Pericardial mesotheliomas are rare tumors which often present with features of constrictive pericarditis. We present clinical, imaging, histological, and immunohistochemical findings of three cases presenting with chronic constrictive pericarditis. [ncbi.nlm.nih.gov]

• Splenomegaly

  In abdominal sonography, congestive hepatomegaly, mild splenomegaly, ascites, and evidence of portal hypertension were seen. In upper endoscopy, esophageal varices were not seen and viral hepatitis serology was negative. [hindawi.com]

• Ascites

  A serum-ascites albumin gradient ≥1.1 g/dL and an ascites fluid total protein >2.5 g/dL are typical of CP and other postsinusoidal causes of ascites. [hindawi.com]

  On physical examination they had tachycardia, jaundice, cachexia, elevated jugular venous pressure, hepatomegaly and ascites. [ncbi.nlm.nih.gov]

  Cardiac MRI has been shown to be useful in detecting increased pericardial thickness and dilatation of the IVC.[1,2] Ascitic fluid analysis In chronic constrictive pericarditis the serum-ascites albumin gradient ≥1.1 g/dL and an ascites fluid total protein [explainmedicine.com]

  On the other hand, when this entity is considered as a possible underlying cause of relatively symptomless hepatomegaly and ascites and appropriate laboratory studies are carried out the presence of the condition may be demonstrated and optimal results [jamanetwork.com]

• Fatigue

  Symptoms may include shortness of breath, coughing, and fatigue. Echocardiography and sometimes other tests are used to make the diagnosis. The cause, if known, is treated, or salt restriction and diuretics may be used to relieve symptoms. [msdmanuals.com]

   Reduced cardiac output is a consequence of impaired ventricular filling and causes fatigue, muscle wasting, and weight loss.  In “absolute” constriction, contractile function is preserved, although ejection fraction can be reduced because of reduced [slideshare.net]

  Symptoms of chronic constrictive pericarditis include: Difficulty breathing ( dyspnea ) that develops slowly and gets worse Fatigue Long-term swelling ( edema ) of the legs and ankles Swollen abdomen Weakness Constrictive pericarditis is very hard to [medlineplus.gov]

  It can be life threatening, causing the following symptoms: Difficulty breathing Weakness and fatigue Ascites and edema Abdominal pain, nausea, and vomiting Pericarditis Diagnosis Diagnosis of pericarditis begins with your doctor getting your medical [everydayhealth.com]

  The common symptoms of constrictive pericarditis are: Swelling in the legs and abdomen Shortness of breath Nausea and vomiting Fatigue Abdominal pain In a survey of 10 people with a history of acute pericarditis, it was reported that only one person among [news-medical.net]

• Recurrent Pleural Effusion

  pleural effusions and syncope.  Can be mistaken for any cause of right-sided heart failure as well as end-stage primary hepatic disease. 11. [slideshare.net]

• Sepsis

  Generally, poor prognostic markers associated with these detrimental outcomes include progressive heart failure or advanced heart failure symptoms (NYHA III-IV), sepsis, renal failure, respiratory failure, arrhythmia, prior mediastinal radiotherapy as [escardio.org]

• Dyspnea

  We present a patient with unexplained dyspnea, recurrent right-side pleural effusion, and ascites. Analysis of the ascitic fluid revealed a high protein content and an elevated serum-ascites gradient. [hindawi.com]

  A 61-year-old male had complained of cough and dyspnea on effort, with right pleural effusion. Computed tomography demonstrated a calcific pericardium surrounding the entire heart, with thickening of 10 mm. [ncbi.nlm.nih.gov]

• Pleural Effusion

  Bilateral and symmetrical effusions were found in 12 patients, and the remaining 6 had unilateral pleural fluid (3 had right-side effusion and 3 had left-side effusion). Our patient had left side pleural effusion. [hindawi.com]

  The patients experienced dyspnea with bilateral lower-limb edema and pleural effusion, suggesting right cardiac dysfunction. [ncbi.nlm.nih.gov]

  Additionally lung fields also can be observed.[2] Pleural fluid analysis If the patient also has a pleural effusion, aspiration of that fluid can be done. [explainmedicine.com]

• Orthopnea

  […] sich zudem ST-Streckenhebungen, sodass… (More) DOI: 10.1007/s00108-004-1182-y Topics Pericarditis Myocardial Infarction Heart failure Dyspnea Pericardiocentesis Virus Diseases Tachycardia Cardiac Tamponade Chest Pain Shock Pericardial body location Orthopnea [semanticscholar.org]

