Constricting pericarditis, although rare, is very dangerous to your he alth. What are the causes and symptoms of constrictive pericarditis? What is the diagnosis and treatment of this disease? Why can it be very dangerous?
Constrictive pericarditis(Latinpericarditis constrictiva , ang. Constrictive pericarditis) is a complication of chronic pericarditis. It is rare, it develops slowly and its symptoms are not very characteristic. Constricting pericarditis has many causes, especially infectious, but also occurs as a complication of treatment of other diseases, such as radiotherapy. The danger of the disease is developing heart failure, the symptoms of which dominate the disease picture, and if heart failure progresses rapidly it can be life-threatening. Diagnosis is most often made on the basis of imaging tests. The mainstay of treatment is to tackle the cause of constrictive pericarditis, and if that is not possible or the treatment is exhausted, an alternative is cardiac surgery.
Constricting pericarditis - causes
The heart is surrounded by a pericardium, or rather a pericardial sac, which has two layers (plaques) - one is attached to the heart muscle and is called the serous pericardium, the other, i.e. the fibrous pericardium, surrounds it from the outside - this in turn is adherent to the diaphragm and indirectly to the sternum. There is a very narrow space between these layers, or the pericardial cavity, filled with a small amount of fluid (less than 30 milliliters). A sudden, large increase in the amount of fluid can lead to cardiac tamponade, and a small amount is necessary for the heart to work properly as it slips during contractions. In addition, the pericardium protects the heart and prevents excessive stretching of the muscle in diastole.
Inflammation of the pericardium is a process that takes place in the laminae of the pericardium. It usually causes an increased production and accumulation of an excessive amount of fluid in the pericardial cavity, and the causes of inflammation may include:
Depending on the duration of the disease, there are acute, recurrent and chronic pericarditis - lasting more than 3 months.
- viral infections orbacterial
- autoimmune diseases, e.g. systemic lupus erythematosus, rheumatoid arthritis, systemic scleroderma
- cancer
- metabolic diseases, e.g. uremia in the course of renal failure
- drugs
- amyloidosis
Constricting pericarditis most often occurs as a result of chronic pericarditis - it is much more common after viral, bacterial and tuberculous inflammation. In addition, they have a negative prognosis:
- high temperature at the onset of illness
- large volume of fluid in the pericardial cavity
- poor treatment response
Less frequentcauses of constrictive pericarditisis radiotherapy or cardiac surgery.
Constricting pericarditis - the mechanism of formation
Symptoms of constrictive pericarditisoccur when the heart is prevented from relaxing freely. Mechanisms vary depending on the cause of constrictive pericarditis. For example, cardiac surgery leads to the formation of adhesions. On the other hand, a chronic inflammatory process related to infection or radiotherapy causes thickening of the pericardium and an increase in the amount of fibrous connective tissue in the pericardial plaques, which is very inflexible and almost impossible to stretch. In a very similar way, this condition causes the deposition of calcium in the pericardial plaques in the course of, for example, tuberculosis. All of these conditions lead to a reduction in the size of the pericardium and the inability to stretch the pericardial sac, preventing the heart from enlarging during diastole. Constrictive pericarditis reduces the amount of blood flowing to the heart. The result of this is not only a reduction in the volume of blood ejected, but also blood stagnation in the veins, i.e. the development of heart failure.
Constricting pericarditis: symptoms
Constrictive pericarditis develops slowly and it is impossible to predict who it will affect. Symptoms appear on average 2 years after the action of the factor that causes the disease. However, in some cases they may appear much later. Symptoms of constrictive pericarditis are non-specific. The most common diagnosis is heart failure, especially the right ventricle, which has a thinner wall, is more susceptible to deformation and does not work as efficiently anymore. The left ventricle is "stronger", so its work will be disturbed when the disease gets worse.
Patients may complain about:
- swelling on legs
- stomach pains
- frequentnighttime urination, or other symptoms of heart failure
During the examination, the doctor may find widening of the jugular veins, fluid in the abdomen, and enlarged liver. When it comes to left ventricular failure associated with a low amount of blood pumped, the most common symptoms are:
- fatigue
- weakness
- shortness of breath
and in the medical examination of the so-called paradoxical heart rate, quiet heart tones, or low blood pressure. Other symptoms that may occur, not related to heart failure, are chest pain, a feeling of uneven heartbeat, and abnormal heart rhythm.
Constricting pericarditis - diagnosis
The most important diagnostic tool is imaging, while the main goal of diagnosis should be to understand the cause of constrictive pericarditis. First, echocardiography is performed - this test allows you to check whether there is fluid in the pericardial cavity, as well as to diagnose many other pathologies, e.g. valve defects, as well as to assess the degree of heart failure.
Other diagnostic tools are: equally often used chest X-ray and computed tomography, which allow to visualize calcifications, and tomography additionally objectively assess the thickness of the pericardium and distinguish between calcifications and adhesions. The condition, however, is to conduct a test with a new generation apparatus. Unfortunately, tomography is less useful if the disease does not have pericardial calcification.
The ECG test is also useful, as it allows you to identify arrhythmias, changes in the T wave, or low voltage of the QRS complex. Magnetic resonance imaging and cardiac catheterization are performed less frequently. The latter is usually needed to evaluate the function of the right ventricle - the one whose work is most often impaired in the course of the disease. Catheterization allows to measure pressures in the right atrium and right ventricle and on this basis to identify right ventricular diastolic abnormalities. If the left ventricle is disrupted, the pressure in the pulmonary artery and the wedge pressure are increased. Exceptionally, cardiac biopsy (during the differentiation from restrictive cardiomyopathy) and coronary angiography are performed, which are performed before surgery in order to exclude coronary artery disease.
Constricting pericarditis - treatment
The most important thing in treating constrictive pericarditis is restoring normal heart function, that is, proper blood flow to the right ventricle and enough blood pumped out of the heart.
Drug treatment can be used to reduce the amount of fluid in the bodypericardium, a decrease in the speed of the heartbeat. Drugs such as glucocorticosteroids, non-steroidal anti-inflammatory drugs and possibly colchicine are used.
If it is possible, causal treatment is used, e.g. tuberculosis is treated in tuberculosis. When causal treatment cannot be used, the only permanently effective therapy is pericardiectomy, i.e. complete removal of the altered pericardial sac. This treatment is reserved for people with an advanced stage of irreversible pericarditis and brings an 80% improvement. sick. On the other hand, the results of cardiac catheterization (i.e. pressures in the right ventricle and right atrium) improve in 60%. sick. The recovery time after surgery varies and depends on the extent of the surgery, the severity of the disease and the load on other systems. Relapses are rare, but if they do occur, the cause is considered to be the failure to remove the entire pericardial sac. Cured people should remain under the care of a cardiologist and have regular examinations, e.g. echocardiographic examination.