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Constrictive pericarditis: old disease, new approaches

Terrence D Welch1, Jae K Oh

  • 1Section of Cardiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA, Terrence.D.Welch@hitchcock.org.

Current Cardiology Reports
|March 2, 2015
PubMed

Insights

Constrictive pericarditis, a cause of heart failure due to stiffening of the pericardium, requires careful diagnosis. Echocardiography and advanced imaging aid in identifying this treatable condition.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Internal Medicine

Background:

  • Constrictive pericarditis is a cardiac filling disorder caused by pericardial inelasticity.
  • It presents as a treatable cause of heart failure, particularly with preserved left ventricular ejection fraction.
  • Diagnosis is challenging, necessitating identification of unique pathophysiological mechanisms.

Purpose of the Study:

  • To highlight the diagnostic challenges of constrictive pericarditis.
  • To emphasize the importance of considering constrictive pericarditis in unexplained right heart failure.
  • To outline diagnostic tools and treatment strategies.

Main Methods:

  • Comprehensive echocardiography with Doppler as the cornerstone diagnostic tool.
  • Cross-sectional imaging and invasive hemodynamic assessment for complex cases.
  • Cardiac MRI for identifying inflammatory constriction amenable to therapy.

Main Results:

  • Constrictive pericarditis is characterized by dissociation of intrathoracic and intracardiac pressures and enhanced ventricular interaction.
  • Echocardiography is crucial, but advanced imaging may be required.
  • Cardiac MRI can differentiate inflammatory from chronic constriction.

Conclusions:

  • Constrictive pericarditis should be considered in patients with unexplained right heart failure.
  • A multi-modal diagnostic approach including echocardiography, advanced imaging, and hemodynamics is often necessary.
  • Surgical pericardiectomy is the definitive treatment for chronic constrictive pericarditis, while anti-inflammatory therapy may benefit inflammatory cases.

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