Understanding Constrictive Pericarditis

Constrictive pericarditis is a chronic inflammation of the pericardium, the protective sac around the heart. Over time, inflammation can cause scarring and thickening of this membrane, leading to a loss of its natural elasticity. As a result, the pericardium becomes rigid and stiff, hindering the heart's ability to function properly. Although it is relatively uncommon in adults and even rarer in children, untreated constrictive pericarditis can have severe consequences, including symptoms of heart failure, which can be life-threatening. Fortunately, there are effective treatment options available for this condition.

Individuals with constrictive pericarditis may experience a range of symptoms, including:

• Gradually worsening difficulty in breathing
• Chronic fatigue
• Abdominal swelling
• Persistent swelling in the legs and ankles
• General weakness
• Low-grade fever
• Chest discomfort or pain

The inflammation of the pericardium can lead to its rigidity, restricting the heart's ability to properly fill with blood during each beat. Although the exact cause of constrictive pericarditis is often unknown, several potential triggers include:

• Previous heart surgeries
• Radiation treatment to the chest area
• Tuberculosis infection

Less frequently, it can be caused by:

• Viral or bacterial infections
• Mesothelioma, a rare cancer linked to asbestos exposure

In some instances, the underlying cause may remain unidentified, but treatment options are still available.

Certain factors can increase the likelihood of developing constrictive pericarditis, including:

Chronic Pericarditis

Untreated cases of pericarditis can become chronic, potentially leading to constrictive pericarditis.

Autoimmune Diseases

Conditions such as systemic lupus erythematosus and rheumatoid arthritis have been linked to an increased risk.

Heart-Related Trauma

Individuals who have had a heart attack or heart surgeries may face an elevated risk.

Medications

Certain medications can occasionally cause pericarditis as a side effect.

Demographics

The condition is primarily observed in men aged 20 to 50.

Diagnosing constrictive pericarditis can be challenging as it shares symptoms with other cardiac conditions, such as:

• Restrictive cardiomyopathy—affecting the heart's ability to fill with blood
• Cardiac tamponade—caused by fluid accumulation between the heart and pericardium

To arrive at a diagnosis, a healthcare provider will assess symptoms through physical examination and may look for specific indications, such as:

• Prominent neck veins due to elevated blood pressure (Kussmaul’s sign)
• Weak or distant heart sounds
• Liver swelling
• Fluid accumulation in the abdominal cavity

Diagnostic tests may include:

Imaging Tests

Chest MRIs, CT scans, and X-rays can provide detailed images to identify thickening of the pericardium and any blood clots.

Cardiac Catheterization

This procedure allows for direct measurements inside the heart and can include blood sample collection and tissue biopsy.

Electrocardiogram (ECG)

An ECG checks the heart’s electrical signals, identifying any irregularities that may be indicative of constrictive pericarditis.

Echocardiogram

Using sound waves, an echocardiogram creates images of the heart, revealing fluid presence or thickening within the pericardium.

The primary goal of treatment is to enhance heart function. Early-stage constrictive pericarditis may be managed through:

• Diuretics to reduce fluid retention
• Pain-relieving medications (analgesics)
• Activity level reduction
• Limiting dietary salt intake
• Over-the-counter anti-inflammatories like ibuprofen
• Colchicine for inflammation reduction
• Corticosteroids

For more severe cases diagnosed as constrictive pericarditis, a surgical approach known as pericardiectomy may be recommended to remove sections of the thickened pericardium. Although complex, this procedure can significantly improve symptoms and quality of life.

If left untreated, constrictive pericarditis can pose serious threats to life, including heart failure symptoms. However, with appropriate medical intervention, many individuals can achieve a full and healthy life despite the condition.