Pericarditis - constrictive

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

Pericardium

Constrictive pericarditis

Pericarditis - constrictive

Alternative Names:

Constrictive pericarditis
Symptoms:

difficulty breathing (dyspnea) that develops slowly and progressively worsens
fatigue, excessive tiredness
weakness
chronic swelling (edema) of the legs, ankles
swollen abdomen

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Symptoms of acute (but not chronic) pericarditis also include:

chest pain (less than that seen with acute pericarditis)
- radiating to the neck, shoulder, back, or abdomen
- described as sharp, stabbing
- increases with breathing
splinting of ribs with deep breathing (requiring the need to bend over or hold chest when breathing deeply)
most comfortable position is upright (standing or sitting)
fever
sweating
chills
dry cough
anxiety

Signs and tests:

Constrictive pericarditis is notoriously difficult to diagnose and must be distinguished from restrictive cardiomyopathy and cardiac tamponade.

The examination of the neck veins may show that the jugular venous pressure is elevated. Neck veins may be prominent and may not decrease when inhaling (related to increased pressure in the veins). This is called Kussmaul's sign and is caused by lack of transmission of intrathoracic respiratory changes to the pericardial space and heart chambers.

Heart sounds may be weak or distant. There may be signs of hepatic (liver) congestion, such as enlargement of the liver and fluid in the abdomen (ascites). The spleen may be examined by touch. Pericardial thickening, scarring, or calcification (mineral deposits) can be verified by the results of the following tests:

a chest X-ray
an echocardiogram -- may also show abnormal movement of the interventricular septum
transesophageal echocardiography (TEE) with respiration correlates
an echo-Doppler -- shows abnormal diastolic filling pattern (blood cannot return normally to the heart)
a chest MRI
tagged cine MRI
a chest CT scan
a coronary angiography or cardiac catheterization
ECG -- may show changes, atrial fibrillation is often present

Both echo-Dopppler and cardiac catheterization may clearly show that during inhalation, the venous blood flow into the right atrium does not increase as it would normally.