12 October 2010

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.
  • Occurs in 10-20% of cases during the resolution of pericardial inflammation.
  • 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.
  • 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).
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
Constrictive Pericarditis - Echocardiography - NSAID - Pericardiectomy - Pericarditis
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