Fact-sheet: Constrictive pericarditis
Updated on 07/19/2022 at 6:27 PM
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Definition
Constrictive pericarditis is a type of pericarditis characterized by fibrous or calcified thickening of the pericardium, leading to diastolic dysfunction and potentially right heart failure.
Clinical features
Increased diastolic pressure in all 4 cardiac chambers --> Restrictive physiology --> Symptoms of global heart failure with right-sided predominance: dyspnea, orthopnea, exertional fatigue, hepatomegaly, ascites, jugular venous distension.
Radiography
Pericardial calcifications (visible in 50% of cases)
Ultrasound
Echocardiography:
- Pericardial thickening +/- pericardial effusion
- Exaggerated ventricular interdependence and intrathoracic-intracardiac dissociation
- Exaggerated respirophasic septal shift with characteristic "shudder" sign
CT
Highly sensitive for detecting pericardial calcifications
Pericardial thickening > 4mm (not sufficient alone to establish the diagnosis)
After injection: septal flattening, reflux of contrast into the inferior vena cava and dilated hepatic veins
MRI
Better than CT for differentiating pericardial thickening from pericardial effusion
Cardiac cine-MRI: septal flattening and septal bounce
Differential diagnosis
Pericarditis
Restrictive cardiomyopathy