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Condition in which a rigid pericardium impairs cardiac filling, causing elevation of systemic and pulmonary venous pressures, and decreased cardiac output. Results from healing and scar formation in some pts with previous pericarditis. Viral, tuberculosis (mostly in developing nations), previous cardiac surgery, collagen vascular disorders, uremia, neoplastic, and radiation-associated pericarditis are potential causes.
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Gradual onset of dyspnea, fatigue, pedal edema, abdominal swelling; symptoms of LV failure uncommon.
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Tachycardia, jugular venous distention (with prominent y descent) that increases further on inspiration (Kussmaul sign); hepatomegaly, ascites, peripheral edema are common; sharp diastolic sound, pericardial knock following S2 sometimes present.
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Low limb lead voltage; atrial arrhythmias are common.
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Rim of pericardial calcification is most common in tuberculous pericarditis.
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Thickened pericardium, normal ventricular contraction; abrupt halt in ventricular filling in early diastole. Dilatation of IVC is common. Dramatic effects of respiration are typical: During inspiration the ventricular septum shifts to the left with prominent reduction of blood flow velocity across mitral valve; pattern reverses during expiration.
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More precise than echocardiogram for demonstrating thickened pericardium (present in >80% of pts with constrictive pericarditis).
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Cardiac Catheterization
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Equalization of diastolic pressures in all chambers; ventricular pressure tracings show “dip and plateau” appearance. Differentiate from restrictive cardiomyopathy (Table 116-3).
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TREATMENT: CONSTRICTIVE PERICARDITIS
Surgical stripping of the pericardium. Progressive improvement ensues over several months.
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APPROACH TO THE PATIENT: Asymptomatic Pericardial Effusion of Unknown Cause
If careful history and physical examination do not suggest etiology, the following may lead to diagnosis:
Testing for tuberculosis (Chap. 94)
Serum albumin and urine protein measurement (nephrotic syndrome)
Serum creatinine and BUN (uremia)
Thyroid function tests (myxedema)
Antineutrophil antibodies (SLE and other collagen-vascular disease)
Search for a primary tumor (especially lung and breast)
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For a more detailed discussion, see Braunwald E: Pericardial Disease, Chap. 288, p. 1571, in HPIM-19.