Constrictive Pericarditis
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General Principles
Constrictive pericarditis, as a cause of right-sided heart failure (HF), often goes undiagnosed. It is often difficult to distinguish from restrictive cardiomyopathies (RCMs). Multiple imaging modalities and invasive hemodynamics are often needed to confirm the diagnosis.
Etiology
- Common
- Idiopathic, viral pericarditis (chronic or recurrent), postcardiotomy, chest irradiation
- Less common
- Autoimmune connective tissue disorders, end-stage renal disease, uremia, malignancy (e.g., breast, lung, lymphoma), tuberculosis (most common cause in developing countries)
Pathophysiology
In the setting of chronic inflammation, the pericardial layers become thickened, scarred, and calcified; the pericardial space is obliterated, and the pericardium becomes noncompliant, which impairs ventricular filling and leads to an equalization of pressures in all four chambers and subsequent HF symptoms.
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