How is constrictive pericarditis treated?

Written by Liu Ying

Cardiology

Updated on September 06, 2024

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We say constrictive pericarditis refers to a disorder of circulatory disturbances caused by the heart being encased in a densely thickened fibrotic or calcified pericardium, which restricts the filling of the ventricles during diastole. Most patients with constrictive pericarditis will progress to chronic constrictive pericarditis.

At this point, the only effective treatment method is pericardiectomy, but the perioperative risk is very high. A small portion of patients have short-term or reversible pericardial constriction, so for patients who are recently diagnosed and have stable conditions, it is possible to try anti-inflammatory treatment for 2-3 months unless complications such as cardiac cachexia, cardiogenic cirrhosis, or myocardial atrophy occur. For tuberculous pericarditis, anti-tuberculosis treatment is recommended to delay the progression of pericardial constriction, and post-surgery, anti-tuberculosis treatment should continue for one year.

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Written by Tang Li

Cardiology

1min 42sec

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What are the symptoms of pericarditis?

Fibrinous pericarditis is primarily characterized by precordial pain, similar to that seen in acute nonspecific pericarditis and infectious pericarditis. Tuberculous or neoplastic pericarditis that develops slowly may not show obvious pain symptoms. The nature of the pain can be sharp and related to respiratory movements. It is often exacerbated by coughing, deep breathing, changing body position, or swallowing. The pain is located in the precordial area and may radiate to the neck, left shoulder, left arm, and left scapula, and can also reach the upper abdomen. The pain can be compressive and located behind the sternum. The most prominent symptom of exudative pericarditis is dyspnea, which may be associated with bronchopulmonary compression and pulmonary congestion. In severe cases of dyspnea, the patient may sit up to breathe, leaning forward, with rapid and shallow breathing and pale complexion. There may be hepatomegaly, as well as compression of the trachea and esophagus causing dry cough, hoarseness, and difficulty swallowing. Rapid pericardial effusion can lead to acute cardiac tamponade, presenting with significant tachycardia and decreased blood pressure. Reduced pulse pressure and increased venous pressure, if the cardiac output significantly drops, can lead to shock. If the fluid accumulates slowly, it could lead to subacute or chronic cardiac tamponade, characterized by systemic venous congestion and distended jugular veins.

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Written by Liu Ying

Cardiology

1min

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Constrictive pericarditis clinical manifestations

Patients with constrictive pericarditis often have a history of pericarditis, pericardial effusion, malignant tumors, and other diseases. Some patients have an insidious onset with no obvious clinical symptoms in the early stages. The main symptoms can include palpitations, exertional dyspnea, decreased exercise tolerance, fatigue, enlarged liver, pleural effusion, abdominal effusion, and edema of the lower limbs. Patients with constrictive pericarditis commonly present with elevated jugular venous pressure, and often have a reduced pulse pressure. Most patients exhibit a negative apical beat during systole, with a commonly faster heart rate. The rhythm can be sinus, atrial, or ventricular, with premature contractions possible, as well as Kussmaul's sign. In the late stages, muscle atrophy, cachexia, and severe edema can occur.

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Written by Liu Ying

Cardiology

1min 8sec

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What are the symptoms of acute pericarditis?

Acute pericarditis is an acute inflammatory disease of the visceral and parietal layers of the pericardium. The most common causes are viral infections and bacterial infections, but autoimmune diseases and uremia can also cause acute pericarditis. Characteristic pain behind the sternum or in the precordial area is common during the fibrinous exudative phase of the inflammation. This pain is associated with respiratory movements and often worsens with coughing, deep breathing, changes in body position, or swallowing. The nature of the pain is very sharp and can radiate to the neck, left shoulder, left arm, or even the upper abdomen. As the condition progresses, symptoms can shift from the fibrinous phase pain to dyspnea during the exudative phase. Some patients may develop significant pericardial effusion, leading to cardiac tamponade, and subsequently exhibit a range of related symptoms, including dyspnea and edema.

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Written by Chen Tian Hua

Cardiology

54sec

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How is acute pericarditis classified?

Acute pericarditis is classified according to the course of the disease, including acute fibrinous pericarditis and acute exudative pericarditis. If classified according to the cause, it can be divided into infectious pericarditis and non-infectious pericarditis. Infectious pericarditis can be caused by viruses, bacteria, tuberculosis, fungi, etc., while non-infectious pericarditis can be seen in tumors, uremia, acute myocardial infarction, aortic dissection, connective tissue disease, trauma, and cardiac surgery, etc. Acute pericarditis is an acute inflammatory disease of the pericardium's parietal layer, and its occurrence requires timely diagnosis. It is also important to further clarify the specific cause of acute pericarditis and actively treat it.

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Written by Liu Ying

Cardiology

1min 10sec

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How is constrictive pericarditis treated?

We say constrictive pericarditis refers to a disorder of circulatory disturbances caused by the heart being encased in a densely thickened fibrotic or calcified pericardium, which restricts the filling of the ventricles during diastole. Most patients with constrictive pericarditis will progress to chronic constrictive pericarditis. At this point, the only effective treatment method is pericardiectomy, but the perioperative risk is very high. A small portion of patients have short-term or reversible pericardial constriction, so for patients who are recently diagnosed and have stable conditions, it is possible to try anti-inflammatory treatment for 2-3 months unless complications such as cardiac cachexia, cardiogenic cirrhosis, or myocardial atrophy occur. For tuberculous pericarditis, anti-tuberculosis treatment is recommended to delay the progression of pericardial constriction, and post-surgery, anti-tuberculosis treatment should continue for one year.