Chronic constrictive pericarditis ( Pericardial Disease ) ppt
power point presentation
Tuberculous constrictive pericarditis was common cause of constriction pre 1960 – decline in incidence.
Post-radiotherapy constriction features prominently today along with post-surgical causes.
Needs to be differentiated from restrictive cardiomyopathy when making diagnosis.
As for acute pericarditis;
Clinical examination – prime symptoms likely to be RHF and SOB
ECG may not show characteristic ST elevation
CXR may see calcification and helps to rule out coexisting effusion
Echo to identify haemodynamic effects on heart and coexisting effusion
Auscultation may reveal a friction rub
MRI/CT scan – data about the thickness of the pericardium
. Cine CT is a new technique which also gives info about the effects of physiology as well.
Normal subjects – inspiration causes a decrease in chest pressure. Increase in venous return – JVP falls
Constrictive pericarditis – Increased venous return cannot be accommodated in RV because of high EDP
So JVP rises on inspiration
Occasionally calcification noted
More useful to determine whether there is a coexisting effusion (fluid accumulation)
- Normal subjects – increase in TV flow velocity on inspiration, and decrease in MV flow
- Due to increased vascular capacity of lungs venous return and RV output increases while return to LA is reduced
- This is exaggerated in tamponade/sig constriction – RV output can’t increase because of high EDP + pulmonary return is reduced further
- The only effective treatment for chronic constrictive pericarditis is complete surgical resection of the pericardium.
- Mortality for procedure ranges from 5-16%
- Symptomatic improvement in ~90%
- 5 year survival rate is 74-87% depending on co-morbidities pre-op