constrictive pericarditis

introduction

scarring and consequent loss of the normal elasticity of the pericardial sac results in impaired ability of the heart to expand and fill with blood, this is termed constrictive pericarditis and needs to be differentiated from:
- cardiac tamponade which is the restriction of cardiac filling due to increased fluid in the pericardial sac
- restrictive cardiomyopathy
- cirrhosis

a complication of acute "viral" pericarditis affecting ~1.5% of such patients and accounts for almost half of all cases
post-cardiac surgery
post-radiation therapy, especially after Rx of Hodgkin's lymphoma or breast cancer
connective tissue (CT) disorders 3-7% of cases
following bacterial pericarditis including tuberculosis (TB) 3-6% of cases
other causes such as malignancy, trauma, drug-induced, asbestosis, sarcoidosis, uraemic pericarditis

symptoms of congestive cardiac failure
symptoms of low cardiac output such as fatiguability or SOBOE
raised JVP
pulsus paradoxus in 20%
Kussmaul's sign (the lack of an inspiratory decline in JVP) in ~20% but also occurs in severe TI or RVF
ECG is non-specific
- nonspecific ST and T wave changes and tachycardia are common, and low voltage may sometimes be present
CXR
- may demonstrate a ring of calcification around the heart, best seen on lateral or anterior oblique projections
echo is the definitive Ix to confirm diagnosis