Constrictive Pericarditis: Symptoms, Causes, Treatment

What are the symptoms of constrictive pericarditis?

Constrictive pericarditis is a condition where the pericardium (the fibrous sac surrounding the heart) becomes thickened and scarred, leading to a restriction in the heart’s normal movement and function. Symptoms of constrictive pericarditis can vary but often include:

1. Dyspnea (shortness of breath): This is the most common symptom and occurs due to increased pressure in the heart chambers and reduced cardiac output.
2. Fatigue: Reduced cardiac output leads to decreased oxygen delivery to the body’s tissues, causing fatigue and weakness.
3. Swelling (edema): Fluid may accumulate in the legs, abdomen (ascites), or other parts of the body due to increased venous pressure.
4. Chest pain or discomfort: Some patients may experience chest pain, although it is less common than in other forms of pericarditis.
5. Palpitations: An irregular or rapid heartbeat may be present.
6. Kussmaul’s sign: This is an abnormal increase in jugular venous pressure during inspiration, seen due to impaired filling of the right ventricle.
7. Hepatomegaly: Enlargement of the liver due to congestion can occur.
8. Jugular venous distension: Visible bulging of the neck veins due to increased venous pressure.
9. Pericardial knock: A high-pitched sound heard early in diastole during auscultation, caused by the abrupt cessation of ventricular filling.

Symptoms can be progressive and may worsen over time, leading to significant limitations in physical activity and overall health. If constrictive pericarditis is suspected, it is important to seek medical evaluation and treatment.

What are the causes of constrictive pericarditis?

Constrictive pericarditis can result from various causes, many of which involve inflammation or injury to the pericardium. Common causes include:

1. Idiopathic or Viral Pericarditis: Often, the exact cause is unknown, but viral infections can lead to inflammation of the pericardium and subsequent scarring.
2. Tuberculosis: In many parts of the world, tuberculosis is a leading cause of constrictive pericarditis, particularly in areas where the disease is endemic.
3. Post-Surgical or Post-Traumatic Pericarditis: Surgery involving the heart (such as coronary artery bypass grafting or valve replacement) or trauma to the chest can lead to inflammation and scarring of the pericardium.
4. Radiation Therapy: Radiation treatment for cancers in the chest area, such as lymphoma or breast cancer, can cause damage and fibrosis of the pericardium.
5. Connective Tissue Diseases: Autoimmune conditions such as rheumatoid arthritis, systemic lupus erythematosus, and scleroderma can cause inflammation of the pericardium.
6. Uremic Pericarditis: Chronic kidney disease or renal failure can lead to pericarditis and subsequent constriction due to the accumulation of toxins in the blood.
7. Infectious Pericarditis: Infections from bacteria, fungi, or parasites can lead to pericarditis and scarring.
8. Neoplastic Pericarditis: Cancer, either primary pericardial tumors or metastases from other sites, can cause pericarditis and constriction.
9. Post-Pericardiotomy Syndrome: This is an inflammatory reaction that occurs weeks to months after heart surgery or injury.
10. Chronic Inflammatory Conditions: Long-standing inflammation from conditions like sarcoidosis or chronic recurrent pericarditis can lead to pericardial scarring.

In some cases, no identifiable cause can be found, and the condition is classified as idiopathic.

What is the treatment for constrictive pericarditis?

The treatment for constrictive pericarditis aims to alleviate symptoms and improve cardiac function. Depending on the severity and underlying cause, treatment options may include:

1. Medications: Diuretics may be prescribed to reduce fluid retention and alleviate symptoms of congestion. Nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine may be used to manage inflammation in cases where it’s appropriate.
2. Pericardiectomy: This surgical procedure involves removing part or all of the pericardium to relieve constriction and improve cardiac function. Pericardiectomy is considered the definitive treatment for constrictive pericarditis, especially in cases where symptoms are severe and medical therapy alone is inadequate.
3. Pericardiocentesis: In cases of acute exacerbation or tamponade (compression of the heart due to fluid accumulation), a needle may be inserted into the pericardial space to drain excess fluid and relieve pressure on the heart.
4. Pericardial Window: This procedure involves creating a small opening in the pericardium to allow fluid to drain into the surrounding space, preventing fluid accumulation and reducing the risk of tamponade.
5. Management of Underlying Causes: If constrictive pericarditis is secondary to another condition, such as tuberculosis or autoimmune disease, treating the underlying cause may help improve symptoms and prevent recurrence.
6. Supportive Care: Patients may require ongoing monitoring and supportive care to manage symptoms and optimize cardiac function. This may include lifestyle modifications, such as sodium restriction and regular exercise, as well as close follow-up with healthcare providers.

Treatment decisions are typically individualized based on the patient’s specific circumstances, including the underlying cause, severity of symptoms, and overall health status. It’s essential for patients with constrictive pericarditis to work closely with a multidisciplinary healthcare team, including cardiologists and cardiac surgeons, to develop a comprehensive treatment plan tailored to their needs.