  Patients typically present with symptoms of both left and right sided heart failure including: dyspnea orthopnea easy fatigability hepatomegaly ascites Characterized by fibrous or calcific constrictive thickening of the pericardium, which prevents normal [radiopaedia.org]

   Elevated pulmonary venous pressures, leading to exertional dyspnea, cough, and orthopnea, may also appear with progressive disease. 10.  Atrial fibrillation and tricuspid regurgitation  In end-stage constrictive pericarditis, the effects of a chronically [slideshare.net]

  Fatigue and orthopnea are common. Lower-extremity edema and abdominal swelling and discomfort are also common. Nausea, vomiting, and right upper quadrant pain, if present, are thought to be due to hepatic congestion, bowel congestion, or both. [emedicine.medscape.com]

  With progression of constrictive pericarditis, symptoms of right-sided heart failure (eg, peripheral edema, nausea, abdominal discomfort, ascites) become apparent and usually precede signs of left-sided failure (eg, exertional dyspnea, orthopnea, paroxysmal [clevelandclinicmeded.com]

• Exertional Dyspnea

   Elevated pulmonary venous pressures, leading to exertional dyspnea, cough, and orthopnea, may also appear with progressive disease. 10.  Atrial fibrillation and tricuspid regurgitation  In end-stage constrictive pericarditis, the effects of a chronically [slideshare.net]

  A history of cardiac surgery, radiation or tuberculosis should heighten clinical suspicion in the presence of edema, abdominal distention and exertional dyspnea. [acc.org]

• Dyspnea at Rest

  Negative predictors of survival were found to be preoperative NYHA class IV (P < 0.01), low-voltage electrocardiogram (ECG) (P < 0.01), ascites (P < 0.01), dyspnea at rest (P < 0.05) and hyperbilirubinemia (P < 0.05). [ncbi.nlm.nih.gov]

• Heart Disease

  METHODS: Preoperative clinical and imaging characteristics were evaluated in 85 consecutive patients with chronic constrictive pericarditis without other valvular or ischemic heart diseases who underwent pericardiectomy. [ncbi.nlm.nih.gov]

  disease; cardiac rhythm disturbances; heart failure and transplantation; disease of the thoracic aorta; tetralogy of Fallot; anesthesia; and postoperative care. [books.google.de]

  Kardiologie und Angiologie HP Kühl, P Hanrath 2004 1 Excerpt Management of effusive and constrictive pericardial heart disease. [semanticscholar.org]

• Chest Pain

  Acute Pericarditis Symptoms Chest pain is the most common symptom of acute pericarditis. [everydayhealth.com]

  This causes chest pain, a common symptom of pericarditis. The chest pain from pericarditis may feel like pain from a heart attack. If you have chest pain, you should call 9-1-1 right away, as you may be having a heart attack. [surgery.ucsf.edu]

  A common symptom of pericarditis is chest pain, caused by the sac’s layers becoming inflamed and possibly rubbing against the heart. It may feel like pain from a heart attack. [heart.org]

  Definition / general Pericarditis is an inflammation of the pericardium characterized by chest pain, pericardial friction rub and serial ECG changes Terminology Idiopathic pericarditis Acute pericarditis Chronic pericarditis Chronic effusive pericarditis [pathologyoutlines.com]

  Patient has a past history of hospitalization one year ago due to chest pain and received coronary angiography, and it was normal. [hindawi.com]

• Pericardial Knock

  The beginning of this anomalous movement was coincident with the pericardial knock in the phonocardiogram and its peak was coincident with the simultaneously recorded deep "y" trough in the jugular pulse tracing. [ncbi.nlm.nih.gov]

  CONSTRICTION RESTRICTION Prominent y descent in venous pressure Present Variable Paradoxical pulse 1/3rd of cases Absent Pericardial knock Present Absent Equal right- and left-sided filling pressures Present Left at least 3-5 mm Hg > right Filling pressures [slideshare.net]

  The first and second heart sounds were normal, with a mildly increased pulmonic sound and a right-sided gallop as well as questionable pericardial knock. [radcliffecardiology.com]

  Corrigan is credited with the pericardial knock in 1842. Kussmaul published his paper on the paradoxical pulse in 1873 [ 11 ]. [patient.info]

  knock. [11] Treatment [ edit ] The definitive treatment for constrictive pericarditis is pericardial stripping, which is a surgical procedure where the entire pericardium is peeled away from the heart. [en.wikipedia.org]

