Constrictive Pericarditis: Causes, Symptoms, and Treatment

Overview

When a patient suffers from constrictive pericarditis, the walls of the pericardium – the fluid-filled pouch that surrounds the heart become too stiff or thick. This condition restricts the heart from beating correctly and may lead to severe long-term complications. However, the treatment options depend on the severity and cause of the condition and the patient’s overall health.

This blog comprehensively explains constrictive pericarditis, its causes, symptoms, and treatments.

What is constrictive pericarditis? 

Constrictive pericarditis is a long-term condition or inflammation of the pericardium that causes the pericardium’s scaring, thickening and tightening. The pericardium is a sac-like membrane surrounding the heart. Over time the elasticity of the pericardium is lost, and it becomes rigid. This condition is rarely found in adults and seldom seen in children. If left untreated, a rigid pericardium can cause heart failure and be life-threatening.   

What are the types of constrictive pericarditis?

The subtypes are as follows:

• Acute: The patient may develop acute constrictive pericarditis when the pericardium is quickly scarred within a few days.
• Subacute: It is similar to acute constrictive pericarditis but has less severe symptoms.
• Effusive-constrictive pericarditis: The accumulation of excess fluid build-up in the pericardium is called effusive-constrictive pericarditis. It puts pressure, constricts the heart from beating correctly and results in cardiac tamponade – restricted heartbeat due to fluid buildup. If untreated, the heart may stop functioning.
• Transient constrictive pericarditis: Generally, it involves acute pericarditis that becomes inflammatory constrictive pericarditis. It can be treated with anti-inflammatory medicines  
• Occult constrictive pericarditis: In the medical term, ‘occult’ means hidden. As the name suggests, it is not easily detectable. It is only diagnosed by accident when undergoing other tests and scans.

What are the symptoms of constrictive pericarditis? 

The following are the symptoms of constrictive pericarditis: 

• Swelling (especially in the lower legs and abdomen ) from fluid build-up
• Loss of appetite and feeling full even if food consumption is very little
• Fatigue
• Shortness of breath (dyspnea)
• Chest pain
• Dizziness
• Loss of muscle mass

When to seek medical help?

Patients should immediately seek medical help if they notice any of the abovementioned symptoms.

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What are the causes of constrictive pericarditis? 

An inflamed pericardial sac  can become rigid to the extent it cannot allow the heart to function peoperly . It prevents the heart chambers from filling up with the right amount of blood and leads to symptoms like heart failure. The causes of this condition are: 

• Infections. In developed countries, viral infections are more likely to cause constrictive pericarditis. In developing countries the infections are due to bacteria, especially tuberculosis (constrictive pericarditis occursd in 20 – 30 per cent of tuberculosis-related cases of pericarditis).
• Cancer. This includes either cancer of the pericardium itself or cancer from somewhere else in your body
• Trauma. Injuries to the chest (either penetration injuries like knife or bullet wounds or blunt impacts) can cause inflammation that leads to scar tissue formation
• Heart and circulatory problems. This includes heart attacks or other conditions that affect the major blood vessels closest to your heart.
• Medical causes. Pericardial thickening or scarring can happen after heart surgery, radiation therapy for cancer or as a side effect of some medications
• Immune system conditions or inflammatory disorders. Instances of these conditions include rheumatoid arthritis, Sjögren’s syndrome or lupus
• Other. Constrictive pericarditis can happen for unknown reasons.

What are the possible risk factors for constrictive pericarditis? 

The factors that increase the risk of constrictive pericarditis are: 

• Pericarditis – If left untreated, it can become chronic 
• Autoimmune disorders – such as systemic lupus and rheumatoid arthritis, can increase the risk of developing constrictive pericarditis
• Trauma or injury to the heart – A recent heart surgery or heart attack may increase the chances of developing constrictive pericarditis
• Medications – Constrictive pericarditis may be a side effect of certain medications. 
• Gender and age – This condition is common in men between the age of 20 and 50. 

How is constrictive pericarditis diagnosed?

The doctor discusses the patient’s medical history, medications, and symptoms to diagnose constrictive pericarditis. The healthcare provider may recommend the following:

1. Imaging tests

X-rays, CT scans, and MRIs of the chest yield detailed images of the heart and pericardium. A CT scan or an MRI detects the pericardial thickening and blood clots.

2. Cardiac catheterization

A  tube is inserted into the heart through the groin or arm during cardiac catheterization. The healthcare professional can use this tube to collect blood samples, biopsy tissue, and take measurements inside the heart. 

3. Electrocardiogram 

The heart’s electrical impulses are measured using an electrocardiogram. An irregularity in the heart may indicate constrictive pericarditis or any other heart condition. 

4. Echocardiogram

The procedure captures the picture of the heart using sound waves. It can also detect the excess fluid or thickening of the pericardium.

• Testing for tuberculosis
• Blood tests to confirm or rule out immune system conditions

What are the treatment options available for constrictive pericarditis? 

The treatment for constrictive pericarditis focuses on improving the functions of the heart. The following treatments are recommended during the early stages of the condition. 

• Diuretics – medications to remove excess fluid 
• Analgesics – Pain medications to control pain 
• Decrease the activity level 
• Decrease the salt level in the diet 
• Taking over-the-counter anti-inflammatories 

However, there are other treatment options, such as

1. Surgery – Pericardiectomy, which involves removing the entire pericardium. It is usually the best option for adequately treating this illness. A human body does not require a pericardium to live and function normally. Most patients, after surgery, bounce back to their normal lifestyle without any issues or long-term consequences.
2. Medication – Different treatments can assist in treating the symptoms of this illness directly or try to cure it by stopping whatever is causing it to happen, depending on the underlying cause and symptoms. In certain circumstances, these drugs are sufficient to treat this problem without the need for surgery

What are the complications of the treatment of constrictive pericarditis?

The complications vary based on the treatment, medication, cause, and type of constrictive pericarditis. It is essential to discuss it with the healthcare provider to get a better understanding of all the possible complications. Some of the complications include the following:

• Heart failure
• Arrhythmias – irregular heart rhythms
• Infections and sepsis
• Death

Conclusion

Constrictive pericarditis is a rare illness that strikes without warning. It also shares symptoms with various other diseases, making diagnosis difficult. Fortunately, medical knowledge and technology developments have made specific imaging tests more effective in diagnosing this illness. Treatments for this illness have also progressed significantly. That means that this ailment is treatable in the vast majority of cases, and in some cases, a cure is feasible.