Pericarditis - constrictive

Definition

Constrictive pericarditis is long-term (chronic) inflammation of the sac-like covering of the heart (the pericardium) with thickening, scarring, and muscle tightening (contracture).

See also:

• Bacterial pericarditis
• Pericarditis
• Pericarditis after heart attack

Alternative Names

Constrictive pericarditis

Causes, incidence, and risk factors

Constrictive pericarditis is most commonly caused by conditions or events that cause inflammation to develop around the heart, including:

• Heart surgery
• Radiation therapy to the chest
• Tuberculosis

Less common causes include:

• Abnormal fluid buildup in the covering of the heart due to bacterial pericarditis or surgical complications
• Mesothelioma

Constrictive pericarditis may also develop without apparent cause.

The inflammation causes the covering of the heart to become thick and rigid, making it hard for the heart to stretch properly when it beats. As a result, the heart chambers don't fill up with enough blood. Blood backs up behind the heart, causing heart swelling and other symptoms of heart failure.

The condition is relatively rare in children.

Symptoms

Symptoms of chronic constrictive pericarditis include:

• Difficulty breathing (dyspnea) that develops slowly and gets worse
• Fatigue, excessive tiredness
• Long-term swelling (edema) of the legs and ankles
• Swollen abdomen
• Weakness

Signs and tests

Constrictive pericarditis is very difficult to diagnose. Signs and symptoms are similar to restrictive cardiomyopathy and cardiac tamponade. Your doctor will need to rule out these conditions when making a diagnosis.

A physical exam may show that your neck veins stick out, suggesting increased blood pressure in the area. This is called Kussmaul's sign. The doctor may note weak or distant heart sounds when listening to your chest with a stethoscope.

The physical exam may also reveal liver swelling and fluid in the belly area.

The following tests may be ordered:

• Chest MRI
• Chest CT scan
• Chest x-ray
• Coronary angiography or cardiac catheterization
• ECG
• Echocardiogram

Treatment

The goal of treatment is to improve heart function. The cause must be identified and treated. This may include antibiotics, antituberculosis medications, or other treatments.

Diuretics ("water pills") are commonly prescribed in small doses to help the body remove excess fluid. Analgesics may be needed to control pain.

Decreased activity may be recommended for some patients.

A low-sodium diet may also be recommended.

The definitive treatment is a type of surgery called a pericardiectomy. This involves cutting or removing the scarring and part of the sac-like covering of the heart.

Expectations (prognosis)

Constrictive pericarditis may be life threatening if untreated.

However, surgery to treat the condition is associated with a relatively high complication rate and is usually reserved for patients who have severe symptoms.

Complications

• Cardiac tamponade
• Damage to the coronary arteries
• Heart failure
• Pulmonary edema
• Scarring of the heart muscle

Calling your health care provider

Call your health care provider if you have symptoms of constrictive pericarditis.

Prevention

Constrictive pericarditis in some cases is not preventable.

However, conditions that can lead to constrictive pericarditis should be adequately treated.

References

LeWinter MM. Pericardial diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap 70.