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Constrictive Pericarditis

by | 20 May, 2020

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Introduction

Constrictive pericarditis is characterised by a thickened, fibrotic and calcified pericardium. This limits ventricular filling and may result in heart failure. These changes are chronic and symptoms do not appear for a relatively long time.

Causes

Clinical features

Symptoms

  • Fatigue
  • Dyspnoea
  • Peripheral oedema

Signs

Investigations

  • ECG: low voltage QRS complexes, generalised T wave inversion
  • Chest x-ray: small heart in the context of heart failure, pericardial calcification
  • Echocardiography: thickened, calcified pericardium with normally contracting ventricles (unlike restrictive cardiomyopathy)
  • Endomyocardial biopsy: can distinguish it from restrictive cardiomyopathy

Management

Surgical excision of the pericardium (pericardiectomy).

Prognosis

Overall, prognosis is poor.

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