What’s constrictive pericarditis?

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Constrictive pericarditis is a chronic condition that negatively affects the physiology of the heart muscle. Treatment for this severe presentation of pericarditis depends entirely on the symptoms and may require hospitalization and surgical removal of the affected pericardium, or sac that surrounds the heart muscle. Complications associated with constrictive pericarditis can include permanent damage and impaired function of the heart muscle.

Pericarditis is an inflammatory condition that affects the thin sac that surrounds the heart muscle, known as the pericardium. Constrictive pericarditis is characterized by chronic inflammation that causes the membranous sac of the heart to stiffen and thicken. As the tone and flexibility of the heart muscle is reduced by scarring, its ability to function properly is also impaired and eventually lost. Blood is not pumped enough through the heart muscle, and as a result of impaired function, it begins to accumulate with fluid around the heart.

There are several situations and conditions that can contribute to the development of constrictive pericarditis. Individuals who have sustained a chest injury are thought to have a greater chance of developing chronic inflammation. The presence of some autoimmune disorders, such as lupus, can also cause some individuals to become symptomatic. Those who have suffered a heart attack, especially multiple attacks, are also considered to be more susceptible to developing this form of pericarditis.

A diagnosis of constrictive pericarditis is usually made after a physical exam and battery of diagnostic tests. Imaging tests, including a chest X-ray and an echocardiogram, may be done to evaluate the physical presentation of the heart and any fluid accumulation. A cardiac catheterization may also be done to evaluate the heart’s ability to flex and function. Additional tests may include blood tests and a cardiac magnetic resonance imaging (MRI) to evaluate pericardial fluid, C-reactive protein levels, and detect any thickening of the pericardium.

Chronic presentations of pericarditis usually present with symptoms lasting more than six months. In addition to shortness of breath, fluid buildup around the heart can induce a variety of signs and symptoms. Some individuals may experience lethargy and weakness, swelling of the extremities, and fever. It is not uncommon for an individual with constrictive pericarditis to also develop pronounced fluid retention and sharp chest pain. The excessive buildup of fluid puts pressure on the heart muscle, further impairing its ability to function.

Treatment for constrictive pericarditis generally involves giving a diuretic drug to flush excess fluids out of the body. Additional medications may also be prescribed to reduce inflammation and restore proper heart rhythm. With medication, most people experience improvement in symptoms. Some presentations of constrictive pericarditis may require a pericardiectomy to remove some or all of the thickened pericardial tissue. Performed under general anesthesia, a pericardiectomy carries the risk of postoperative complications, including infection, excessive bleeding, and incision rupture.

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