What is Constrictive Pericarditis?

Constrictive pericarditis is a chronic condition that adversely affects the physiology of the heart muscle. Treatment for this severe presentation of pericarditis is entirely dependent on one’s symptoms and may necessitate hospitalization and the surgical removal of the affected pericardium, or sac that surrounds the heart muscle. Complications associated with constrictive pericarditis can include permanent damage to and impaired functionality of the heart muscle.

Pericarditis is an inflammatory condition that affects the thin sac that surrounds the heart muscle, known as the pericardium. Constrictive pericarditis is characterized by a chronic inflammation that causes a stiffening and thickening of the heart's membranous sac. As the tone and flexibility of the heart muscle is reduced by scarring, its ability to properly function is likewise impaired and eventually lost. Blood is not sufficiently pumped through the heart muscle and, in the wake of impaired function, begins to accumulate with fluid around the heart.

There are several situations and conditions that may contribute to the development of constrictive pericarditis. Individuals who have sustained a chest injury are considered to have an increased chance for developing chronic inflammation. The presence of certain autoimmune disorders, such as lupus, may also cause certain individuals to become symptomatic. Those who have suffered a heart attack, especially multiple attacks, are also considered to be more susceptible to developing this form of pericarditis.

A diagnosis of constrictive pericarditis is generally made following a physical examination and a battery of diagnostic tests. Imaging tests, including a chest X-ray and echocardiogram, may be performed to evaluate the physical presentation of the heart and any fluid accumulation. A cardiac catheterization may also be performed to assess the heart's ability to flex and function. Additional testing may include blood tests and a cardiac magnetic resonance imaging (MRI) to evaluate the pericardium fluid, C reactive protein levels, and detect any thickening of the pericardium.

Chronic presentations of pericarditis generally present with symptoms that last longer than six months. Aside from shortness of breath, the accumulation of fluid around the heart can induce a variety of signs and symptoms. Some individuals may experience lethargy and weakness, swelling of the extremities, and fever. It is not uncommon for individual with constrictive pericarditis to also develop pronounced fluid retention and sharp chest pain. The excessive accumulation of fluid places pressure on the heart muscle, further impairing its ability to function.

Treatment for constrictive pericarditis generally involves the administration of a diuretic medication to flush one’s body of excess fluids. Additional medications may also be prescribed to reduce inflammation and restore proper heart rhythm. With medication, most individuals experience an improvement in their symptoms. Some presentations of constrictive pericarditis may necessitate a pericardiectomy to remove thickened pericardium tissue, either in part or entirely. Performed under general anesthesia, a pericardiectomy does carry risk for post-operative complications, including infection, excessive bleeding and incision rupture.