Pericarditis - constrictive

Alternative names

Constrictive pericarditis

Definition

Constrictive pericarditis is a disorder caused by inflammation of the pericardium (the sac-like covering of the heart) with subsequent thickening, scarring, and contracture of the pericardium.

Causes, incidence, and risk factors

Constrictive pericarditis is a chronic form of pericarditis in which the pericardium is rigid, thickened, scarred, and less elastic than normal. The pericardium cannot stretch as the heart beats, which prevents the chambers of the heart from filling.

A direct consequence is a reduced cardiac output (the amount of blood pumped by the heart). The blood backs up behind the heart, resulting in symptoms of heart failure.

The inflamed pericardium may cause pain when it rubs against the heart.

The most common causes of constrictive pericarditis are conditions that induce chronic inflammation of the pericardium: tuberculosis, radiation therapy to the chest, and cardiac surgery.

Less frequently, constrictive pericarditis results from mesothelioma (a tumor) of the pericardium or from incomplete drainage of abnomal fluid accumulating in the pericardial sac, which can occur in purulent pericarditis or in post-surgery hemopericardium (bleeding within the pericardial sac). Constrictive pericarditis may also develop without apparent cause.

The condition is relatively rare in children.

Symptoms

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

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

• chest pain (less than that seen with acute pericarditis)
  o radiating to the neck, shoulder, back, or abdomen
  o described as sharp, stabbing
  o 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