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Constrictive pericarditis

constrictive pericarditis, constrictive pericarditis symptoms
Constrictive pericarditis is a medical condition characterized by a thickened, fibrotic pericardium, limiting the heart's ability to function normally1 In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause2

Contents

  • 1 Signs and symptoms
  • 2 Causes
  • 3 Pathophysiology
  • 4 Diagnosis
  • 5 Treatment
  • 6 References
  • 7 Further reading
  • 8 External links

Signs and symptomsedit

Signs and symptoms of constrictive pericarditis are consistent with the following: fatigue, swollen abdomen, difficulty breathing dyspnea, swelling of legs and general weakness Related conditions are bacterial pericarditis, pericarditis and pericarditis after a heart attack1

Causesedit

The cause of constrictive pericarditis in the developing world are idiopathic in origin, though likely infectious in nature In regions where tuberculosis is common, it is the cause in a large portion of cases3

Tuberculosis-x-ray

Causes of constrictive pericarditis include:

  • Tuberculosis4
  • Incomplete drainage of purulent pericarditis4
  • Fungal and parasitic infections4
  • Chronic pericarditis4
  • Postviral pericarditis4
  • Postsurgical4
  • Following MI, post-myocardial infarction4
  • In association with pulmonary asbestos5

Pathophysiologyedit

The pathophysiological characteristics of constrictive pericarditis are due to a thickened, fibrotic pericardium that forms a non-compliant shell around the heart This shell prevents the heart from expanding when blood enters it This results in significant respiratory variation in blood flow in the chambers of the heart6

During inspiration, pressure in the thoracic cavity decreases but is not relayed to the left atrium, subsequently a reduction in flow to the left atrium and ventricle happens During diastole, less blood flow in left ventricle allows for more room for filling in right ventricle and therefore a septal shift occurs7

During expiration, the amount of blood entering the right ventricle will decrease, allowing the interventricular septum to bulge towards the right ventricle, and increased filling of the left ventricle and subsequent increased pressure generated by the left ventricle during systoleThis is known as ventricular interdependence, since the amount of blood flow into one ventricle is dependent on the amount of blood flow into the other ventriclemedical citation needed

Diagnosisedit

The diagnosis of constrictive pericarditis is often difficult to make In particular, restrictive cardiomyopathy has many similar clinical features to constrictive pericarditis, and differentiating them in a particular individual is often a diagnostic dilemma8

  • Chest X-Ray - pericardial calcification common but not specific, pleural effusions are common findings9
  • Echocardiography - the principal echographic finding is changes in cardiac chamber volume9
  • CT and MRI - useful in select cases9
  • BNP blood test - tests for the existence of the cardiac hormone brain natriuretic peptide, which is only present in RCMP but not in CP10
  • Conventional cardiac catheterization11
  • Physical examination -can reveal clinical features including Kussmaul's sign and a pericardial knock11

Treatmentedit

The definitive treatment for constrictive pericarditis is pericardial stripping, which is a surgical procedure where the entire pericardium is peeled away from the heart This procedure has significant risk involved,12 with mortality rates of 6% or higher in major referral centers13

A poor outcome is almost always the result after a pericardiectomy is performed for constrictive pericarditis whose origin was radiation-induced,further some patients may develop heart failure post-operatively14

Referencesedit

  1. ^ a b "Contrictive pericarditis" Medline Plus NIH Retrieved 21 September 2015 
  2. ^ Schwefer, Markus; Aschenbach, Rene; Heidemann, Jan; Mey, Celia; Lapp, Harald September 2009 "Constrictive pericarditis, still a diagnostic challenge: comprehensive review of clinical management" European Journal of Cardio-Thoracic Surgery 36 3: 502–510 doi:101016/jejcts200903004 Retrieved 21 September 2015 
  3. ^ Dunn, editor, Brian P Griffin ; associate editors, Thomas D Callahan, Venu Menon ; guest editors, Willis M Wu, Clay A Cauthen, Justin M 2013 Manual of cardiovascular medicine 4th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins p 653 ISBN 978-1-4511-3160-4 Retrieved 21 September 2015 CS1 maint: Extra text: authors list link
  4. ^ a b c d e f g "Constritive pericarditis" eMedicine MedScape Retrieved 21 September 2015 
  5. ^ Lloyd, editors-in-chief, Joseph G Murphy, Margaret A 2013 Mayo Clinic cardiology : concise textbook 4th ed Oxford: Mayo Clinic Scientific Press/Oxford University Press p 718 ISBN 978-0-199915712 Retrieved 21 September 2015 CS1 maint: Extra text: authors list link
  6. ^ Crouch, edited by Michael A 2010 Cardiovascular pharmacotherapy : a point-of-care guide Bethesda, Md: American Society of Health-System Pharmacists p 376 ISBN 978-1-58528-215-9 Retrieved 21 September 2015 CS1 maint: Extra text: authors list link
  7. ^ Camm, Demosthenes G Katritsis, Bernard J Gersh, A John 2013 Clinical cardiology : current practice guidelines 1st ed Oxford: Oxford University Press p 388 ISBN 978-0-19-968528-8 Retrieved 21 September 2015 
  8. ^ "Restrictive pericarditis" eMedicine MedScape Retrieved 21 September 2015 
  9. ^ a b c "Imaging in Constrictive pericarditis" eMedicine MedScape Retrieved 21 September 2015 
  10. ^ Semrad, Michal 2014 Cardiovascular Surgery Charles University p 114 ISBN 978-80-246-2465-5 Retrieved 21 September 2015 
  11. ^ a b Khandaker, Masud H; Espinosa, Raul E; Nishimura, Rick A; Sinak, Lawrence J; Hayes, Sharonne N; Melduni, Rowlens M; Oh, Jae K June 2010 "Pericardial Disease: Diagnosis and Management" Mayo Clinic Proceedings 85 6: 572–593 PMC 2878263  PMID 20511488 doi:104065/mcp20100046 
  12. ^ Cinar B, Enc Y, Goksel O, Cimen S, Ketenci B, Teskin O, Kutlu H, Eren E 2006 "Chronic constrictive tuberculous pericarditis: risk factors and outcome of pericardiectomy" Int J Tuberc Lung Dis 10 6: 701–6 PMID 16776460 
  13. ^ Chowdhury UK, Subramaniam GK, Kumar AS, Airan B, Singh R, Talwar S, Seth S, Mishra PK, Pradeep KK, Sathia S, Venugopal P 2006 "Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques" Ann Thorac Surg 81 2: 522–9 PMID 16427843 doi:101016/jathoracsur200508009 
  14. ^ Greenberg, editors, Jeffrey D Hosenpud, Barry H 2007 Congestive heart failure 3rd ed Philadelphia: Lippincott Williams & Wilkins p 410 ISBN 0-7817-6285-5 Retrieved 21 September 2015 CS1 maint: Extra text: authors list link

Further readingedit

  • Smiseth, Otto A; eds, Michał Tendera 2008 Diastolic heart failure London: Springer ISBN 978-1-84628-890-6 Retrieved 21 September 2015 CS1 maint: Extra text: authors list link
  • Hoit, B D 25 June 2002 "Management of Effusive and Constrictive Pericardial Heart Disease" Circulation 105 25: 2939–2942 doi:101161/01CIR000001942107529C5 Retrieved 21 September 2015 

External linksedit

  • Constrictive Pericarditis

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    29.10.2014


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