Treatment of constrictive pericarditis

Written by Liu Ying
Cardiology
Updated on September 26, 2024
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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 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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How is constrictive pericarditis treated?

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 Liu Yong
Cardiology
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Constrictive pericarditis causes hepatomegaly.

The so-called constrictive pericarditis refers to the presence of fibrotic calcifications and fibrotic hyperplasia in the pericardium, which severely affects the diastolic function of the heart. Once the diastolic function of the heart is compromised, the return flow of venous blood becomes severely obstructed, leading to congestion of the liver. Therefore, once congestion of the liver and spleen occurs, enlargement of the liver can occur, and in severe cases, it can lead to systemic edema, including ascites and similar conditions. Thus, the basic principle behind the enlargement of the liver in constrictive pericarditis is as such. Especially in such cases, patients will experience severe dietary problems, including poor appetite and indigestion, which further lead to low protein levels and malnutrition, exacerbating the enlargement of the liver and edema.

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Written by Han Shun Li
Pulmonology
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What causes constrictive pericarditis?

Constrictive pericarditis refers to the fibrosis or calcification of the pericardium, which restricts the filling of the ventricles during diastole and leads to a series of symptoms. What causes constrictive pericarditis? Generally, constrictive pericarditis is secondary to acute pericarditis. In our country, the most common cause of constrictive pericarditis is tuberculous pericarditis, followed by purulent or traumatic pericarditis. A minority of constrictive pericarditis cases may be associated with tumors of the pericardium, acute nonspecific pericarditis, and radiation-induced pericarditis, among others. Of course, some patients have idiopathic constrictive pericarditis.

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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.