How is constrictive pericarditis treated?

Written by Liu Ying
Cardiology
Updated on September 06, 2024
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We say constrictive pericarditis refers to a disorder of circulatory disturbances caused by the heart being encased in a densely thickened fibrotic or calcified pericardium, which restricts the filling of the ventricles during diastole. Most patients with constrictive pericarditis will progress to chronic constrictive pericarditis.

At this point, the only effective treatment method is pericardiectomy, but the perioperative risk is very high. A small portion of patients have short-term or reversible pericardial constriction, so for patients who are recently diagnosed and have stable conditions, it is possible to try anti-inflammatory treatment for 2-3 months unless complications such as cardiac cachexia, cardiogenic cirrhosis, or myocardial atrophy occur. For tuberculous pericarditis, anti-tuberculosis treatment is recommended to delay the progression of pericardial constriction, and post-surgery, anti-tuberculosis treatment should continue for one year.

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Written by Li Hai Wen
Cardiology
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Is pericarditis serious?

Pericarditis refers to a group of diseases mainly characterized by inflammation and effusion of the pericardium. The severity of pericarditis depends on the condition of the disease. Firstly, if the inflammation and effusion of the pericardium are not severe, patients often experience symptoms such as chest tightness or chest pain. In general, this type of pericarditis is not considered severe. Secondly, if the inflammation and effusion of the pericardium are more pronounced, it can lead to pericardial effusion, especially in cases of large amounts of pericardial fluid. At this time, the condition is often quite serious, and it is essential to undergo formal treatment under the guidance of a doctor, including pericardial drainage therapy.

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Written by Liu Ying
Cardiology
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acute pericarditis clinical manifestations

The clinical manifestations of acute pericarditis include symptoms and signs. The symptoms of acute pericarditis are pain behind the sternum and in the precordial region, which often occurs during the fibrinous exudative phase of inflammation. The pain can radiate to the neck, left shoulder, left arm, and even the upper abdomen. The nature of the pain is sharp, related to respiratory movements. As the condition progresses, the pain can disappear and be replaced by difficulty breathing. Some patients may develop significant pericardial effusion leading to cardiac tamponade, resulting in symptoms such as difficulty breathing, edema, and other related symptoms. During acute pericarditis, the most diagnostically valuable sign is the pericardial friction rub, typically located in the precordial area. A typical friction rub can be heard consistent with atrial contraction, ventricular contraction, and ventricular relaxation, known as a triphasic friction rub, and so on.

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Written by Tang Li
Cardiology
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What are the clinical considerations for acute pericarditis?

The treatment and prognosis of acute pericarditis mainly depend on the cause, and are also related to whether it is diagnosed and treated correctly early on. For various types of pericarditis, if constrictive syndrome occurs, pericardiocentesis should be performed immediately to relieve symptoms. In cases like tuberculous pericarditis, if not treated aggressively, it can usually progress to chronic constrictive pericarditis. Acute nonspecific pericarditis and post-cardiac injury syndrome may lead to recurrent attacks of pericarditis after the initial episode, known as recurrent pericarditis, with an incidence rate of about 20%-30%. This is one of the most difficult complications of acute pericarditis to manage. Clinically, it generally presents similar to acute pericarditis, with recurrent attacks months or years after the initial episode, accompanied by severe chest pain. Most patients should be treated again with high doses of non-steroidal anti-inflammatory drugs, slowly tapering over several months until the medication can be stopped. If ineffective, corticosteroid treatment may be administered; in severe cases, intravenous methylprednisolone may be given, and symptoms in most patients may improve within a few days. However, it is important to note that symptoms often reappear during steroid tapering.

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Written by Liu Ying
Cardiology
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Treatment of constrictive pericarditis

Constrictive pericarditis refers to a disease in which the heart is surrounded by a densely thickened fibrotic or calcified pericardium, restricting ventricular diastolic filling and producing a series of circulatory disorders, typically chronic in nature. In China, the most common cause of constrictive pericarditis is tuberculosis. Constrictive pericarditis is a progressive disease, and most patients will develop chronic constrictive pericarditis. At this stage, pericardiectomy is the only effective treatment method. It should be performed early to avoid complications such as cardiac cachexia, severe liver dysfunction, and myocardial atrophy, with surgery usually carried out after controlling the pericardial infection. For tuberculosis patients, anti-tuberculosis treatment should continue for one year after surgery.

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Written by Tang Li
Cardiology
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What are the symptoms of pericarditis?

Fibrinous pericarditis is primarily characterized by precordial pain, similar to that seen in acute nonspecific pericarditis and infectious pericarditis. Tuberculous or neoplastic pericarditis that develops slowly may not show obvious pain symptoms. The nature of the pain can be sharp and related to respiratory movements. It is often exacerbated by coughing, deep breathing, changing body position, or swallowing. The pain is located in the precordial area and may radiate to the neck, left shoulder, left arm, and left scapula, and can also reach the upper abdomen. The pain can be compressive and located behind the sternum. The most prominent symptom of exudative pericarditis is dyspnea, which may be associated with bronchopulmonary compression and pulmonary congestion. In severe cases of dyspnea, the patient may sit up to breathe, leaning forward, with rapid and shallow breathing and pale complexion. There may be hepatomegaly, as well as compression of the trachea and esophagus causing dry cough, hoarseness, and difficulty swallowing. Rapid pericardial effusion can lead to acute cardiac tamponade, presenting with significant tachycardia and decreased blood pressure. Reduced pulse pressure and increased venous pressure, if the cardiac output significantly drops, can lead to shock. If the fluid accumulates slowly, it could lead to subacute or chronic cardiac tamponade, characterized by systemic venous congestion and distended jugular veins.