Constrictive pericarditis

Pulsus paradoxus Exaggeration of normal variation in the pulse during respiration—the pulse becomes weaker during inhalation and stronger during exhalation characteristic of constrictive pericarditis or pericardial effusion. 

Severe congestive heart failure and constrictive pericarditis... 

Patients with pericardial tamponade, restrictive cardiomyopathy, constrictive pericarditis, solutions containing dextrose in patients with known allergy to corn or corn products (IV). 

Contraindications Allergy to adhesives (transdermal), closed-angle glaucoma, constrictive pericarditis (IV), early MI (sublingual), GI hypermotility or malabsorption (extended-release), head trauma, hypotension (IV), inadequate cerebral circulation (IV), increased intracranial pressure (ICP), nitrates, orthostatic hypotension, pericardial tamponade (IV), severe anemia, uncorrected hypovolemia (IV)... 

Cardiovascular disease. The hypotensive effects of thiopentone are exaggerated in patients with myocardial dysfunction, fixed cardiac output (valvular stenosis, constrictive pericarditis), and in the hypovolaemic... 

Flypertrophic obstructive cardiomyopathy, Wolff-Parkinson-White (WPW) syndrome, atrioventricular block and constrictive pericarditis. 

Davies D, Andrews MI, Jones JS. 1991. Asbestos induced pericardial effusion and constrictive pericarditis. Thorax 46(6) 429-432. 

Patients with fixed cardiac output, e.g. with aorhc stenosis or constrictive pericarditis, are at special risk from reduced cardiac output with drugs that depress the myocardium and vasomotor centre, for they cannot compensate. Induction with propofol or thiopental is particularly liable to cause hypotension in these patients. Hypoxia is obviously harmful. Skilled technique rather than choice of drugs on pharmacological grounds is the important factor. 

An increase in blood both in the sinusoids and in Disse s spaces culminates in hepatomegaly. This can be witnessed particularly in cases of right heart failure, constrictive pericarditis, veno-occlusive disease and the Budd-Chiari syndrome. Inflammation-related hyper-aemia also occurs in acute viral hepatitis. 

The most frequent cause of posthepatic portal hypertension is right ventricular insufficiency. The central venous pressure is transferred to the hepatic veins and the sinusoids. Constrictive pericarditis leads to a state of pronounced posthepatic portal hypertension with the early development of ascites. Severe tricuspid valve incompetence also culminates in this condition. A membranous obstruction of the inferior vena cava was likewise described in 1968 as a genetically determined cause of posthepatic portal hypertension (S. Yamamoto et al.). Three variants can be distinguished by angiography, depending on the different ways in which the hepatic veins are involved or whether they are affected at all. Thrombosis of the inferior vena cava can develop either from thrombosis of the pelvic veins or independently in the presence of predisposing factors. 

Encephalopathy can be triggered by (7.) degenerative causes (cerebral sclerosis, arterial hypertension, diabetes, etc.), (2.) hypoxaemia (chronic cardiac insufficiency, constrictive pericarditis (2), respira-... 

Arora, A., Seth, S., Acharya, S.K., Sharma, M.R Hepatic coma as a presenting feature of constrictive pericarditis. Amer. J. Gastroenterol. 1993 88 430-432... 

Venous congestion (see chapters 14, 39) Budd-Chiari syndrome Constrictive pericarditis Right-sided heart failure... 

Constrictive pericarditis The clinical picture and hepatic changes of the liver are similar to those of the Budd-Chiari syndrome. Considerable thickening of the liver capsule may resemble sugar icing. The liver is enlarged and firm. Tense ascites is present. Histologically, the changes resemble those of cardiac cirrhosis. 

Cardiovascular diseases Constrictive pericarditis Obstruction of inferior vena cava Pylephlebitis Tricuspid insufficiency Tumour of the right atrium Umbilical vein infection Veno-occlusive disease ... 

Constrictive pericarditis has been reported in a 37-year-old woman with chronic ulcerative colitis who had taken mesalazine 2 g/day for 2 weeks (26). She recovered after radical pericardiectomy. 

Oxentenko AS, Loftus EV, Oh JK, Danielson GK, Mangan TF. Constrictive pericarditis in chronic ulcerative colitis. J Clin Gastroenterol 2002 34(3) 247-51. 

