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Sunday, February 20, 2011

CHRONIC PERICARDIAL CONSTRICTION

Tuberculosis is a frequent cause. some cases accompany rheumatoid arthritis and other follow a haemopericardium or, rarely, acute pericarditis. Often the cause is obscure. A slowly progressive fibrosis of the pericardium develops and constricts the movement of the heart,so that it cannot expand in diastole.
The fibrous tissue is dense and inelastic and calcification is common. the inflow to the heart is impeded, so that cardiac output is diminished and systemic venous pressure raised.
Clinical features
Breathlessness is not a prominent symptom as the lungs are seldom congested. A raised jugular venous pressure is present, with a rapid and transitory y descent. The arterial pulse tends to be rapid, of small volume, and pulsus paradoxus may be present. Hepatomegaly and ascites occur relatively early compared with peripheral oedema. The heart is usually not enlarged but chest radiography may show pericaridal calcification. The main differential diagnosis is from restrictive myopathy. In countries where constrictive pericarditis is common the diagnosis is usually be made clinically. Where both constrictive pericarditis and restrictive cardiomyopathy are rare, and there is no pericardial calcification, cardiac catheterisation is indicated.
Management
The problem is primarily a mechanical one, and rapid improvement is usual if surgical resection of the pericardium is performed.

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