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Constrictive pericarditis: diagnosis, management and clinical outcomes
1Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Heart (British Cardiac Society)
|November 28, 2017
Summary
Constrictive pericarditis (CP) is diastolic heart failure caused by a stiff pericardium limiting heart filling. Diagnosis requires advanced imaging and hemodynamic assessment, with surgery being the primary treatment for chronic cases.
Area of Science:
- Cardiology
- Cardiac Surgery
- Internal Medicine
Background:
- Constrictive pericarditis (CP) presents as diastolic heart failure, often with preserved ejection fraction.
- It is crucial in the differential diagnosis of unexplained heart failure.
- Risk factors include prior cardiac surgery and radiation, though many cases are idiopathic.
Purpose of the Study:
- To outline the diagnostic challenges and key pathophysiological concepts of constrictive pericarditis.
- To discuss the primary treatment modalities for constrictive pericarditis.
Main Methods:
- Diagnosis relies on meticulous echocardiography, supplemented by cross-sectional cardiac imaging.
- Hemodynamic catheterization is often employed for diagnostic confirmation.
- Cardiac MRI can identify subacute inflammatory CP.
Main Results:
- Key diagnostic criteria are based on dissociation of intrathoracic and intracardiac pressures and enhanced ventricular interaction.
- Complete surgical pericardiectomy is the definitive treatment for chronic constrictive pericarditis.
- A subset of patients with subacute inflammatory CP may benefit from anti-inflammatory treatments.
Conclusions:
- Constrictive pericarditis is a significant cause of diastolic heart failure requiring a high index of suspicion.
- Accurate diagnosis necessitates a combination of advanced imaging and hemodynamic evaluation.
- Treatment strategies vary from surgical intervention for chronic disease to anti-inflammatory approaches for specific subacute cases.
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