Fibrotic complications can extend to the heart, resnlt-ing in constrictive pericarditis. 

Constrictive pericarditis occurred in two men aged 63 and 69 years treated respectively with bromocriptine 40 mg/day for 4 years and 30 mg/day for 2 years (21). Pericardiectomy was performed in both cases, but bromocriptine was not suspected at that time. In one case the drug was continued until a pleural effusion occurred 7 months later in the other withdrawal of bromocriptine was prompted by an episode of confusion just before pericardiectomy. 

Champagne S, Coste E, Peyriere H, Nigond J, Mania E, Pons M, Hillaire-Buys D, Balmes P, Blayac JP, Davy JM. Chronic constrictive pericarditis induced by long-term bromocriptine therapy report of two cases. Ann Pharmacother 1999 33(10) 1050. ... 

A 76-year-old man taking cabergoline 10 mg/day developed constrictive pericarditis after 11 months (6). He required pericardiectomy, but cabergoline was continued and a few months later he was found to have pleuropulmonary fibrosis, which did not resolve on drug withdrawal. 

Cardiac glycosides are contraindicated in conditions in which there is obstruction to ventricular outflow, for example hypertrophic obstructive cardiomyopathy, constrictive pericarditis, and cardiac tamponade. Acute myocarditis may also increase the risk of toxicity. 

Aortic and mitral valvular fibrosis can lead to congestive cardiac failure fibrosis rarely affects the endocardium more extensively (extending into the myocardium) or the pericardium (resulting in constrictive pericarditis). Vasospastic effects can occasionally be as severe in susceptible subjects as with ergotamine especially dangerous are combinations with ergotamine tartrate, as are combinations of ergot alkaloids with beta-blockers (SEDA-9,128). 

Figure 3.28 A patient with chronic constrictive pericarditis. The T wave is negative in many leads, but not quite deep, without the mirror pattern in the frontal plane. The T wave is only positive in VR and V1 because as this is a diffuse subepicardial ischaemia, they are the only two leads in which the ischaemia vector that is directed away from the ischaemic area is approaching the exploring electrode.

In dilated cardiomyopathy, the cardinal feature is dilatation of the ventricles. Systohc fnnction is abnormal, leading to a decreased cardiac ontpnt. Inpatients with hypertrophic cardiomyopathy (HCM), the ventricnlar cavity is not dilated, and the ventricnlar mnscle mass is increased. Ventricnlar cavity size is normal or decreased, and systolic function often is preserved. Patients with HCM may have an obstructive or nonobstructive form. Patients with restrictive cardiomyopathy have inadequate ventricular comphance causing diastolic dysfunction owing to endocardial and/or myocardial disease. The chnical presentation is similar to that of constrictive pericarditis. 

The diagnosis of restrictive cardiomyopathy should be considered in any patient who presents with signs and symptoms of CHF but has only mild cardiomegaly. Differentiation from constrictive pericarditis is important because pericardectomy is an effective form of treatment for constrictive pericarditis. 

Jager BV, Ransmeier JC. Constrictive pericarditis due to Bacterium tularense Report of a case and review of reported cases of pericarditis occurring with tularemia. Bull Johns Hopkins Hosp. 1943 72 166-178. 

An interesting complication of uremia is the development of so-called uremic pericarditis. In the early stage of pericarditis, urea precipitates at the surface of the pericardium. This precipitation results in the development of a fibrinous exudate, which covers both the parietal and visceral aspects of the pericardium, giving the typical appearance of the bread and butter pericardium. Despite this extensive fibrinous exudate, constrictive pericarditis is a rare complication of uremic pericarditis. 

Lewis BS, Gotsman MS (1973b) Left ventricular function in systole and diastole in constrictive pericarditis. Amer H J 86 23-41... 

Exposure to asbestos occasionally causes benign pericardial effusion, thickening, and calcification (Figs. 8.22 and 8.23) (Davies et al. 1991). These manifestations are analogous to the effects of asbestos on the pleura, and pericardial disease is usually associated with pleural disease. The pericardial thickening may result in constrictive pericarditis with functional cardiac consequences. Both anatomical and functional aspects of pericardial constriction may be demonstrated by magnetic resonance imaging (Al )arad et al. 1993). 

---