Introduction
A chronic or long-lasting inflammation of the pericardium is called constrictive pericarditis. This membrane that encircles the heart is called the pericardium. Muscle rigidity, thickening, and scarring result from inflammation in this heart area. As time passes, the pericardium stiffens and loses its flexibility. Even less frequently does the illness affect youngsters than it does adults. It may worsen into a major health problem. If an inflexible pericardium is not addressed, it may result in life-threatening heart failure symptoms. The illness has efficacious therapies.
What Is Pericarditis?
The pericardium is a thin, two-layered sac that surrounds the heart. Pericarditis is the inflammation of this sac. The pericardium aids in the heart's internal positioning within the chest wall. A tiny quantity of fluid is positioned between each layer to minimize friction during a heartbeat. There may be chest discomfort if the layers become inflamed.
Viral infections account for 80 to 90 percent of cases of pericarditis; the etiology of the remaining cases is unknown. Three weeks is the average duration. Pericarditis usually goes away on its own over time. That being said, some therapies can shorten the illness's course and stop relapses.
What Is Constrictive Pericarditis?
The disease known as constrictive pericarditis is characterized by an abnormally thickening and stiffening of the pericardium, the thin membrane that surrounds the heart. That can cause serious issues like heart failure by interfering with the heart's ability to pump blood. Although it is typically a chronic (long-term) issue, most instances may be treated, particularly with an early diagnosis.
What Causes Constrictive Pericarditis?
With constrictive pericarditis, scar tissue from past medical illnesses frequently causes the pericardium to become thicker or more rigid than usual. Several factors might cause this stiffness of the pericardium, including.
1. Infection
Constrictive pericarditis occurs in 20 percent to 30 percent of instances of pericarditis due to tuberculosis. Bacterial infections, particularly tuberculosis, are the predominant cause of these in underdeveloped nations. Viral infections in wealthy nations more frequently bring on this illness.
2. Heart and Circulatory Problems
Heart attacks and other ailments affecting the main blood veins nearest to the heart fall under this category.
3. Trauma
Chest injuries, whether from blunt trauma or penetrating wounds from knives or bullets, can produce inflammation that eventually forms scar tissue.
4. Immune System Conditions or Inflammatory Disorders
Sjögren's syndrome, lupus, and rheumatoid arthritis are a few examples of these ailments.
5. Therapeutic Reasons
After cardiac surgery, radiation therapy for cancer, or as a side effect of some drugs, pericardial thickening or scarring may occur.
6. Cancer
This can include cancer originating elsewhere in the body or from the pericardium.
7. Other
There are unidentified causes of constrictive pericarditis. For statistical reasons, medical professionals frequently think these occurrences result from a viral infection or a combination of viral and unexplained factors.
What Are the Symptoms of Constrictive Pericarditis?
Constrictive pericarditis symptoms include:
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Breathing problems that gradually get worse with exhaustion.
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Enlarged abdomen.
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Persistent, severe ankle and leg edema.
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Weakness.
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Low-grade temperature.
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Chest discomfort.
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Loss of appetite.
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Dizziness.
How Is Constrictive Pericarditis Diagnosed?
It is challenging to diagnose this illness. It might be mistaken for other cardiac disorders, such as:
- Restrictive Cardiomyopathy - Restrictive cardiomyopathy is the condition where the heart's rigidity prevents the heart chambers from filling with blood.
- Cardiac Tamponade - Cardiac tamponade happens when the heart is compressed by fluid between the pericardium and the heart muscle.
The following are the diagnostic criteria that are used to diagnose constrictive pericarditis:
1. Imaging Examinations
The heart and the pericardium may be seen in great detail on chest MRIs, CT scans, and X-rays. An MRI or CT scan can see blood clots and thickening of the pericardium.
2. Cardiac Catheter Application
The physician inserts a tiny tube into the heart through the arm or groin during cardiac catheterization. Using this tube, they can extract tissue for a biopsy, get blood samples, and assess internal cardiac conditions.
3. ECG
An electrocardiogram measures the electrical impulses in the heart. An irregular heartbeat might indicate constrictive pericarditis or another cardiac disease.
What Are the Treatment Modalities That Are Used to Treat Pericarditis Constrictive?
Constrictive pericarditis typically manifests as a chronic condition that has been worsening over time by the time it is recognized. When constrictive pericarditis is diagnosed in a patient who has had it for several months or more, it is a chronic illness that is likely to worsen. For most patients with constrictive pericarditis, therefore, immediate surgical intervention is advised.
Constrictive pericarditis can be diagnosed for the first time in a person whose cardiac symptoms seem mild and stable and whose underlying medical condition is thought to be treatable. In these cases, surgical therapy can be postponed for a few months while the underlying medical disorder is aggressively treated.
Surgery:
Pericardiectomy, or the surgical removal of a significant amount of the thickened, fibrous pericardial sac, is the only viable therapy for the majority of patients with constrictive pericarditis. The thickened pericardium is removed, which releases the heart from constriction, relieves the cardiac filling limitation, and allows the heart to resume its normal function.
Pericardiectomy is sometimes a demanding and complex treatment. This is partially because the damaged pericardial sac frequently adheres to the heart muscle, which makes the surgery exceedingly challenging technically.
Since pericardiectomy is a rather unusual treatment and a highly skilled technique, it should ideally be carried out in large cardiac centers where the surgeons have extensive expertise in this difficult procedure.
Conclusion
The inflammation that results in constrictive pericarditis makes the heart's outer layer thick and inflexible. Because of this, the heart finds it difficult to expand fully throughout a heartbeat. The outcome is insufficient blood filling the heart chambers. Heart edema and other heart failure symptoms are brought on by blood clotting behind the heart. If left untreated, constrictive pericarditis might be fatal. There is a significant chance of problems when treating the issue surgically. It is, therefore, most frequently performed on patients with significant symptoms.
