Constrictive pericarditis vs restrictive cardiomyopathy pdf

It is important to distinguish between constrictive pericarditis and restrictive cardiomyopathy as the. Constrictive pericarditis and restrictive cardiomyopathy both lead to diastolic heart failure with normal or near normal systolic function, and characteristically abnormal ventricular filling that results in similar clinical and hemodynamic features. The differentiation of restrictive cardiomyopathy and constrictive pericarditis has been a perennial problem in clinical cardiology. Constrictive pericarditis symptoms and ecg medical library. This treatable cause of heart failure should be considered in all patients with unexplained right heart failure symptoms or signs, especially when the left ventricular ejection fraction is preserved. Gersh, mbchb, dphil abstract differentiation of constrictive pericarditis cp from restrictive cardiomyopathy rcm is a complex and often challenging process.

Differentiating constrictive pericarditis and restrictive. Constrictive pericarditis occurs when a scarred, thickened, and calcified pericardium impairs cardiac filling. The diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics mimic restrictive cardiomyopathy. Restrictive cardiomyopathy versus constrictive pericarditis. Constrictive pericarditis is a disorder of cardiac filling caused by an inelastic pericardium. Untreated, patients with restrictive cardiomyopathies have, in general, poor outcomes 7. A 38yearold man was hospitalized for cardiac catheterization. The full text of this article is available as a pdf 103k. Therefore, the ability to differentiate between these conditions remains paramount to therapy. Pdf advances in the differentiation of constrictive pericarditis and. In the developing world tuberculosis is a common cause of constrictive pericarditis. Restrictive versus constrictive restrictive cardiomyopathy constrictive pericarditis history infiltrative disease pericarditis, trauma, surgery mantle radiation, cardiac surgery mantle radiation, cardiac surgery respiratory effects no bulging increased ventricular interaction bulging of the septum towards lv cmr cw infiltrative disease. A summagraphics digitiser and prime 750 computer system were used to digitise the echocardiograms of 15 patients with restrictive cardiomyopathy, 10 with constrictive pericarditis and a group of 20 age and sex matched normal subjects of similar age and sex distribution. Comparison of new doppler echocardiographic methods to differentiate constrictive pericardial heart disease and restrictive cardiomyopathy.

Untreated, patients with restrictive cardiomyopathies have, in general, poor. Differentiation of constriction and restriction jacc. As many as 1015% have either restrictive cardiomyopathy or constrictive pericarditis. Table 2 treatment of the restrictive cardiomyopathies. Diagnosing constrictive pericarditis remains challenging, and the most effective tools are designed. Constrictive pericarditis is potentially curable by a pericardiectomy. Clinically, it is difficult to differentiate between constrictive pericarditis and restrictive cardiomyopathy. Patients with restrictive cardiomyopathies and constrictive pericarditis are often excluded or underrepresented in large randomized clinical trials 2,5,6,makingitdif. We present the case of a 14yearold boy with a previous history of tuberculosis and right heart failure, in whom constrictive pericarditis was diagnosed. However, significant respiratory variation of mitral, tricuspid, pulmonary, and hepatic flows occurs only with constriction.

Brain natriuretic peptide levels in constrictive pericarditis and restrictive cardiomyopathy. Differentiating constrictive pericarditis and restrictive cardiomyopathy. In the developing world where tuberculosis is still common, it remains the major cause of constrictive pericarditis. Constrictive pericarditis versus restrictivecardiomyopathy. More importantly, the clinical and hemodynamic features of many types of restrictive cardiomyopathy may mimic those of constrictive pericarditis. Various diagnostic advances over the years enable us to differentiate between these two conditions. Constrictive pericarditis is the result of scarring and consequent loss of the normal. Constrictive pericarditis cp is a potentially reversible cause of heart failure, whereas restrictive cardiomyopathy rcm has very limited therapeutic options. Advances in the differentiation of constrictive pericarditis and restrictive cardiomyopathy. Radiationinduced constrictive pericarditis usually presents 10 years after therapy. The case highlights the need to integrate all information, including clinical data, noninvasive cardiac imaging, and even invasive hemodynamic. Patients with restrictive cardiomyopathy typically present with the usual constellation of hf symptoms, including dyspnea and fatigue with typical findings of chf on physical exam. Constrictive pericarditis radiology reference article.

Constrictive pericarditis is an uncommon disease in children, usually difficult to diagnose. Constrictive pericarditis requires surgical treatment and is usually curable, while restrictive cardiomyopathy, short of cardiac transplantation, is treatable only by medical means and often responds unsatisfactorily. Differentiating constrictive pericarditis from restrictive. In both constrictive pericarditis and in advanced restrictive cardiomyopathy, the deceleration time of the lv early filling pulsed doppler is short, consistent with a restrictive filling pattern. Fischbein and colleagues relating constrictive pericardial physiology to calcified pericarditis associated with asbestos exposure chest 1988. Differential diagnosis of restrictive cardiomyopathy and. The pathophysiological hallmark of pericardial constriction is equalization of the enddiastolic pressures in all four cardiac chambers. Differentiation of constriction and restriction complex cardiovascular hemodynamics jeffrey b.