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Pericarditis - constrictive

Constrictive pericarditis is long-term (chronic) inflammation of the sac-like covering of the heart (the pericardium) with thickening, scarring, and muscle tightening (contracture ).

Related conditions include:

Pericardium

Alternative Names

Constrictive pericarditis

Causes

Most of the time, constrictive pericarditis occurs due to things that cause inflammation to develop around the heart, such as:

Less common causes include:

  • Abnormal fluid buildup in the covering of the heart. This may occur because of infection or as a complication of surgery.
  • Mesothelioma

The condition may also develop without a clear cause.

It is rare in children.

Constrictive pericarditis

Symptoms

When you have constrictive pericarditis, the inflammation causes the covering of the heart to become thick and rigid. This makes it hard for the heart to stretch properly when it beats. As a result, the heart chambers don't fill up with enough blood. Blood backs up behind the heart, causing heart swelling and other symptoms of heart failure.

Symptoms of chronic constrictive pericarditis include:

Exams and Tests

Constrictive pericarditis is very hard to diagnose. Signs and symptoms are similar to other conditions such as restrictive cardiomyopathy and cardiac tamponade . Your doctor will need to rule out these conditions when making a diagnosis.

A physical exam may show that your neck veins stick out. This indicates increased blood pressure in the area. It is called Kussmaul's sign. The doctor may note weak or distant heart sounds when listening to your chest with a stethoscope.

The physical exam may also reveal liver swelling and fluid in the belly area.

The following tests may be ordered:

Treatment

The goal of treatment is to improve heart function. The cause must be identified and treated. Depending on the source of the problem, treatment may include antibiotics, medicines for tuberculosis, or other treatments.

Diuretics ("water pills") are often used in small doses to help the body remove excess fluid. Pain medicines may be needed for discomfort.

Some people may need to cut down on their activity. A low-sodium diet may also be recommended.

If other methods do not control the problem, surgery called a pericardiectomy may be needed. This involves cutting or removing the scarring and part of the sac-like covering of the heart.

Outlook (Prognosis)

Constrictive pericarditis may be life threatening if untreated.

However, surgery to treat the condition has a high rate of complications. For this reason, it is most often done in people who have severe symptoms.

Possible Complications

When to Contact a Medical Professional

Call your health care provider if you have symptoms of constrictive pericarditis.

Prevention

Constrictive pericarditis in some cases is not preventable.

However, conditions that can lead to constrictive pericarditis should be properly treated.

References

Jouriles NJ. Pericardial and Myocardial Disease. In Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Mosby Elsevier; 2013:chap 82.

LeWinter MM, Tischler MD. Pericardial diseases. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap75.

Little WC, Oh JK. Pericardial diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 77.

Updated: 5/13/2014

Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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