarring of the [[pericardium]] and usually fusion of the visceral and parietal [[pericardium]]. <ref> Mehta A, Mehta M, Jain AC. Constrictive pericarditis. Clin Cardiol 1999; 22:334-44.</ref> <ref>Cameron J, Oesterle SN, Baldwin JC, Hancock EW. The etiologic spectrum of constrictive pericarditis. Am Heart J 1987; 113:354-60. </ref> <ref>Ling LH, Oh JK, Schaff HV, et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation 1999; 100:1380-6. </ref>. The pericardium is composed of a double-layered sac that surrounds the [[heart]] and the roots of the [[great vessels]]. The [[serous]] layer (smooth [[visceral]]) and a [[fibrous]] layer (tough [[parietal]]) of the [[pericardium]] encloses the [[pericardial cavity]] which contains [[pericardial fluid]].The [[pericardium]] function is to protect the [[heart]] against [[infection]] and to provide it with [[lubrication]]. Constrictive pericarditis is a chronic inflammation that leads to the thickening, fibrosis, and scarring of the pericardial sac. The thickened fibrotic [[pericardium]] restricts the normal late [[diastolic]] filling in constrictive pericarditis and results in significant [[respiratory]] variation in [[blood flow]] in the [[ventricles]]. This is known as [[ventricular]] interdependence, where the amount of [[blood flow]] into one [[ventricle]] is dependent on the amount of [[blood flow]] into the other [[ventricle]].The intrapericardial space contains 50 mL of plasma ultrafiltrate that minimize [[friction]] during cardiac motion. pericarditis causes that can trigger the development of constrictive pericarditis are tuberculosis, viral infection, radiation therapy, trauma, post-cardiac surgery. | ||
==Historical Perspective== | ==Historical Perspective== |
Revision as of 17:37, 27 December 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Muhammad Umer Tariq, M.D., Atif Mohammad, M.D.
Overview
Pericardial constriction occurs when a fibrotic, adherent pericardium restricts diastolic filling of the heart. Variants of constrictive pericarditis have been described such as transient, subtle, effusive and chronic, depending on the course of the disease. The disease process typically begins with pericardial inflammation that progresses onto fibrosis. It may occasionally follow an episode of acute pericarditis. There is fibrous scarring of the pericardium and usually fusion of the visceral and parietal pericardium. [1] [2] [3]. The pericardium is composed of a double-layered sac that surrounds the heart and the roots of the great vessels. The serous layer (smooth visceral) and a fibrous layer (tough parietal) of the pericardium encloses the pericardial cavity which contains pericardial fluid.The pericardium function is to protect the heart against infection and to provide it with lubrication. Constrictive pericarditis is a chronic inflammation that leads to the thickening, fibrosis, and scarring of the pericardial sac. The thickened fibrotic pericardium restricts the normal late diastolic filling in constrictive pericarditis and results in significant respiratory variation in blood flow in the ventricles. This is known as ventricular interdependence, where the amount of blood flow into one ventricle is dependent on the amount of blood flow into the other ventricle.The intrapericardial space contains 50 mL of plasma ultrafiltrate that minimize friction during cardiac motion. pericarditis causes that can trigger the development of constrictive pericarditis are tuberculosis, viral infection, radiation therapy, trauma, post-cardiac surgery.
Historical Perspective
- In 1989, Hatle et al reported the two characteristic features in constrictive pericarditis:[4]
- First, they showed dissociation between intrathoracic and intracardiac pressures
- Second, enhanced ventricular interaction can also occur
Classification
Pathophysiology
Causes
Differentiating Pericardial constriction from other Diseases
Constrictive pericarditis must be differentiated from restrictive cardiomyopathy as they are treated very differently. Multi-modality imaging including echocardiography with flow and tissue doppler imaging, cardiac MRI and heart catheterization are used to differentiate between the two conditions that may present with similar clinical signs and symptoms. The finding of ventricular interdependence (respiratory variation of mitral and tricuspid flows) as demonstrated by different imaging modalities is key in differentiating the two syndromes.
Epidemiology and Demographics
Risk Factors
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ Mehta A, Mehta M, Jain AC. Constrictive pericarditis. Clin Cardiol 1999; 22:334-44.
- ↑ Cameron J, Oesterle SN, Baldwin JC, Hancock EW. The etiologic spectrum of constrictive pericarditis. Am Heart J 1987; 113:354-60.
- ↑ Ling LH, Oh JK, Schaff HV, et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation 1999; 100:1380-6.
- ↑ Hatle LK, Appleton CP, Popp RL (1989). "Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography". Circulation. 79 (2): 357–70. doi:10.1161/01.cir.79.2.357. PMID 2914352.