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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
In 50% of cases the cause of constrictive pericarditis is unknown and is presumed to be a consequence of viral pericarditis. The causes of constrictive pericarditis are: Presumed postviralPost-cardiac surgeryPost-mediastinal radiotherapyChronic renal failureConnective-tissue disordersPulmonary asbestosisTB
Pericardium
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Constrictive pericarditis occurs when a normal thin compliant pericardium gets replaced by a thick, calcified, non-compliant pericardium that interferes with ventricular filling. Varying degrees of pericardial thickening and calcification is present in about 80% of these cases. The aetiological basis of constrictive pericarditis has evolved over the past few decades.
Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Restrictive cardiomyopathy causes exertional dyspnea, PND, orthopnea, and peripheral edema. A fixed CO rate causes fatigue because of resistance to ventricular filling. Atrial and ventricular arrhythmias as well as AV block are seen, but angina and fainting are rare. The signs and symptoms closely resemble constrictive pericarditis. During physical examination, the precordium is quiet. There a low-volume yet rapid carotid pulse, with pulmonary crackles. Sometimes there is a murmur due to functional mitral or tricuspid regurgitation.
Advances in multi-modality imaging for constrictive pericarditis and pericardial inflammation: role of imaging-guided therapy
Published in Expert Review of Cardiovascular Therapy, 2023
Tahir S Kafil, Tom Kai Ming Wang, Ankit Agrawal, Muhammad Majid, Alveena B Syed, Erika Hutt, Ben Alencherry, Joshua A Cohen, Sachin Kumar, Agam Bansal, Brian P Griffin, Allan L Klein
Constrictive pericarditis (CP) is a serious morbid condition occurring in 1–2% of the patients with subacute or chronic pericardial inflammation from a variety of etiologies. CP can lead to heart failure, decreased cardiac output, and poor quality of life. In developed countries, common etiologies include post-cardiac surgery, viral or idiopathic [1–3]. In developing countries, common etiologies include infections such as tuberculosis [3]. Any process that causes inflammation in the pericardium can potentially lead to CP. Numerous causes of CP are well established (Table 1). However, more recently, autoimmune etiologies for this condition are being increasingly recognized due to advances in multimodality imaging (Table 2). These include connective tissue disorders, vasculitis, and IgG4 disease [3]. It is important to note that constrictive pericarditis is a clinical diagnosis where the clinical, imaging, and invasive hemodynamic features are assessed together to confirm the diagnosis. Clinically, CP should be considered in any patient with significant heart failure symptoms and relatively preserved ejection fraction, as the symptoms may be due to impaired diastolic filling and diastolic dysfunction from constriction [4]. The individual features of this condition may also be seen in other conditions such as restrictive cardiomyopathy, severe tricuspid regurgitation, or pulmonary disease, so integration of the entire picture is needed [4].
Malignant cardiac tamponade: safety and efficacy of intrapericardial bleomycin instillation
Published in Acta Clinica Belgica, 2022
Loran Defruyt, Emine Özpak, Sofie Gevaert, Marc De Buyzere, Els Vandecasteele, Michel De Pauw, Fiona Tromp
In general, major advances in cancer management have led to the improved survival of cancer patients and even result in the cure of many patients. This means it is worthwhile to closely monitor the occurrence of cardiotoxic events, which require specific and effective treatment. In particular, instillation of sclerosing agents could lead to extensive sclerosis, resulting in constrictive pericarditis with clinical repercussions [7]. However, no preventive measures can be taken. Because of no prophylactic implications, no routine echocardiographic follow-up was foreseen in asymptomatic patients after intrapericardial instillation of bleomycin. Moreover, cumulative 1-year survival was low (37%) in our series, so no data were available concerning the occurrence of constrictive pericarditis in the long term. This issue could be further addressed in studies regarding the use of different instillation agents.
Constrictive pericarditis decades after aortic valve repair
Published in Baylor University Medical Center Proceedings, 2020
Pericarditis can be acute or chronic. Acute pericarditis lasts <6 weeks; common etiologies include medications, postmyocardial infarction, and viral infections. Chronic pericarditis lasts >6 months and can lead to development of constrictive pericarditis. Etiologies of constrictive pericarditis include past cardiac surgeries, viral infections, radiation, trauma, or uremia. Our patient had no recent viral infections and no history of radiation, trauma, or uremia. Signs and symptoms of chronic pericarditis include elevated jugular venous pressure, pulsus paradoxus, and right heart failure symptoms, such as dyspnea, ascites, hepatomegaly, pitting edema, and pleural effusions.3 In patients with constrictive pericarditis, the pericardium becomes fibrotic and thickened. This leads to a decrease in compliance of the atria and ventricles, which decreases the blood return, subsequently causing the signs and symptoms described above. While ventricular interdependence is always present, constrictive pericarditis leads to a marked increase of ventricular interdependence due to the increase in right ventricular pressure, causing a decrease in left ventricular end diastolic volume.4