Pericarditis - constrictive

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Constrictive pericarditis

Pericardium

Pericardium

Constrictive pericarditis

• Difficulty breathing (dyspnea) that develops slowly and progressively worsens
• Fatigue , excessive tiredness
• Weakness
• Chronic swelling (edema) of the legs, ankles
• Swollen abdomen

Symptoms of acute (but not chronic) pericarditis also include:

• Chest pain (less than that seen with acute pericarditis)
  • Radiating to the neck, shoulder, back, or abdomen
  • Described as sharp, stabbing
  • Increases with breathing
• Splinting of ribs with deep breathing (requiring the need to bend over or hold chest when breathing deeply)
• Most comfortable position is upright (standing or sitting)
• Fever
• Sweating
• Chills
• Dry cough
• Anxiety

Constrictive pericarditis is notoriously difficult to diagnose and must be distinguished from restrictive cardiomyopathy and cardiac tamponade.

The examination of the neck veins may show that the jugular venous pressure is elevated. Neck veins may be prominent and may not decrease when inhaling (related to increased pressure in the veins). This is called Kussmaul's sign and is caused by lack of transmission of intrathoracic respiratory changes to the pericardial space and heart chambers.

Heart sounds may be weak or distant. There may be signs of hepatic (liver) congestion, such as enlargement of the liver and fluid in the abdomen ( ascites ). The spleen may be examined by touch. Pericardial thickening, scarring, or calcification (mineral deposits) can be verified by the results of the following tests:

• Chest x-ray
• Echocardiogram -- may also show abnormal movement of the interventricular septum
• Transesophageal echocardiography (TEE) with respiration correlates
• Echo-Doppler -- shows abnormal diastolic filling pattern (blood cannot return normally to the heart)
• Chest MRI
• Tagged cine MRI
• Chest CT scan
• Coronary angiography or cardiac catheterization
• ECG -- may show changes, atrial fibrillation is often present

Both echo-Doppler and cardiac catheterization may clearly show that during inhalation, the venous blood flow into the right atrium does not increase as it would normally.

Review Date: 05/31/2006
Reviewed By: Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY. Review provided by VeriMed Healthcare Network.