Understanding Constrictive Pericarditis: Causes, Symptoms, Diagnosis, Treatment, and Prevention
Constrictive pericarditis occurs when the membrane surrounding the heart thickens, scars, or calcifies. In constrictive pericarditis, the pericardium thickens and stiffens, restricting the heart's ability to expand and fill properly during the cardiac cycle. Common causes include:
Previous pericarditis (pericardial inflammation)
Surgery or trauma to the heart
Chest radiation therapy
Infection with tuberculosis
Chronic kidney disease
Connective tissue disorders
Idiopathic causes (unknown origin)
A constrictive pericarditis may develop gradually and worsen over time. Common symptoms include:
Exertion-induced shortness of breath (dyspnea)
Fatigue and weakness
Ascites and peripheral edema in the legs and abdomen
Chest pain
Heart palpitations (rapid or irregular heartbeat)
Having trouble breathing when lying flat (orthopnea) or during physical activity (exertional dyspnea).
Inflammation of the abdomen caused by fluid accumulation (ascites)
A combination of clinical evaluation, imaging tests, and diagnostic procedures is needed to diagnose constrictive pericarditis:
In order to assess for symptoms of constrictive pericarditis and identify potential underlying causes, a thorough medical history and physical examination must be performed.
A number of imaging tests can be used to assess the structure and function of the heart and pericardium, detect signs of constrictive pericarditis, and assess pericardial thickening or calcification. These include echocardiography (ultrasound), chest X-rays, computed tomography (CT), and magnetic resonance imaging (MRI).
To determine the pressure within the heart chambers and assess for characteristic hemodynamic findings of constrictive pericarditis, invasive procedures such as cardiac catheterization and hemodynamic testing may be performed. Such findings include equalization of diastolic pressures in the cardiac chambers and exaggerated respiratory variation in the ventricular filling pressures.
Constrictive pericarditis is treated to relieve symptoms and improve cardiac function:
If you have pericarditis, you may be prescribed diuretics to reduce fluid retention and relieve symptoms of congestion. Nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine may be used to reduce inflammation.
If constrictive pericarditis is severe and does not respond to medical therapy, pericardiectomy (surgical removal of the thickened or scarred pericardium) may be recommended. It is possible to improve symptoms, restore cardiac function, and provide long-term relief after a pericardiectomy.
To relieve constriction and improve cardiac function without requiring open-heart surgery, pericardial stripping or pericardiotomy can be considered in select cases.
It is crucial to manage underlying conditions and minimize factors that may contribute to pericardial inflammation and fibrosis in order to prevent constrictive pericarditis:
Timely diagnosis and treatment of pericarditis can prevent progression to constrictive pericarditis. Treating underlying infections or inflammatory conditions promptly can reduce the risk of scarring and fibrosis of the heart.
Reduce the risk of constrictive pericarditis by minimizing exposure to chest trauma or radiation therapy.
Chronic conditions such as tuberculosis, chronic kidney disease, and connective tissue disorders can be managed in order to prevent complications such as constrictive pericarditis caused by pericardial inflammation and fibrosis.
A constrictive pericarditis is characterized by thickening, scarring, or calcification of the pericardium, which results in impaired cardiac function and symptoms of heart failure. In order to relieve symptoms, improve cardiac function, and prevent complications associated with constrictive pericarditis, prompt diagnosis, appropriate treatment, and management of underlying conditions are essential. A healthcare provider should be consulted if you experience symptoms of constrictive pericarditis or have concerns about your heart health.
