Constrictive pericarditis - Revision history

Rossdonaldson1: /* Background */

2022-12-14T18:41:26Z

Background

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	==Background==		==Background==
	~~[[File:Pericarditis.jpg\|thumbnail\|Pericarditis compared with normal pericardium]]~~
	[[File:2004 Heart Wall.jpg\|thumb\|Anatomy of the pericardium.]]		[[File:2004 Heart Wall.jpg\|thumb\|Anatomy of the pericardium.]]
	*Occurs when normally elastic pericardium becomes thickened and fibrotic (i.e., loss of elasticiticty)<ref>Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.</ref>		*Occurs when normally elastic pericardium becomes thickened and fibrotic (i.e., loss of elasticiticty)<ref>Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.</ref>

Rossdonaldson1: /* Background */

2022-12-14T18:41:06Z

Background

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	==Background==		==Background==
			[[File:Pericarditis.jpg\|thumbnail\|Pericarditis compared with normal pericardium]]
			[[File:2004 Heart Wall.jpg\|thumb\|Anatomy of the pericardium.]]
	*Occurs when normally elastic pericardium becomes thickened and fibrotic (i.e., loss of elasticiticty)<ref>Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.</ref>		*Occurs when normally elastic pericardium becomes thickened and fibrotic (i.e., loss of elasticiticty)<ref>Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.</ref>
	*Can be infectious, post-cardiac surgery, inflammatory, idiopathic or related to radiation exposure<ref>Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.</ref>		*Can be infectious, post-cardiac surgery, inflammatory, idiopathic or related to radiation exposure<ref>Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.</ref>

Rossdonaldson1: /* BackgroundSingh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55. */

2022-12-14T18:38:31Z

BackgroundSingh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.

← Older revision		Revision as of 18:38, 14 December 2022
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	==Background<ref>Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.</ref>==		==Background==
	*Occurs when normally elastic pericardium becomes thickened and fibrotic (i.e., loss of elasticiticty)		*Occurs when normally elastic pericardium becomes thickened and fibrotic (i.e., loss of elasticiticty)<ref>Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.</ref>
	*Can be infectious, post-cardiac surgery, inflammatory, idiopathic or related to radiation exposure		*Can be infectious, post-cardiac surgery, inflammatory, idiopathic or related to radiation exposure<ref>Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.</ref>
	*Impairs diastolic filling of heart		*Impairs diastolic filling of heart
	*Must distinguish from [[restrictive cardiomyopathy]]		*Must distinguish from [[restrictive cardiomyopathy]]

Rossdonaldson1: /* Differential Diagnosis */

2022-12-14T18:23:28Z

Differential Diagnosis

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 ==Differential Diagnosis==
 {{Cardiomyopathy DDX}}
+{{CHF}}
 ==Evaluation==

Rossdonaldson1: /* Workup */

2022-12-14T18:21:43Z

Workup

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	''Advanced evaluation''		''Advanced evaluation''
	**Cardiac CT/MR		*Cardiac CT/MR
	**Invasive hemodynamic evaluation		*Invasive hemodynamic evaluation

	===Diagnosis===		===Diagnosis===

Rossdonaldson1: /* Workup */

2022-12-14T18:21:30Z

Workup

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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	*Initial evaluation:		''Initial evaluation:''
	*CBC		*CBC
	*Chemistry		*Chemistry
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	*[[Ultrasound]]		*[[Ultrasound]]
	**Formal [[echocardiography\|TTE/TEE]]		**Formal [[echocardiography\|TTE/TEE]]
	*Advanced evaluation:
			''Advanced evaluation''
	**Cardiac CT/MR		**Cardiac CT/MR
	**Invasive hemodynamic evaluation		**Invasive hemodynamic evaluation

Rossdonaldson1: /* Workup */

2022-12-14T18:20:51Z

Workup

← Older revision		Revision as of 18:20, 14 December 2022
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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
			*Initial evaluation:
	*CBC		*CBC
	*Chemistry		*Chemistry
	*[[ECG]]		*[[ECG]]
			**No pathognomonic findings, however may be associated with nonspecific ST and T wave changes, atrial fibrillation, and low voltage <ref> Talreja DR, Edwards WD, Danielson GK, Schaff HV, Tajik AJ, Tazelaar HD, Breen JF, Oh JK. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation. 2003 Oct 14;108(15):1852-7. doi: 10.1161/01.CIR.0000087606.18453.FD. Epub 2003 Sep 29. PMID: 14517161.</ref>
	*[[CXR]]		*[[CXR]]
			**Ring of calcification around the heart, however the majority of patients will not have this
	*[[Troponin]]/CK		*[[Troponin]]/CK
	*BNP		*BNP
	*[[Ultrasound]]		*[[Ultrasound]]
	**Formal [[echocardiography\|TTE/TEE]]		**Formal [[echocardiography\|TTE/TEE]]



	*Initial evaluation:
	**ECG: No pathognomonic findings, however may be associated with nonspecific ST and T wave changes, atrial fibrillation, and low voltage <ref> Talreja DR, Edwards WD, Danielson GK, Schaff HV, Tajik AJ, Tazelaar HD, Breen JF, Oh JK. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation. 2003 Oct 14;108(15):1852-7. doi: 10.1161/01.CIR.0000087606.18453.FD. Epub 2003 Sep 29. PMID: 14517161.</ref>
	**CXR: Ring of calcification around the heart, however the majority of patients will not have this