• Pulsus Paradoxus

  This situation, termed “pulsus paradoxus,” is the classic hallmark of cardiac tamponade. [aafp.org]

  paradoxus in the absence of an effusion annulus paraxodus elevated filling pressures with a preserved mitral septal annular velocity ( septal e' ) annulus reversus tissue Doppler of the mitral annuli reveals a septal e' > lateral e' the lateral e' is [radiopaedia.org]

  Pulsus paradoxus, a finding in cardiac tamponade, is uncommon [ 2 ]. A patient with intense venous congestion but no heart enlargement or valvular disease, should lead one to suspect constrictive pericarditis. [patient.info]

  Pulsus paradoxus: definition and relation to the severity of cardiac tamponade. Am Heart J 1988; 115:391–398. Bilchick KC, Wise RA. Paradoxical physical findings described by Kussmaul: pulsus paradoxus and Kussmaul's sign. [clevelandclinicmeded.com]

  Physical examination findings commonly reported in the literature involve elevated jugular venous pressure (being most common), oedema, ascites, pulsus paradoxus, Kussmaul's sign, and pericardial knock [ 1, 3 ]. [cardiothoracicsurgery.biomedcentral.com]

• Hepatojugular Reflux

  Hepatojugular reflux may be observed. Fluid (and hence signs) usually develop slowly with cardiac tamponade developing late as a complication. [patient.info]

  Patients present with findings of right-sided heart failure, including peripheral edema, jugular venous distension, hepatojugular reflux, hepatomegaly, and ascites. [cancertherapyadvisor.com]

• Hepatomegaly

  On physical examination they had tachycardia, jaundice, cachexia, elevated jugular venous pressure, hepatomegaly and ascites. [ncbi.nlm.nih.gov]

  On the other hand, when this entity is considered as a possible underlying cause of relatively symptomless hepatomegaly and ascites and appropriate laboratory studies are carried out the presence of the condition may be demonstrated and optimal results [jamanetwork.com]

  In abdominal sonography, congestive hepatomegaly, mild splenomegaly, ascites, and evidence of portal hypertension were seen. In upper endoscopy, esophageal varices were not seen and viral hepatitis serology was negative. [hindawi.com]

  […] increased pericardial thickness and dilatation of the IVC.[1,2] Ascitic fluid analysis In chronic constrictive pericarditis the serum-ascites albumin gradient ≥1.1 g/dL and an ascites fluid total protein >2.5 g/dL. [1] Abdominal sonography Congestive hepatomegaly [explainmedicine.com]

  The peripheral signs were dominated by the turgidity of the jugular veins (76, 7%) and hepatomegaly (74, 7%). [chu-fes.ma]

• Jaundice

  On physical examination they had tachycardia, jaundice, cachexia, elevated jugular venous pressure, hepatomegaly and ascites. [ncbi.nlm.nih.gov]

  Other signs of hepatic congestion or cardiac cirrhosis include jaundice, spider angiomas, and palmar erythema.  Lower extremity edema. 12.  Inspiratory increase in right atrial pressure (Kussmaul’s sign) 13. [slideshare.net]

  In more advanced stages, the patient may appear ill, with marked muscle wasting, cachexia, or jaundice. Constriction should be considered in the presence of otherwise unexplained jugular venous distention, pleural effusion, hepatomegaly, or ascites. [emedicine.medscape.com]

  In advanced disease the patient may be ill with jaundice, cachexia and muscle wasting. [patient.info]

• Hepatosplenomegaly

  Physical examination revealed peripheral oedema, jugular venous distension, hepatosplenomegaly and ascites in decreasing frequency in our study. [cardiothoracicsurgery.biomedcentral.com]

Cardiac workup revealed chronic constrictive pericarditis; no evidence of coronary or valvular disease was found. She underwent corrective surgery for pericardiectomy. [ncbi.nlm.nih.gov]

Unfortunately, confirming a diagnosis of constrictive pericarditis is challenging and often requires extensive workup. III. Default Management. A. Immediate management. [cancertherapyadvisor.com]

Failure of conventional medical therapy for CHF often follows an extensive diagnostic workup, leading to the final diagnosis of constrictive pericarditis. [emedicine.medscape.com]

• Pericardial Calcification

  Thoraco-abdomino-pelvic CT from both patients revealed chronic liver disease with congestion, pleural effusion, pericardial calcifications, ascites and massive mediastinal and abdominal adenopathies. Blood cultures and IGRA test were negative. [ncbi.nlm.nih.gov]

