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Constrictive Pericarditis

  • Normal Heart

Definition

The sac of fibrous tissue that surrounds the heart is called the pericardium. Constrictive pericarditis results from scarring of this lining. The scar encases the heart and may limit its ability to pump blood.

What is going on in the body?

The pericardium is a thin sac that covers the heart. As it heals from an infection or injury, a scar may form. The pericardium becomes rigid due to the scarring. This may restrict the filling of the heart with blood, which leads to other symptoms and complications.

Risks

What are the causes and risks of the condition?

While the cause of this condition is often not known, the scarring may be due to:
  • infections, such as tuberculosis
  • tumors or cancer
  • injury
  • open heart surgery
  • radiation therapy
  • autoimmune disease, which causes a person's immune system to attack his or her own tissue

Prevention

What can be done to prevent the condition?

In most cases, nothing can be done to prevent this condition. Early treatment for some infections, cancers, and autoimmune diseases may help prevent some cases.

Diagnosed

How is the condition diagnosed?

A medical history and physical examination often make the healthcare provider suspect this condition. In some cases, special imaging tests, such as a CT scan, can make the diagnosis.
In other cases, the diagnosis is much more difficult and requires special tests or procedures. Cardiac catheterization involves inserting a thin tube called a catheter into a vein in the groin or neck. This tube is then slipped through the vein into the heart. Special blood pressure measurements, and even a biopsy of the heart muscle can be obtained during catheterization.

Long Term Effects

What are the long-term effects of the condition?

This condition can cause an irregular heartbeat and damage the heart and liver. Its long-term effects depend on how much harm is done to the heart and liver. Often, treatment can reverse most of this damage. Death may occur in severe and unusual cases.

Other Risks

What are the risks to others?

This condition poses no risk to others. If it is due to an infection, such as tuberculosis, that infection might be contagious.

Treatments

What are the treatments for the condition?

Bed rest, salt restriction, and water pills may help relieve many symptoms. Medication may be needed for arrhythmias and to increase the pumping ability of the heart.
Someone with severe symptoms may need to have the pericardium surgically removed.
The underlying cause of this condition also needs to be treated if possible. For example, if the cause is an infection, antibiotics may be needed.

Side Effects

What are the side effects of the treatments?

Surgery can be complicated by infection, bleeding, or an allergic reaction to the anesthetic. Each medication has its own set of possible side effects. Some of the more common are, allergic reactions and stomach upset.

After Treatment

What happens after treatment for the condition?

If necessary, heart medications can be used to help relieve symptoms of congestive heart failure. The liver is assessed for permanent damage. If the underlying heart muscle and liver are normal, surgery often allows people to return to normal activities.

Monitor

How is the condition monitored?

Regular office visits may be needed to adjust medications and perform blood tests. In some cases, an echocardiogram or other imaging test may be done to check the heart. Other monitoring depends on the underlying cause of this condition.

Sources

Merck Manual, 1999

Harrison's Principals of Internal Medicine, 1991

Current Medical Diagnosis and Treatment, 1996

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