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Constrictive pericarditis: clinical and pathophysiologic characteristics.

R B Myers1, D H Spodick

  • 1Sunnybrook Health Science Centre, Division of Cardiology, University of Toronto, Ontario, Canada. robert.myers@sunnybrook.on.ca

American Heart Journal
|July 30, 1999
PubMed
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Constrictive pericarditis, a rare heart disorder, impedes diastolic filling due to pericardial encasement. Diagnosis relies on advanced imaging, and surgical pericardiectomy offers the best outcomes for patients.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Constrictive pericarditis is an uncommon condition with diverse etiologies, including idiopathic, post-cardiac surgery, radiation therapy, and tuberculosis.
  • The disease involves the heart being encased by a rigid pericardium, leading to impaired diastolic filling, ventricular interdependence, and respiratory pressure dissociation.

Purpose of the Study:

  • To summarize the pathophysiology, diagnosis, and management of constrictive pericarditis.
  • To highlight the diagnostic challenges and the role of various imaging modalities.

Main Methods:

  • Review of literature on constrictive pericarditis.
  • Discussion of diagnostic tools including cardiac catheterization, echocardiography, Doppler measurements, and MRI.
  • Emphasis on differentiating constrictive pericarditis from restrictive cardiomyopathy (RCM).

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Main Results:

  • Constrictive pericarditis presents insidiously with systemic venous congestion.
  • Cardiac catheterization, echocardiography, Doppler, and MRI are crucial for diagnosis, often obviating the need for thoracotomy.
  • Medical management provides only temporary symptom relief.

Conclusions:

  • Accurate diagnosis of constrictive pericarditis is achievable with modern imaging techniques.
  • Pericardiectomy is the definitive treatment for constrictive pericarditis, as medical management is insufficient for long-term improvement.