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Chronic Constrictive Pericarditis

Chronic Constrictive Pericarditis Syndrome


Presentation

  • We present a case of chronic constrictive pericarditis caused by actinomycetes. The actinomycosis infection was present for 20 years, thereby representing the longest duration reported in the literature, to our knowledge.[ncbi.nlm.nih.gov]
  • We report our experience with a chronic form of presentation in which calcified pericardial haematoma presented as a mass causing chronic constrictive pericarditis symptoms in a patient with no prior history of chest wall injury.[ncbi.nlm.nih.gov]
  • We present a case in which a needle broke off during intravenous injection and embolized to the right heart.[ncbi.nlm.nih.gov]
  • 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]
  • Whereas elevated jugular venous pressure was present in nearly all patients with CP in a large case series, peripheral edema was absent in approximately 25% of patients, particularly early in the disease process, and less than 6% of patients presented[hindawi.com]
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]
Fatigue
  • Case Report The patient is a 52-year-old man who gradually suffered since about 5 years from exertional dyspnea, weakness and lack of energy, fatigue feeling, pleuritic chest pain, distension of abdomen, and peripheral edema.[hindawi.com]
  • 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]
  • 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]
  • 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]
Cape Verde
  • A 21-year-old man born in Cape Verde living in Europe for 4 years and a 24-year-old man born in Guiné Bissau were both admitted due to intense precordial pain and syncope after exertion.[ncbi.nlm.nih.gov]
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]
  • The patients experienced dyspnea with bilateral lower-limb edema and pleural effusion, suggesting right cardiac dysfunction.[ncbi.nlm.nih.gov]
  • 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).(ABSTRACT TRUNCATED AT 250 WORDS).[ncbi.nlm.nih.gov]
  • Interestingly both had fatigability, dyspnea, chest discomfort and palpitations on exertion, as well as progressive involuntary weight loss and decubitus cough.[ncbi.nlm.nih.gov]
Pleural Effusion
  • The patients experienced dyspnea with bilateral lower-limb edema and pleural effusion, suggesting right cardiac dysfunction.[ncbi.nlm.nih.gov]
  • Pleural effusion occurs in 44–50% of patients with CP [ 4 , 20 ]. Tomaselli and coworkers retrospectively analyzed 30 patients who presented with CP and found that 60% (18 patients) had pleural effusion [ 21 ].[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]
  • 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]
  • 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]
  • 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
  • Case Report The patient is a 52-year-old man who gradually suffered since about 5 years from exertional dyspnea, weakness and lack of energy, fatigue feeling, pleuritic chest pain, distension of abdomen, and peripheral edema.[hindawi.com]
  • A history of cardiac surgery, radiation or tuberculosis should heighten clinical suspicion in the presence of edema, abdominal distention and exertional dyspnea.[acc.org]
  • 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]
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).(ABSTRACT TRUNCATED AT 250 WORDS).[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]
  • Get comprehensive coverage of all areas of cardiac surgery , including ischemic, valvular, and congenital heart disease; cardiac tumors; constrictive pericarditis; thoracic aortic surgery; cardiac transplantation; coronary artery disease; aortic valve[books.google.de]
  • disease, congestive heart failure, asthma, immune system dysfunction, and more.Features a new, more user-friendly design and organization to expedite quick access to the answers you need.[books.google.de]
  • ICD-10-CM Codes › I00-I99 Diseases of the circulatory system › I30-I52 Other forms of heart disease › I31- Other diseases of pericardium › Chronic constrictive pericarditis 2016 2017 2018 2019 Billable/Specific Code I31.1 is a billable/specific ICD-10[icd10data.com]
  • In adults, inflammatory heart disease often progresses to symptomatic dilated cardiomyopathy and heart failure.[radcliffecardiology.com]
Chest Pain
  • Patient has a past history of hospitalization one year ago due to chest pain and received coronary angiography, and it was normal.[hindawi.com]
  • Med J Aust 2005; 182 (7): 353. doi: 10.5694/j.1326-5377.2005.tb06736.x Published online: 4 April 2005 A 58-year-old man of British descent presented in 2003 with chest pain, facial flushing and elevated jugular venous pressure but no leg oedema.[mja.com.au]
  • 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]
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]
  • 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]
  • A pericardial knock, which corresponds with the sudden cessation of ventricular filling early in diastole, occurs in approximately half the cases. It is usually heard along the left sternal border and may be mistaken for an S 3 gallop.[emedicine.medscape.com]
  • 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]
  • 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 is a variable finding. If present, it rarely exceeds 10 mm Hg unless a concomitant pericardial effusion with an abnormally elevated pressure exists.[emedicine.medscape.com]
  • 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]
  • Patients may also have Kussmaul’s sign (paradoxical rise in JVP with inspiration), pericardial knock (extra heart sound occurring slightly earlier than an S3), and pulsus paradoxus (exaggerated drop in systemic blood pressure during inspiration). E.[cancertherapyadvisor.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]
  • Gastrointestinal, pulmonary, and other organ system findings Hepatomegaly with prominent hepatic pulsations can be detected in as many as 70% of patients.[emedicine.medscape.com]
Neglect
  • The diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process.[hindawi.com]

