Constrictive Pericarditis: Symptoms, Causes, Risk Factors and Treatment

Definition: is a long-term, or chronic, inflammation of the pericardium.

The pericardium is the membrane that surrounds the heart. Inflammation in this part of the heart causes scarring, thickening and hardening of the muscles, or contracture.

Over time, the pericardium loses its elasticity and becomes rigid. The condition is rare in adults, and it is even less common in children.

It can become a serious health problem. If left untreated, a rigid pericardium can lead to symptoms of heart failure, and can even be life-threatening. There are effective treatments for the condition.

What are the symptoms?

  1. Symptoms of constrictive pericarditis include:
  2. Respiratory difficulty that develops slowly and worsens.
  3. Fatigue.
  4. Swollen abdomen.
  5. Chronic severe swelling in the legs and ankles.
  6. Weakness.
  7. Fever.
  8. Some may experience chest pain.

What are the causes of constrictive pericarditis?

When the covering of your heart becomes chronically inflamed, it becomes stiff. As a result, your heart can not stretch as much as it should when it beats.

This can prevent the heart chambers from filling with the correct amount of blood. This is what leads to the symptoms of heart failure.

The cause of constrictive pericarditis is not always known. However, possible causes may include:

  • Heart surgery.
  • Radiation therapy in the chest.
  • Tuberculosis.
  • Some of the less common causes are:
  • Viral infection.
  • Bacterial infection
  • Mesothelioma, which is an uncommon type of cancer caused by exposure to asbestos.

In some cases, your doctor may not be able to find the cause of the inflammation. There are a lot of treatment options, even if the cause of the condition is never found.

Which are the risk factors?

The following factors increase the risk of developing this condition:

Pericarditis Untreated pericarditis can become chronic.

Autoimmune disorders It has been shown that systemic lupus, rheumatoid arthritis and other immune diseases increase the risk of constrictive pericarditis.

Trauma or injury to the heart. Having had a heart attack or having a heart surgery may increase your risk.

Medicines. Pericarditis is a side effect of some medications.

Gender and age. Constrictive pericarditis is more common in men between the ages of 20 and 50.

How is it diagnosed?

This condition is difficult to diagnose. It can be confused with other heart conditions such as:

Restrictive cardiomyopathy, which occurs when the heart chambers can not fill with blood due to stiffness in the heart.

Cardiac tamponade, which occurs when the fluid between the heart muscle and the pericardium compresses the heart.

A diagnosis of constrictive pericarditis is often made ruling out these other conditions.

Your doctor will ask about your symptoms and perform a physical exam. The following signs are common:

  • Veins in the neck that protrude due to the increase in blood pressure, which is called Kussmaul’s sign.
  • Weak or distant heart sounds.
  • Inflammation of the liver
  • Liquid in the belly area.

Your doctor can order one or more of the following tests:

Image tests. Magnetic resonance imaging, CT scans, and chest X-rays produce detailed images of the heart and pericardium.

A CT scan and an MRI scan can detect thickening of the pericardium and blood clots.

Cardiac catheterization. In cardiac catheterization, your doctor inserts a thin tube into your heart through your groin or arm. The tube collects blood samples, removes tissue for biopsy and takes measurements from inside the heart.

Electrocardiogram. An electrocardiogram measures the electrical impulses of your heart. Irregularities may suggest that you have constrictive pericarditis or another heart condition.

Echocardiogram. An echocardiogram makes an image of your heart using sound waves. It can detect fluid or thickening in the pericardium.

What are the treatment options?

The treatment focuses on improving the function of your heart. In the early stages of pericarditis, the following may be recommended:

  • Take pills to eliminate excess fluids, which are called diuretics.
  • Take analgesics to control pain, which are called analgesics.
  • Decreasing your activity level
  • Decrease the amount of salt in your diet.
  • Take over-the-counter anti-inflammatories, such as Advil or Motrin.
  • Tomar colchicina (Colcrys).
  • Take Corticosteroids

If it is clear that you have constrictive pericarditis and your symptoms have become severe, your doctor may suggest a pericardiectomy.

In this surgery, parts of the healed sac are cut around the heart. This is a complicated surgery that has some risk, but it is often the best option.

What is the long-term perspective?

If left untreated, this condition can be life threatening. You can develop symptoms of heart failure. However, many people with constrictive pericarditis can lead healthy lives if they receive treatment for their condition.

The normal pericardium is a fibro-elastic sac that surrounds the heart and contains a thin layer of fluid.

When larger amounts of fluid accumulate (pericardial effusion) or when the pericardium becomes scarred and inelastic, one of the three pericardial compressive syndromes may occur:

  • Cardiac tamponade – Cardiac tamponade, which can be acute or subacute, is characterized by the accumulation of pericardial fluid under pressure. Variants include low pressure (hidden) and regional tamponade.
  • Effusion-Constrictive Pericarditis – Constrictive pericarditis is characterized by an underlying constrictive physiology with a coexisting pericardial effusion, often with cardiac tamponade. This usually results in a mixed hemodynamic image with both constriction and tamponade characteristics.

It can be mistakenly thought that these patients only have cardiac tamponade; However, the elevation of right atrial pressure and pulmonary pressure after drainage of the pericardial fluid points to the underlying constrictive process.

Both in the typical constrictive pericarditis and effusive-constrictive pericarditis, cardiac filling is prevented by an external force.

The normal pericardium can stretch to accommodate physiological changes in cardiac volume. However, after exceeding its reserve volume, the pericardium hardens markedly.

In severe pericardial compression syndromes, the pericardium becomes virtually inelastic, resulting in a minimal capacity to adapt to changes in volume.