Transient Constrictive Pericarditis

Transient Constrictive Pericarditis Clinical Features:

• Transient form of constrictive pericarditis lasting around 3 months.
• Approximately 2/rds of cases will have either a pericardial effusion or pericardial thinkening on echocardiography.
  

Epidemiology:

• Occurs in 10-20% of cases during the resolution of pericardial inflammation.

Investigation:

• Serial echocardiography.
• Inflammatory markers - ESR, CRP, WCC.
• ECG.
  

Pathophysiology & Aetiology:

• Occurring during or following acute pericarditis.
• May occur spontaneously.
• Commonly seen after empiric use of anti-inflammatory therapies.

Prognosis:

• Research evidence suggests that if constrictive findings are going to resolve, they will generally do so at an average time of three months.

Treatment & Management:

• Ensure there is absence of features suggesting chronicity - i.e. cachexia, atrial fibrillation (AF), liver dysfunction, or pericardial calcification).
• Assess for possible haemodynamic instability.
• If the patient is haemodynamically stable with no evidence of chronicity then a trial period (2-3 months) of conservative management with empiric anti-inflammatory therapy, or watchful waiting is recommended.
• Use NSAIDs for chest pain.
• Appropriate antibiotics for infection.
• Treat fluid retention with diuretics.
• Patients with worsening symptoms or clinical deterioration which is not responsive to medical treatment should be considered for early surgery (pericardiectomy).

References:
Haley, J. H. et al. Transient constrictive pericarditis: causes and natural history. J. Am. Coll. Cardiol. 43, 271-275 (2004).

Image: from Mystery To Medicine
Tags: Constrictive Pericarditis - Echocardiography - NSAID - Pericardiectomy - Pericarditis
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