If you have never heard the term constrictive pericarditis it probably sounds ominous. What is constrictive pericarditis? Simply put, it is inflammation of the pericardium, which is a sac-like membrane that surrounds the human heart. Inflammation like this can lead to scarring, thickening, and muscle tightening in the heart area. Eventually, the pericardium loses elasticity and can become rigid. When left untreated, a rigid pericardium can cause heart failure. In other words, it can be life-threatening.
Prevalence of constrictive pericarditis
Constrictive pericarditis is considered relatively rare. Acute pericarditis, a type of pericarditis that usually lasts less than six weeks, is diagnosed in about one out of one thousand hospital admissions. Constrictive pericarditis is about one in ten thousand admissions. While rare in the adult population, it is even less likely to occur in children. People who have had cardiac surgery are more likely to suffer constrictive pericarditis. In the past, studies suggested the average age of someone who gets constrictive pericarditis is 45 years old, but more recent research indicates the median age is 61 years of age. Interestingly, there is also some evidence to suggest that people who are already hospitalized for some other ailment are more likely to suffer from constrictive pericarditis.
What are the causes and risk factors of constrictive pericarditis?
There are a number of different causes of constrictive pericarditis. The bottom line is that when the heart is inflamed and becomes rigid, the heart can’t stretch as much as it should when it beats. This means that the heart chambers might not fill up with the right amount of blood and heart failure will occur.
The following list outlines various constrictive pericarditis causes:
Heart surgery
As mentioned earlier, previous surgery can lead to inflammation of the pericardium. This is due to the invasive nature of opening and manipulating the body, which can induce inflammation.
Radiation therapy to the chest
Used in the treatment of hematologic, breast, and other malignancies. Usually appears 5–10 years following radiation.
Tuberculosis
This is a leading cause of constrictive pericarditis in developing nations.
Neoplasms
An abnormal growth of tissue in the body, such as breast and lung cancers or lymphomas. Although less common, melanoma has also been linked to constrictive pericarditis.
Connective tissue disorders
This includes autoimmune issues, including those linked to conditions like rheumatoid arthritis, lupus, and scleroderma.
Uremia
A condition associated with fluid, hormone, electrolyte, and metabolic abnormalities, which develop along with kidney problems. Constrictive pericarditis seems to be linked to those who have experienced long-term kidney dialysis.
Trauma
Blunt injuries to the chest wall can lead to inflammation and cause constrictive pericarditis.
Myocardial infarction
Constrictive pericarditis has been known to be linked to post-myocardial infarction, especially if the patient has a history of Dressler syndrome, which is a secondary form of pericarditis or has blood in the sac of the heart following thrombolytic therapy (clot-busting).
Drugs
Certain medications can cause constrictive pericarditis, including cyclosporine, warfarin, and heparin.
Idiopathic
In many cases, no reason is found for constrictive pericarditis. Some idiopathic cases may be related to viral pericarditis that was previously undetected or unrecognized.
As you may have guessed, pericarditis can become chronic if it is not treated. Trauma, medications, and autoimmune diseases are all risk factor for constrictive pericarditis but it is also important to know that gender and age play a role in this condition. The latest research suggests that constrictive pericarditis is more common in men who are between the ages of 20 and 50.
Symptoms and complications of constrictive pericarditis
Some constrictive pericarditis symptoms can mimic other heart problems, but there are some distinct signs that this condition could be rearing its ugly head. For example, although symptoms of constrictive pericarditis involve chest pain, with pericarditis, sitting up and leaning or bending forward often relieves the pain. Here we look at the many different constrictive pericarditis symptoms.
- Chest pain: Almost always present, but sharp or stabbing pain can also be felt in the neck, shoulder, back, or abdomen. Pain increases with deep breathing, coughing or even swallowing.
- Fever and chills or sweating: Can happen if cause is an infection,
- Breathing difficulty: Often develops slowly but becomes worse,
- Fatigue
- Swelling: In abdomen, feet, and legs
- Dry cough
Along with the condition, there can be further complications. Some patients have the following signs:
- Right-sided heart failure: Can include peripheral edema, which essentially means fluid build-up that leads to swelling.
- Jugular venous distension: This is a visible bulging of the jugular vein in the neck.
- Hepatojugular reflux: when the jugular vein distends as pressure is being applied to the liver.
- Hepatomegaly: Abnormal enlargement of the liver
- Ascites: Abnormal accumulation of fluid in the abdominal cavity
How to diagnose constrictive pericarditis
A constrictive pericarditis diagnosis is usually made after other conditions have been ruled out. During the examination, a doctor may recommend a chest MRI, a CT scan, or X-rays of the heart and pericardium. Both the MRI and the CT scan detect thickening in the pericardium. Blood clots may also show up.
Cardiac catheterization is another tool that could be used. In this case, a thin tube is inserted into the heart through either the groin or the arm. The tube is able to collect blood samples, remove tissue for biopsy and take measurements inside the heart. Electrocardiograms are done to measure the heart’s electrical pulses. An irregularity could suggest constrictive pericarditis or some other heart issue. Electrocardiograms should not be mixed up with an echocardiogram. An echocardiogram takes a picture of the heart using sound waves. It can detect fluid or thickening so it too can be used in the diagnosis of constrictive pericarditis.
Treatment of constrictive pericarditis
Treatment of constrictive pericarditis usually focuses on improving the function of the heart. It is also normal practice for constrictive pericarditis treatment to be adjusted a number of times during recovery. In the early stages, taking diuretics can be a common approach. These are commonly called water pills as they remove excess fluids. Analgesics, which are painkillers, are also prescribed as treatment for constrictive pericarditis.
When symptoms of constrictive pericarditis are severe, surgery may be needed. During a pericardiectomy, parts of the scarred sac are cut away from around the heart. This can be a complicated surgery so it is only considered when other options are ruled out.
Here are some other treatment approaches:
- Decreasing physical activity level
- Decreasing amount of salt in diet
- Taking anti-inflammatories
- Taking corticosteroids
- Taking colchicine (gout medication)
Prevention of constrictive pericarditis
Although constrictive pericarditis can develop for no apparent reason, the best way to prevent the condition is to make sure that any conditions that put you at a higher risk for getting it are well managed. For example, if you have a connective tissue disorder, liver issues, or recently went through heart surgery, it is important to maintain a healthy lifestyle, which includes following any instructions your doctor gives you and getting regular check-ups. Post heart surgery check-ups can be particularly important since you want to make sure that any manipulation of the heart has not caused further inflammation.
Prognosis of constrictive pericarditis
Thankfully, constrictive pericarditis is rare and it is a potentially curable disease when diagnosed early. If it is not treated early, it can be fatal. One study suggests that survival rates are 71 percent and 52 percent at 5 and 10 years. Long-term survival really depends on the underlying cause. The best prognosis is with idiopathic constrictive pericarditis, followed by cardiac surgery, which is 66 percent at seven years. The worst prognosis is linked to post-radiation constrictive pericarditis. It has a 27 percent survival rate at seven years.
It should be pointed out that when it comes to surgery, although the statistics are favorable, data does tell us that the long-term outcome for patients is not as positive with advanced age. Poor liver function has also been associated with a less favorable outcome.
Although constrictive pericarditis is rare, it still gets a lot of interest in the medical community. This is due to the fact that the success rate associated with modern treatment has been positive. This opens minds to the possibility of being able to make the prognosis even better in the coming years. While recent studies indicate surgery alleviates or improves symptoms, the emphasis is not on how to improve outcomes for those who suffer from radiation-induced constrictive pericarditis and other forms of the condition.
Related: Resting heart rate chart: Factors that influence heart rate in elderly