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Pericardium: constrictive disease
Synonym(s): Constrictive pericarditis, constrictive-effusive pericarditis
Introduction
- Uncommon.
- Cause: usually a complication of long-standing pericardial effusion or repeated pericardiocentesis; occasionally no previous history.
- Signs: right-sided heart failure, exercise intolerance, syncope.
- Diagnosis: difficult if little/no associated pericardial effusion or history of previous pericardial disease.
- Treatment: medical usually ineffective, surgical treatment high risk and variable results.
- Prognosis: guarded.
Presenting signs
- Previous pericardial disease Pericardial disease may be reported.
- Insidious onset of exercise intolerance and right-sided heart failure.
Age predisposition
- Any age (but usually middle-aged or older).
Breed/Species predisposition
- Large breeds predisposed to pericardial effusion.
Cost considerations
- Variable - diagnostic investigation is more complicated than routine cardiac examination; surgical intervention can be expensive.
Special risks
- Congestive heart failure Heart: congestive heart failure.
Pathogenesis
Etiology
- May be idiopathic.
- May be due to long-standing pericardial effusion Pericardial disease.
Specific
- Pericarditis (bacterial or fungal).
- Idiopathic pericardial hemorrhage Pericardium: idiopathic hemorrhage.
- Pericardial effusion associated with neoplasia Pericardium: neoplasia (heartbase tumor) - a rare complication.
Pathophysiology
- Long-standing pericardial effusion or repeated pericardiocentesis Pericardiocentesis → reactive fibrosis and organization of parietal pericardium plus or minus visceral pericardium → rigid pericardium → compromised ventricular compliance (distensibility) → increased diastolic pressures in all 4 chambers → right side most susceptible to altered compliance (thinner walls and lower pressure system) → venous congestion and signs of right-sided congestive failure.
- The heart is encased in a rigid pericardial sac and is constricted; diastolic function is compromised.
- Elevated end-diastolic pressures in the atria and ventricles result in backwards failure - the right side of the heart is most susceptible.
Timecourse
- Insidious subclinical course.
- Clinical presentation of ascites is often tolerated by the patient for many months, with or without therapy.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Heinritz C K, Gilson S D, Soderstrom M J, Robertson T A, Gorman S C, Boston R C (2005) Subtotal pericardectomy and epicardial excision for treatment of coccidioidomycosis-induced effusive-constricitive pericarditis in dogs: 17 cases (1999-2003). JAVMA 227 (3), 435-440 PubMed.
- Ha J W et al (2004) Differentiation of constrictive pericarditis from restrictive cardiomyopathy using mitral annular velocity by tissue Doppler echocardiography. Am J Cardiol 94 (3), 316-319 PubMed.
- Hatle L F et al (1989) Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography. Circulation 79 (2), 357-70 PubMed.
- Schiavone W A et al (1989) Doppler echocardiographic demonstration of pulmonary venous flow velocity in three patients with constrictive pericarditis before and after pericardiectomy. Am J Cardiol 63 (1), 145-147 PubMed.
- Santamore W P et al (1986) Ventricular coupling in constricitive pericarditis. Circulation 74 (3), 597-602 PubMed.
- Thomas W P et al (1984) Constrictive pericardial disease in the dog. JAVMA 184 (5), 546-553 PubMed.
Other sources of information
- Kienle R D (2005) Chapter 25Pericardial Disease and Cardiac Neoplasia - Constrictive and Constrictive-Effusive Pericarditis.In: Kittleson & KienleSmall Animal Cardiovascular Medicine. 2nd edn. Veterinary Information Network:http://www.vin.com/Members/Proceedings/Proceedings.plx/CID=sacardio&PID=pr11387&0=VIN
- Feigenbaum H (1994)Constrictive pericardial disease.In: FeigenbaumEchocardiography. 5th edn. Philadelphia: Lea & Febiger. pp 577-583. (Good review of the echo techniques to reach this diagnosis (with references).)