Constrictive Pericarditis

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Definition

  • A dense fibrous thickening of the pericardium which limits diastolic filling.
  • Intrinsic myocyte function remains normal
  • Normal early myocardial relaxation up to point of constriction
  • Can have dramatic improvement with pericardiectomy.


Etiology

  • Idiopathic
  • Posttraumatic, ie following heart surgery
  • Tumor invasion (lung CA)
  • Chest radiation
  • Infections. Bacterial,tuberculosis, fungual


Echocardiographic assessment

  1. Check for a thickened pericardium
  2. Check for Left Atrial Enlargement Secondary to increased left atrial pressure
  3. Check for abnormal septal motion
  4. Check for dilated IVC and hepatic veins
  5. Check for Tethering of the pericardium
  6. Check Doppler
    1. Mitral and Pulmonary Flow Velocities decrease with inspiration (>25%)
    2. Tricuspid and Hepatic Flow Velocities increase with inspiration
    3. Hepatic venous diastolic flow reversal with expiration (systolic flow > diastolic flow)
    4. Deceleration time < 160 ms and E/A >1
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