Constrictive Pericarditis: Understanding the Disease, Symptoms, and Treatment

Introduction

Constrictive pericarditis is a serious condition in which the pericardium (the sac surrounding the heart) becomes thickened and rigid, restricting the heart’s ability to expand properly during filling. This leads to a decrease in cardiac output, causing symptoms like swelling, shortness of breath, and fatigue.

Causes

This condition arises due to scar formation in the pericardium, which can be caused by: - Infections (viral, bacterial, or tuberculosis-related pericarditis) - Previous heart surgery or radiation therapy - Autoimmune diseases (e.g., rheumatoid arthritis, lupus) - Malignancies (cancer affecting the pericardium) - Idiopathic cases (cases with no identifiable cause)

Symptoms

Patients with constrictive pericarditis may experience: - Shortness of breath, particularly when lying down - Swelling of the legs and abdomen - Fatigue and weakness - Jugular vein distension (prominent veins in the neck) - Heart palpitations - Reduced appetite and weight loss

Diagnosis

To confirm the diagnosis, several tests may be required: 1. Echocardiography – Assessing heart function and pericardial thickness 2. Cardiac MRI/CT Scan – Providing detailed images of the pericardium 3. Cardiac Catheterization – Measuring pressures in the heart chambers 4. Blood Tests – Identifying underlying infections or autoimmune conditions

Treatment Options

Treatment depends on the severity of symptoms and may include:

1. Medical Therapy

• Diuretics to reduce fluid buildup
• Anti-inflammatory medication (if inflammation is ongoing)
• Treatment of underlying infections (e.g., TB treatment if tuberculosis is the cause)

2. Surgical Intervention

• Pericardiectomy: Surgical removal of the thickened pericardium is the only definitive treatment for chronic cases.

Prognosis

The prognosis of constrictive pericarditis varies depending on the cause and treatment response. If diagnosed early and managed effectively, surgical outcomes can be favorable, allowing for a near-normal quality of life.

Conclusion

Constrictive pericarditis is a potentially reversible condition if appropriately treated. If you or someone you know has persistent swelling, breathlessness, or unexplained fatigue, it is crucial to consult a cardiologist for early diagnosis and intervention.

Source recommendations

1. European Society of Cardiology (ESC) Guidelines on Pericardial Diseases

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
2. https://academic.oup.com/eurheartj/article/36/42/2921/2293375
3. https://pubmed.ncbi.nlm.nih.gov/26320112/
4. https://www.escardio.org/Working-groups/Working-Group-on-Myocardial-and-Pericardial-Diseases/Publications/Paper-of-the-Month/2015-esc-guidelines-on-the-diagnosis-and-management-of-pericardial-diseases
5. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2015/10/30/12/01/2015-esc-guidelines-for-the-diagnosis-and-management-of-pericardial-diseases

2. American Heart Association (AHA) Guidelines on Pericardial Disease

1. https://www.ahajournals.org/doi/10.1161/circulationaha.105.561514
2. https://www.jacc.org/doi/10.1016/j.jacc.2019.11.021
3. https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis
4. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
5. https://www.sciencedirect.com/science/article/abs/pii/S1936878X24001608

3. American College of Cardiology (ACC) Guidelines for Cardiovascular Disease Management

1. https://www.acc.org/Guidelines
2. https://www.ahajournals.org/doi/10.1161/cir.0000000000000678
3. https://www.acc.org/guidelines/guidelines-search
4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001168
5. https://pubmed.ncbi.nlm.nih.gov/30879355/