Workup

  • 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]
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]
  • Applicable To Concretio cordis Pericardial calcification The following code(s) above I31.1 contain annotation back-references Annotation Back-References In this context, annotation back-references refer to codes that contain: Applicable To annotations[icd10data.com]
Right Pleural Effusion
  • 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]
  • In chest and abdominal CT, right pleural effusion, pericardial thickness and calcification, ascites, and inferior vena cava dilation were seen (Figure 1 ).[hindawi.com]
T Wave Inversion
  • inversion in leads with ST-segment elevation PR-segment depression Q waves during evolution ST-segment elevation in anatomically contiguous leads, with possible reciprocal ST-segment depression Upward convex ST-segment elevation T-wave inversion in leads[aafp.org]
  • 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).(ABSTRACT TRUNCATED AT 250 WORDS).[ncbi.nlm.nih.gov]
Pleural Effusion
  • The patients experienced dyspnea with bilateral lower-limb edema and pleural effusion, suggesting right cardiac dysfunction.[ncbi.nlm.nih.gov]
  • Pleural effusion occurs in 44–50% of patients with CP [ 4 , 20 ]. Tomaselli and coworkers retrospectively analyzed 30 patients who presented with CP and found that 60% (18 patients) had pleural effusion [ 21 ].[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]
  • 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]
  • 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]

Treatment

  • 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]
  • Abstract The results of operative treatment of 11 patients with chronic constrictive pericarditis with the aid of cardiopulmonary bypass are described.[ncbi.nlm.nih.gov]
  • We consider that our surgical technique is a useful method for treatment of chronic constrictive pericarditis, and advocate the use of the Ultrasonic Scalpel for a safe and easy pericardiectomy.[ncbi.nlm.nih.gov]
  • In the first case, pleural effusion recurred seven months after the pericarditis; bromocriptine was suspected and treatment was discontinued.[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • […] 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]
  • Prognosis is strongly linked to the underlying cause but long-term survival is more likely with surgery and the best results are achieved if surgery is offered early.[patient.info]
  • Treatment and prognosis Constrictive pericarditis is potentially curable by a pericardiectomy. Clinically, it is difficult to differentiate between constrictive pericarditis and restrictive cardiomyopathy .[radiopaedia.org]

Etiology

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

Epidemiology

  • ., The European Study of Epidemiology and Treatment of Cardiac Inflammatory Diseases (ESETCID). First epidemiological results, Herz, 2000;25:279–85.[radcliffecardiology.com]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • 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]
  • Pathophysiology Because of the surrounding rigid pericardium the main pathophysiological feature of constrictive pericarditis is an impaired diastolic filling of the heart.[wikiecho.org]

Prevention

  • Early surgical removal of contaminated intrapericardial foreign bodies remains a safe and effective approach to preventing such complications.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • 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]
  • Constrictive pericarditis in some cases is not preventable. However, conditions that can lead to constrictive pericarditis should be properly treated. Constrictive pericarditis Jouriles NJ. Pericardial and Myocardial Disease.[medlineplus.gov]

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