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Constrictive pericarditis results from thickening and fibrosis of the parietal and/or visceral pericardium, which become very rigid. This prevents the heart from filling adequately in diastole. The pericardial layers may fuse, obliterating the pericardial space, or the pericardial space may contain a small volume of fluid (constrictive-effusive disease).
Constrictive pericarditis results from thickening and fibrosis of the parietal and/or visceral pericardium, which become very rigid. This prevents the heart from filling adequately in diastole. The pericardial layers may fuse, obliterating the pericardial space, or the pericardial space may contain a small volume of fluid (constrictive-effusive disease).
The rigid pericardium increases the ''ventricular interdependence''. The decrease in left ventricle filling with inspiration causes increased right ventricle filling, causing the interventricular septum to shift to the left (''paradoxical septal motion'').
==Diagnosis==
==Diagnosis==
===History and Physical Examination===
* Abdominal distension due to hepatosplenomegaly and ascites
* '''Pericardial knock''' may be detected on auscultation. This is the sound produced by the sudden deceleration of blood as it hits the non-distensible ventricular walls in early diastole.
===Thoracic Radiographs===
* May be unremarkable
* Cardiac silhouette may appear rounded
* Dilation of the caudal vena cava may be observed
===Echocardiography===
* Paradoxical septal motion
* Increased early diastolic filling (E-wave) velocity (Doppler)
* Short E-wave deceleration time, as early diastolic filling stops abruptly after left ventricular pressures are elevated
* Difficult to differentiate from restrictive cardiomyopathy (RCM)
==Management==
==Management==
Surgical pericardiectomy is the treatment of choice.
==Prognosis==
==Prognosis==
Dependent on severity of disease. In cases with involvement of the visceral pericardium (epicardium), prognosis is poor even with surgical pericardiectomy.
==References==
==References==