Constrictive Pericarditis
Definition
A fibrotic, thickened, and adherent pericardium restricting diastolic filling of the heart
Etiology
- Tuberculosis
- Chronic renal failure
- Systemic lupus erythematosus
- Mediastinal irradiation
- Post-cardiac surgery
- Post-myocardial infarction
- Post-pericardial effusion
Signs and Symptoms
- Dyspnea
- Jugular venous distention
- Hepatomegaly
- Systemic edema
- Ascites
Complications
- Decreased cardiac output
Cardiac Auscultation
- Diastolic pericardial knock
Electrocardiogram
- May be normal
- Atrial fibrillation
Chest X-ray
- Maybe normal
- Calcification of the pericardium may be seen
Cardiac Catheterization
- Simultaneous right and left ventricular pressures where a "dip and Plateau pattern of diastolic pressures is noted
Treatment
- Pericardiectomy (pericardial stripping)
M-Mode
- Pericardial thickening
- Rapid, early, and flat diastolic motion of the posterior wall of the LV
- Paradoxical septal motion
- Abnormal early diastolic ventricular septal motion: abrupt anterior or posterior motion
- Posterior atrial systolic notch of inter-ventricular septum
- Premature opening of the pulmonic valve
- Increased “a” wave depth of the pulmonic valve with inspiration
- Rapid, early, and flat mid-diastolic motion of the posterior aortic root
2-D
- Thickened pericardium
- Normal-sized ventricle with enlarged atria
- Atrial and ventricular septal bulge to left during inspiration("septal bounce")
- "Bound-down" appearance of the lateral walls of the heart best seen in apical four-chamber view)
- Dilated inferior vena cava (1.2 to 2.3 cm) and hepatic veins (normal 0.5 to 1.1 cm) with lack of inspiratory variation (50%)
- Enlarged liver, spleen, ascites
PW and CW Doppler
- Excessive (> 25% inspiratory decrease in the mitral E velocity
- Preserved mitral A velocity, normal E/A ratio
- Mild decrease in mitral deceleration time during inspiration
- Excessive increase in left ventricular isovolumic relaxation time during inspiration.
- Excessive decrease in tricuspid velocity during expiration
- Hepatic venous flow:
- Normal inspiratory increase in systolic and diaslolic forward flows; systolic greater than diastolic
- Normal inspiratory decrease in atrial and systolic reversal
- Marked decrease or reversal of forward diastolic flow in inspiration
- Prominent atrial reversal flow in expiration; systolic flow reversed in expiration (less common)