Constrictive pericarditis- its causes, symptoms, diagnosis, and treatment

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Cardiac diseases are well known and very common in our society. Millions of people around the world are suffering from a lot of diseases. There are people who are suffering from not so common and rare illnesses that have no effective treatment or cure. Same as that constrictive pericarditis is a rare disease and also not commonly found in children or adults. CP or Constrictive Pericarditis is generally inflammation of the pericardium (layer of the heart). In this condition the pericardium becomes inelastic. It is a long term chronic disease. The part of the heart that is affected by the inflammation causes thickening, scarring, and tightening of that muscle. 

This condition gets worse with time and the heart muscle can be rigid and non-elastic. CP is a serious health issue that has complications like heart failure or even death. But fortunately, there are treatments that give good results. 

Causes of Constrictive Pericarditis

The actual cause of constrictive pericarditis is unknown. But there are possible causes that can make the heart become rigid and chronically thick and non-elastic. Due to rigidity, no appropriate amount of blood is pumping from the heart and it gets near to the failure. The causes can be:

  • Idiopathic
  • Heart surgery 
  • Tuberculosis (TB)
  • Expose to radiation therapy of the chest
  • Infections like viral, bacterial, parasitic, or fungal 
  • Mesothelioma (cancer due to exposure to asbestos) 
  • Post or following myocardial infarction (MI)
  • Post-surgical 

Sometimes it is very difficult for the physician to find the cause of constrictive pericarditis. It is seen in many patients who are diagnosed with constrictive pericarditis that they had acute pericarditis which further transformed into constrictive and fused.

Characteristics of constrictive pericarditis

The characteristics of constrictive pericarditis are no less than some facts that are hard to examine. Constrictive pericarditis usually clears up within months usually three months but when it is repetitive it comes and clears. Sometimes it stocks in the body and starts developing complications and characters that are confusing to diagnose. The pathophysiologic characters of constrictive pericarditis are:

  • Due to rigidity, the heart is unable to stretch.
  • The chambers of the heart do not fill up completely so an inadequate amount of blood is pumped.
  • These conditions make the pericardium fibrotic.
  • This fibrotic nature makes a shell around the heart which is non-compliant and non-elastic. 
  • Due to this shell formation, the blood can not get into the heart properly because it prevents it from expanding. 
  • Due to this, respiration is also affected.

During inspiration:

  • Thoracic pressure decreases
  • There is a reduction in flow on the left side both in the atrium and ventricle

During expiration,

  • It decreases the blood filling on the right side
  • It bulges the intraventricular septum on the right ventricle

Sign and Symptoms of Constrictive Pericarditis

Sometimes sign and symptoms of constrictive pericarditis depend on how long the inflammation stays. When it is a short time, there are mild symptoms or no. When it is repetitive there will be symptoms for a brief time. But when it goes for a long time then symptoms will be severe and for a time period. The sign and symptoms of constrictive pericarditis include:

  • Shortness of breath 
  • Slow and difficult breathing that gets worse with time. 
  • Abdominal pain
  • Sharp stabbing chest pain
  • Heart palpitations
  • Low fever 
  • Fatigue
  • Anxiety  
  • Weakness
  • Severe and chronic swelling in legs
  • Swelling in abdomen 
  • Edema in ankles 
  • Pain gets worse when the patient coughs or swallows 
  • Pain in neck, shoulder, back, and left arm.
  • Dry cough 

When constrictive pericarditis is high at risk?

There are certain factors in which the reversing or developing risk of pericarditis increases. It can be either procedure, other illnesses, or different medicines. This risk can be moderate or high, for this it needs preventions or preventive measures and discusses with the physician which will help in reducing the risk. Constrictive pericarditis is high at risk when the patient has:

  • Viral pericardial infection 
  • After a surgical procedure of the heart 
  • After a heart attack 
  • After a trauma or injury to the heart 
  • Autoimmune disorders like systemic lupus, rheumatoid arthritis, and other autoimmune illnesses
  • Post pericardiotomy syndrome 
  • Radiation therapy 
  • Percutaneous treatment 
  • Cardiac catheterization 
  • Radiofrequency ablation 
  • Water retention 
  • Repetitive pericarditis
  • Pericarditis is sometimes a result of some medications  

Complications of constrictive pericarditis

Constrictive pericarditis should be known early. If it is diagnosed late or left untreated then it can give worse complications like they can have permanent thickening and scarring of the heart with lifetime complications. People will experience episodes of recurring pericarditis for life-long. A condition called Cardiac tamponade also develops when there is too much fluid in the pericardium or is left untreated pericarditis. The most dangerous complication of constrictive pericarditis is heart failure. 

To prevent all these life-threatening complications, early diagnosis, and effective treatment are necessary.

Diagnosis of constrictive pericarditis

The hardest part of this condition is the diagnosis because it gets mixed with multiple cardiac disorders and has similar symptoms like them. The physician will ask multiple questions regarding family and medical history. He will also do a physical exam of listening to heart sounds, check the swelling in the liver, and fluid in the belly area. Then the person will go through some diagnostic procedures including blood tests and imaging tests that are:

  • ECG 
  • Echocardiogram 
  • Chest X-ray
  • CT Scan 
  • Cardiac MRI 
  • Blood tests for the presence of any virus or bacteria.
  • Cardiac catheterization 

Treatment for constrictive pericarditis

Treatment for constrictive pericarditis depends on the cause and severity. Some pericarditis resolves on its own but in severe cases, medications and treatment should go on the way. The treatment options for constrictive pericarditis are:

1. Medications

Medications are the first and most recommended option for pericarditis. Medications are prescribed after the diagnosis of the cause. If the cause is due to some infection viral fungal etc so antibiotics will be preferred otherwise medication for improving the heart functions, reducing inflammation, and water is given to the patients. Pain relievers are also prescribed for relief. Medications used for constrictive pericarditis are:

  • Pain relievers like aspirin, ibuprofen, strength pain reliever. 
  • An anti-inflammatory drug, like colchicine (colcrys, mitigare)
  • Corticosteroids like prednisone. 
  • Analgesics 
  • Diuretics to remove excess fluid
  • Antibiotics, if the underlying cause is a bacterial infection 

Warning: Don’t take any medication without consulting with your doctor.

Surgical procedures

If pericarditis gets severe and worse, hospitalization will be required. Followed by some surgical procedures. The procedure to expel the fluid accumulation are:

  • Pericardiocentesis: drainage and removal of the fluid buildup in the pericardium with the help of the catheter. It may take a few days to fully drain the fluid. This procedure is done in local anesthesia. 
  • Pericardiectomy: removal of some part of the pericardium that becomes rigid or non-elastic

These surgeries have some risks and side effects but they are the best and quick options for treating constrictive pericarditis. 

Before you leave!

This is a rare disease and not so common among children and adults but is found. The information regarding this disease is scant and somehow limited because it is not found common among us. It commonly develops in young adults who went through trauma or surgery but it can be prevented by many lifestyle-changing options that require a good diet. Regular exercising, regular checkup if anybody is suspecting or experiencing relative symptoms. It is better to report early to a cardiac professional for early diagnosis and treatment. As it is more important for any disease before it gets complicated.