Home

Loading...

Table of contents

Constrictive pericarditis

Background

Overview

Definition
Constrictive pericarditis is a chronic disease characterized by symptoms of fluid overload, progressive reduction in cardiac output, and congestive HF.
1
2
Pathophysiology
Constrictive pericarditis is caused by fibrous thickening of the pericardium due to idiopathic reasons, prior cardiac surgery, postradiotherapy, postinfection (tuberculosis and non-tuberculous bacterial infection), connective tissue disease, malignancy, uremia, and sarcoidosis.
1
2
Disease course
Chronic fibrous thickening of the pericardium due to various infectious and non-infectious causes result in constrictive pericarditis, which causes clinical manifestations of dyspnea, peripheral edema, chest pain, palpitation, abdominal distension, fever, fatigue, weight loss, jugular venous distension, pulsus paradoxus, hepatosplenomegaly, ascites, Kussmaul's sign, and pericardial shock.
1
2
Prognosis and risk of recurrence
In-hospital mortality associated with constrictive pericarditis is 2.1%.
1
2

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of constrictive pericarditis are prepared by our editorial team based on guidelines from the European Society of Cardiology (ESC 2021) and the European Society of Cardiology (ESC/EACTS 2015). ...
Show more

Diagnostic investigations

Initial evaluation: as per EACTS/ESC 2015 guidelines, evaluate all patients with suspected pericardial disease using auscultation, ECG, TTE, CXR and routine blood tests, including markers of inflammation such as CRP and/or ESR, WBC count with differential, renal function, liver tests, and cardiac biomarkers.
B
Create free account

More topics in this section

  • Transthoracic echocardiography

  • CXR

  • Cardiac MRI/CT

Diagnostic procedures

Diagnostic pericardiocentesis: as per EACTS/ESC 2015 guidelines, perform diagnostic pericardiocentesis with cytological analyses of pericardial fluid to confirm malignant pericardial disease.
B

More topics in this section

  • Cardiac catheterization

Medical management

Empiric antibacterial therapy: as per EACTS/ESC 2015 guidelines, initiate intravenous antibiotic therapy in patients with purulent pericarditis.
B

More topics in this section

  • Empiric anti-inflammatory therapy

  • Empiric anti-tuberculous therapy

Therapeutic procedures

Intrapericardial urokinase: as per EACTS/ESC 2015 guidelines, consider administering intrapericardial urokinase to reduce the risk of constriction in tuberculous effusive pericarditis.
C

Surgical interventions

Indications for pericardiectomy: as per EACTS/ESC 2015 guidelines, refer patients with chronic, permanent constriction for pericardiectomy when clinically appropriate.
B

Specific circumstances

Patients with tuberculous pericarditis: as per EACTS/ESC 2015 guidelines, administer standard antituberculosis drugs for 6 months for the prevention of tuberculous pericardial constriction.
B
Show 3 more

More topics in this section

  • Patients with purulent pericarditis

  • Patients with radiation-induced constrictive pericarditis