	**TTE

	*Advanced evaluation:		*Advanced evaluation:
	**Cardiac CT/MR		**Cardiac CT/MR

Rossdonaldson1 at 18:19, 14 December 2022

2022-12-14T18:19:21Z

@@ Line 7: / Line 7: @@
 ==Clinical Features==
 *Symptoms similar to [[congestive heart failure]], especially right sided
 **[[Dyspnea]]
 **Lower extremity edema
 **Jugular venous distention
 ==Differential Diagnosis==
@@ Line 48: / Line 51: @@
 **Formal [[echocardiography|TTE/TEE]]
 *Initial evaluation:
 **ECG: No pathognomonic findings, however may be associated with nonspecific ST and T wave changes, atrial fibrillation, and low voltage <ref> Talreja DR, Edwards WD, Danielson GK, Schaff HV, Tajik AJ, Tazelaar HD, Breen JF, Oh JK. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation. 2003 Oct 14;108(15):1852-7. doi: 10.1161/01.CIR.0000087606.18453.FD. Epub 2003 Sep 29. PMID: 14517161.</ref>
@@ Line 103: / Line 71: @@
 **Chronic signs: Anasarca, cachexia, [[atrial fibrillation]], hepatic dysfunction, pericardial calcification
 *If chronic process: Pericardiectomy <ref> Welch TD. Constrictive pericarditis: diagnosis, management and clinical outcomes. Heart. 2018 May;104(9):725-731. doi: 10.1136/heartjnl-2017-311683. Epub 2017 Nov 25. PMID: 29175978.</ref>
 ==Disposition==
@@ Line 108: / Line 77: @@
 ==See Also==
+*[[Restrictive cardiomyopathy]]
 ==External Links==
@@ Line 115: / Line 88: @@
 ==References==
 <references/>

Rossdonaldson1 at 18:00, 14 December 2022

2022-12-14T18:00:53Z

← Older revision		Revision as of 18:00, 14 December 2022
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	==Background<ref>Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.</ref>==		==Background<ref>Singh M, Niemann JT. Cardiomyopathies and Pericardial Disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw-Hill; 2020:(Ch) 55.</ref>==
	*Occurs when normally elastic pericardium becomes thickened and fibrotic		*Occurs when normally elastic pericardium becomes thickened and fibrotic (i.e., loss of elasticiticty)
	*Can be infectious, post-cardiac surgery, inflammatory, idiopathic or related to radiation exposure		*Can be infectious, post-cardiac surgery, inflammatory, idiopathic or related to radiation exposure
	*Impairs diastolic filling of heart		*Impairs diastolic filling of heart
	*Must distinguish from [[restrictive cardiomyopathy]]		*Must distinguish from [[restrictive cardiomyopathy]]
			*Typically chronic complication of [[pericarditis]]

	==Clinical Features==		==Clinical Features==
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	==Background==		==Background==
	*Result of scarring and loss of elasticity of the pericardial sac
	*Typically chronic complication of [[pericarditis]]

	==Clinical Features==		==Clinical Features==

Rossdonaldson1 at 17:58, 14 December 2022

2022-12-14T17:58:44Z

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	[[Category:Cardiology]]		[[Category:Cardiology]]

			==Background==
			*Result of scarring and loss of elasticity of the pericardial sac
			*Typically chronic complication of [[pericarditis]]

			==Clinical Features==
			*Pleuritic chest pain
			*Dyspnea
			*Malaise
			*Characteristic symptoms of [[pericarditis]] less frequent in recurrent presentations

			==Differential Diagnosis==


			==Evaluation==
			===Workup===
			*Initial evaluation:
			**ECG: No pathognomonic findings, however may be associated with nonspecific ST and T wave changes, atrial fibrillation, and low voltage <ref> Talreja DR, Edwards WD, Danielson GK, Schaff HV, Tajik AJ, Tazelaar HD, Breen JF, Oh JK. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation. 2003 Oct 14;108(15):1852-7. doi: 10.1161/01.CIR.0000087606.18453.FD. Epub 2003 Sep 29. PMID: 14517161.</ref>
			**CXR: Ring of calcification around the heart, however the majority of patients will not have this

			**TTE

			*Advanced evaluation:
			**Cardiac CT/MR
			**Invasive hemodynamic evaluation

			===Diagnosis===
			*No single diagnostic imaging/evaluation parameter
			*Must be differentiated from [[tamponade]] and disorders such as [[restrictive cardiomyopathy]] as management is different for each of these pathologies

			==Management==
			*If no signs of chronic process: Medical management (Colchicine, NSAIDs for 2-3 months)
			**Chronic signs: Anasarca, cachexia, [[atrial fibrillation]], hepatic dysfunction, pericardial calcification
			*If chronic process: Pericardiectomy <ref> Welch TD. Constrictive pericarditis: diagnosis, management and clinical outcomes. Heart. 2018 May;104(9):725-731. doi: 10.1136/heartjnl-2017-311683. Epub 2017 Nov 25. PMID: 29175978.</ref>

			==Disposition==
			*Admit

			==See Also==


			==External Links==


			==References==
			<references/>