  The radiological findings include a small or slightly enlarged heart, pericardial calcification, relatively clear lungs fields, diminshed contractions on fluoroscopy and paradoxical response of cardiac silhouette to vals alva manouvere. [pkheartjournal.com]

  Inclusion Term Concretio cordis Pericardial calcification See also ICD 10 code for Related Terms to “Chronic constrictive pericarditis” Calcification pericardium - I31.1 — See also Pericarditis Concato's disease (pericardial polyserositis) - A19.9 nontubercular [icd10coded.com]

  Pericardial calcification is associated with a longer duration of the constrictive process but not with a specific etiology. Therefore, absence of calcification does not exclude constrictive pericarditis. [explainmedicine.com]

  On examination the cardiac tachycardia (25, 5%) and the muffling of heart sounds (32, 5%).Radiography has objectified cardiomegaly (81, 3%) and pericardial calcification in 46, 5% of cases. [chu-fes.ma]

• Hyponatremia

  In-hospital mortality has been associated with advanced age, the duration of symptoms, functional class, presence of atrial fibrillation, left ventricular dysfunction, kidney failure, hyponatremia, hyperbilirubinemia, and elevated right atrium pressure [revespcardiol.org]

  Hyponatremia is seen with fluid overload. Hypoalbuminemia is seen with protein-losing enteropathy from chronic hepatic congestion. BNP is typically only slightly elevated because the constrictive pericardial sac prevents myocardial stretch. [cancertherapyadvisor.com]

• Hypoalbuminemia

  Hypoalbuminemia is seen with protein-losing enteropathy from chronic hepatic congestion. BNP is typically only slightly elevated because the constrictive pericardial sac prevents myocardial stretch. [cancertherapyadvisor.com]

• Base Deficit

  deficit, mean blood sugar, and mean blood lactate levels as compared to the preoperative values The mean (±SD) systemic arterial blood pressure in the postoperative period was 86.5 ± 11.23 mmHg as compared to the preoperative values of 85 ± 12.9 mmHg [annals.in]

• T Wave Inversion

  Upward convex ST-segment elevation May have T-wave inversion in leads with ST-segment elevation No PR-segment depression No Q waves View/Print Figure FIGURE 2. [aafp.org]

  […] lead aVR demonstrates ST segment depression this lead also may demonstrate PR segment elevation diffuse PR segment depression excluding the aforementioned (lead aVR) later, T wave inversions may develop In general, infection is the most common cause [radiopaedia.org]

  Electrocardiogram demonstrated sinus rhythm ( n = 30), low voltage QRS complex ( n = 30), flattening or T-wave inversion ( n = 29), and premature ventricular contraction ( n = 3). [annals.in]

  Ancillary observations regarding the effect of reperfusion on the rapidity and amplitude of T wave inversion after acute myocardial infarction. Circulation 1993; 88:896–904. Khan AH. The postcardiac injury syndromes. Clin Cardiol 1992; 15:67–72. [clevelandclinicmeded.com]

• Low-Voltage Electrocardiogram

  Negative predictors of survival were found to be preoperative NYHA class IV (P < 0.01), low-voltage electrocardiogram (ECG) (P < 0.01), ascites (P < 0.01), dyspnea at rest (P < 0.05) and hyperbilirubinemia (P < 0.05). [ncbi.nlm.nih.gov]

• Pleural Effusion

  Bilateral and symmetrical effusions were found in 12 patients, and the remaining 6 had unilateral pleural fluid (3 had right-side effusion and 3 had left-side effusion). Our patient had left side pleural effusion. [hindawi.com]

  The patients experienced dyspnea with bilateral lower-limb edema and pleural effusion, suggesting right cardiac dysfunction. [ncbi.nlm.nih.gov]

  Additionally lung fields also can be observed.[2] Pleural fluid analysis If the patient also has a pleural effusion, aspiration of that fluid can be done. [explainmedicine.com]

Issues pertaining to management of this rare condition are discussed and a case made for surgical treatment for such patients. [ncbi.nlm.nih.gov]

It is however possible to focus attention on modes and results of treatment end therefrom derive a very important insight Into this disease whose early diagnosis and timely surgical treatment gives excellent results in most cases To reappraise the state [erepository.uonbi.ac.ke]

Surgical treatment of chronic constrictive pericarditis using cardiop-ulmonary bypass. [medical-dictionary.thefreedictionary.com]

