Causes, Symptoms, Treatment & Surgery For Constrictive Pericarditis

Submitted by Nic on May 6, 2013

When the fluid sac surrounding the heart known as the pericardium become inflamed, it leads to constrictive pericarditis. A chronic condition, constrictive pericarditis leads to scar tissue forming on the heart muscle, which, in turn, makes the heart thicker, restricting its movements and disallowing the ventricles to fill with sufficient blood. This affects the way the heart functions. When the heart is squeezed together due to the constrictive process, blood may flow to the abdominal area, lungs, and legs, which leads to swelling. This condition is serious and could be fatal if left untreated.

Causes

Constrictive pericarditis causes could be any of the following:

  • Cancerous pericardial infiltration
  • Chronic renal failure being treated with hemodialysis
  • Idiopathic with causes unknown
  • Fungal and parasitic infections
  • Post-surgery complications
  • Previous radiation therapy
  • Post-viral pericarditis
  • Heart attacks
  • Tuberculosis

Constrictive pericarditis is mostly associated with health conditions that lead to inflammation around the heart like tuberculosis, heart surgery, or radiation therapy to the chest. Other causes which are rare are mesothelioma a rare form of cancer or an uncharacteristic buildup of fluids in the covering of the heart due to complications related to surgery or viral or bacterial infections. There are cases where constrictive pericarditis could develop without any clear reason.

Symptoms

Symptoms of Constrictive pericarditis include

  • Chest pains
  • Breathing difficulty while lying down
  • Anxiety
  • Fatigue
  • Pain in the neck, back or left shoulder
  • Dry cough
  • Inflammation of feet, ankles or legs

Chest pains could affect you more while you swallow your food, cough, take deep breaths, or are lying on your back. Sharp and stabbing pains are also common for people suffering from Constrictive pericarditis due to the pericardium rubbing against the heart. Patients may also find breathing more comfortable when they hold their chest or bend over.

Temporary relief for your chest pain can be achieved by sitting up and bending forward. Constrictive pericarditis can be diagnosed by having a chest X-ray, echocardiography, CT, electrocardiography, or MRI done.

The final diagnosis can be confirmed by cardiac catheterization. If you have any of the symptoms of constrictive pericarditis, call your doctor for medical attention.

Treatment

The main purpose of constrictive pericarditis treatment is to make sure that the heart functions better. Once the cause is identified, it can be treated with either antibiotics to get rid of the bacteria or virus, antituberculosis medications, or other treatment plans depending on the cause. Doctors sometimes may prescribe diuretics and analgesics to help get rid of extra fluids and keep the pain under control. Cutting down on your sodium intake might be suggested, while cutting down on physical activity may be recommended for some patients. One treatment option is to have the pericardium completely resected by means of a pericardiectomy.

Surgery

Constrictive pericarditis surgery is called periadiectomy. Part of or the entire pericardium, the membranous sac that holds the heart in place, is surgically removed. An incision is made in the side of the front of the chest to help remove the pericardium. A radical pericardiectomy requires that the whole pericardium be removed. The procedure is done to make sure that all the thick scar tissue around the heart is removed. There is an alternate option where pericardiectomy is performed with a thorascope. This surgery is also invasive. An incision between the sixth and seventh ribs is made on the side of the chest to insert the video thorascope. Three more incisions are made on the front of the chest between the fifth and sixth rib to help remove the pericardium. Consult with your doctor before going in for surgery and weigh out all the pros and cons before deciding whether the surgery is for you.

References

  • http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002093/
  • http://www.nhlbi.nih.gov/health//dci/Diseases/peri/peri_signs.html
  • http://www.nlm.nih.gov/medlineplus/ency/article/000182.htm
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350120/
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC152831/
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