Constrictive Pericarditis - Symptom, Causes, Treatment

The pericardium is a two-layered sac that encircles the heart, the inner serosal layer adhering to the outer wall of the heart and being reflected back upon itself, at the level of the great vessels, to join the though fibrous outer layer. Constrictive pericarditis is a chronic form of pericarditis in which the pericardium is rigid, thickened, scarred, and less elastic than normal. Constrictive pericarditis is caused by inflammation of the pericardium (the sac-like covering of the heart) with subsequent thickening, scarring, and contracture of the pericardium. Constrictive Pericarditis is present when a fibrotic, thickened, and adherent pericardium restricts diastolic filling of the heart. It usually begins with an initial episode of acute pericarditis, which may not be detected clinically. Acute and subacute forms of pericarditis (which may or may not be symptomatic) may deposit fibrin, which may, in turn, evoke a pericardial effusion. This often leads to pericardial organization, chronic fibrotic scarring, calcification, and restricted cardiac filling. The most common causes of constrictive pericarditis are conditions that induce chronic inflammation of the pericardium: tuberculosis, radiation therapy to the chest, and cardiac surgery. The condition is relatively rare in children.

Pericarditis can lead to inflammation of the epicardial myocardium. Less frequently, constrictive pericarditis results from mesothelioma of the pericardium or from incomplete drainage of abnormal fluid accumulating in the pericardial sac, which can occur in purulent pericarditis or in post-surgery hemopericardium. Constrictive pericarditis may also develop without apparent cause. Pericarditis may be acute or chronic. Acute pericarditis develops quickly, producing an inflammatory reaction. Chronic pericarditis develops more slowly; its prominent feature is effusion. On rare, occasions, pericarditis may develop as a reaction to certain medications. The diagnosis of constrictive pericarditis often difficult to make. The definitive treatment for constrictive pericarditis is pericardial stripping, which is a surgical procedure where the entire pericardium is peeled away from the heart. In patients who have undergone coronary artery bypass surgery with pericardial sparing, there is danger of tearing a bypass graft while removing the pericardium.

Causes of Constrictive pericarditis

The main causes of Constrictive pericarditis:

• Drugs, including hydralazine (Apresoline), procainamide (Procan SR), and phenytoin (Dilantin).
• Auto-immune diseases (such as rheumatoid arthritis, lupus, or scleroderma).
• Postsurgical.
• The most common causes of constrictive pericarditis are conditions that induce chronic inflammation of the pericardium: tuberculosis, radiation therapy to the chest, and cardiac surgery.
• Incomplete Drainage of Purulent pericarditis.
• Tumors.

Signs and symptoms of Constrictive pericarditis

Signs and symptoms often experienced with Constrictive pericarditis are:

• Dry cough.
• Fatigue, excessive tiredness.
• Chills.
• Weakness.
• Low-grade fever.
• Anxiety.
• Increase in heart-rate.

Treatment of Constrictive pericarditis

Some most common treatmet of Constrictive Pericarditis:

• Non-steroidal anti-inflammatory agents are used to decrease the pain and inflammation.
• Antibiotics if the pericarditis is due to infection.
• Due to the significant risks involved with pericardial stripping, many patients are treated medically, with judicious use of diuretics.
• Analgesics may be needed to control pain.
• Decreased activity may be recommended for some cases, and a low-sodium diet may be recommended.
• Subacute constrictive pericarditis may respond to steroids if treated before pericardial fibrosis occurs.

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