- Brian D Hoit, MD
Brian D Hoit, MD
- Professor of Medicine and Physiology and Biophysics
- Case Western Reserve University and University Hospitals of Cleveland
- Section Editors
- Martin M LeWinter, MD
Martin M LeWinter, MD
- Section Editor — Myopericardial Disease
- Professor of Medicine and Molecular Physiology and Biophysics
- University of Vermont
- Gabriel S Aldea, MD
Gabriel S Aldea, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington
- Edward Verrier, MD
Edward Verrier, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington School of Medicine
The normal pericardium is a fibroelastic sac surrounding the heart that contains a thin layer of fluid. When larger amounts of fluid accumulate (pericardial effusion) or when the pericardium becomes scarred and inelastic, one of three pericardial compressive syndromes may occur:
●Cardiac tamponade – Cardiac tamponade, which may be acute or subacute, is characterized by the accumulation of pericardial fluid under pressure. Variants include low pressure (occult) and regional tamponade.
●Constrictive pericarditis – Constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. Pericardial constriction is typically chronic, but variants include subacute, transient, and occult constriction.
●Effusive-constrictive pericarditis – Effusive-constrictive pericarditis is characterized by underlying constrictive physiology with a coexisting pericardial effusion, often with cardiac tamponade . This usually results in a mixed hemodynamic picture with features of both constriction and tamponade. Such patients may be mistakenly thought to have only cardiac tamponade; however, elevation of the right atrial and pulmonary wedge pressures after drainage of the pericardial fluid points to the underlying constrictive process.
In both typical constrictive pericarditis and effusive-constrictive pericarditis, cardiac filling is impeded by an external force. The normal pericardium can stretch to accommodate physiologic changes in cardiac volume. However, after its reserve volume is exceeded the pericardium markedly stiffens. In severe pericardial compressive syndromes, the pericardium becomes virtually inelastic, resulting in minimal ability to adapt to volume changes.
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- CLINICAL PRESENTATION
- Physical examination
- Chest radiograph
- Two-dimensional and M-mode
- Doppler echocardiography
- CT scan
- Magnetic resonance imaging
- Hemodynamic evaluation
- Plasma BNP
- DIFFERENTIAL DIAGNOSIS
- Comparison with restrictive cardiomyopathy
- Comparison with cardiac tamponade
- Comparison with chronic liver disease
- TREATMENT AND OUTCOME
- Transient constrictive pericarditis
- Chronic constrictive pericarditis
- OCCULT CONSTRICTIVE PERICARDITIS
- EFFUSIVE CONSTRICTIVE PERICARDITIS
- Incidence and etiology
- Clinical features
- Treatment and course
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS