Constrictive Pericarditis: Understanding the Most Common Clinical Manifestations

Constrictive pericarditis is a condition in which the heart becomes encased in a thickened, fibrotic, or calcified pericardium, leading to restricted ventricular filling during diastole and resulting in a range of circulatory complications. The most common types of constrictive pericarditis include tuberculous pericarditis, purulent pericarditis, and traumatic pericarditis. Patients often have a history of acute pericarditis, recurrent episodes of pericarditis, or previous pericardial effusion.

Key Symptoms of Constrictive Pericarditis

The primary clinical symptoms associated with constrictive pericarditis include exertional dyspnea, reduced exercise tolerance, fatigue, hepatomegaly, ascites, pleural effusion, and bilateral lower limb edema. These manifestations are primarily due to the impaired ability of the ventricles to expand properly during diastole, which limits cardiac filling and reduces cardiac output.

Cardiac Rhythm Disturbances in Constrictive Pericarditis

To compensate for the reduced cardiac output, the heart rate increases in a compensatory manner. This can lead to various types of arrhythmias, including sinus tachycardia, atrial fibrillation, atrial flutter, atrial premature contractions, and ventricular premature contractions. These rhythm disturbances are common among patients and significantly impact their quality of life.

Treatment Options for Constrictive Pericarditis

The only definitive treatment for constrictive pericarditis is surgical intervention. In cases where the condition is caused by tuberculosis or infection, it is crucial to complete an appropriate course of anti-tuberculosis or antimicrobial therapy before proceeding with surgery. The surgical procedure typically involves pericardiectomy, which is the removal of the thickened pericardium to restore normal cardiac function.

Importance of Timely Diagnosis and Management

Early diagnosis and timely management of constrictive pericarditis are essential to prevent long-term complications and improve patient outcomes. Clinicians should maintain a high index of suspicion, especially in patients with a prior history of pericardial disease. A multidisciplinary approach involving cardiologists, infectious disease specialists, and cardiothoracic surgeons is often necessary to ensure optimal care and successful recovery.