Most cases of pericarditis are mild; they clear up on their own or with rest and simple treatment. Other times, more intense treatment is needed to prevent complications. Treatment may include medicines and, less often, procedures or surgery. [surgery.ucsf.edu]

OBJECTIVE: Prognosis after pericardiectomy remains to be clearly elucidated, especially in Asian countries, where the causes of constrictive pericarditis differ from those in Western countries. [ncbi.nlm.nih.gov]

Prognosis and Patient Counseling. Prognosis depends on the stage of disease and underlying comorbidities. If the patient is deemed to be an appropriate surgical candidate, prognosis can be quite good. [cancertherapyadvisor.com]

Prognosis. Abstract The aim of this study was to assess early and late outcomes following treatment of chronic constrictive pericarditis by pericardiectomy. [revespcardiol.org]

Systemic lupus erythematosus (SLE) and scleroderma also may lead to constrictive pericarditis; in the latter case, the prognosis is poor. [emedicine.medscape.com]

[…] drugs (NSAIDs) Pericardiocentesis to treat pericardial effusion / tamponade Antibiotics to treat tuberculosis or other bacterial causes Steroids are not recommended because they increase the risk of recurrent pericarditis Pericardiectomy in rare cases Prognosis [pathologyoutlines.com]

The etiology of this constrictive pericarditis was related to an asbestosis pericarditis involvement. [ncbi.nlm.nih.gov]

Imazio M, Trinchero R, Myopericarditis: Etiology, management, and prognosis, Int J Cardiol, 2008;127:17–26. Cooper LT Jr, Myocarditis, N Engl J Med, 2009;360:1526–38. [radcliffecardiology.com]

Values of P RESULTS The etiology of pericarditis was idiopathic in 15 (48%) patients, tuberculous in 9 (29%), following radiotherapy in 3 (9%), neoplasia in 2 (6%), and following heart surgery in 2 (6%). [revespcardiol.org]

Pathological studies of autopsy and operative material obtained from patients with constrictive pericarditis have shown some variation in the etiology, but in all the series reported, a large percentage of cases have been placed in the group with no specific [nejm.org]

Idiopathic: No identifiable etiology found after routine testing Specific causes: Immunologic conditions including systemic lupus erythematosus (more common among women) or rheumatic fever Myocardial infarction (Dressler syndrome) Trauma to the heart [pathologyoutlines.com]

References Hufnagel G, Pankuweit S, Richter A, et al., The European Study of Epidemiology and Treatment of Cardiac Inflammatory Diseases (ESETCID). First epidemiological results, Herz, 2000;25:279–85. [radcliffecardiology.com]

Epidemiology As with many diseases that once were predominantly infectious in origin, the clinical spectrum of constrictive pericarditis has changed. [emedicine.medscape.com]

Organized by disease, the new edition of this popular guide has been completely revised and updated to reflect the latest information on definition, current pathophysiology, significant pre-, intra-, and postoperative factors of the disease process, anesthetic [books.google.de]

PATHOPHYSIOLOGY The pathophysiologic consequence of pericardial scarring is markedly restricted filling of the heart.[This results in elevation and equilibration of filling pressures in all chambers and the systemic and pulmonary veins. [slideshare.net]

Due to the paucity of knowledge in this field, the authors reviewed and collected existing data to identify the possible pathophysiological aetiology of this finding. [oatext.com]

[ edit ] The pathophysiological characteristics of constrictive pericarditis are due to a thickened, fibrotic pericardium that forms a non-compliant shell around the heart. [en.wikipedia.org]

[…] pericardium characterized by chest pain, pericardial friction rub and serial ECG changes Terminology Idiopathic pericarditis Acute pericarditis Chronic pericarditis Chronic effusive pericarditis and chronic constrictive pericarditis Recurrent pericarditis Pathophysiology [pathologyoutlines.com]

The authors have used a femoro-femoral cardiopulmonary bypass in nine cases of constrictive pericarditis to prevent the complications of the traditional approach. [ncbi.nlm.nih.gov]

The pericardium contains about 50 cc of fluid that lubricates the heart during its normal pumping movements and prevents friction between the heart and the pericardium lining. [my.clevelandclinic.org]

Other times, more intense treatment is needed to prevent complications. Treatment may include medicines and, less often, procedures or surgery. You usually can't prevent acute pericarditis. [surgery.ucsf.edu]

Like most cardiac lesions, the incidence of chronic constrictive pericarditis can be reduced appreciably by preventive measures. Once established however, the only treatment is surgical release of the constriction. [erepository.uonbi.ac.ke]