Skip to Main Content

KEY FEATURES

ESSENTIALS OF DIAGNOSIS

  • Echocardiographic demonstration of pericardial fluid with fibrinous strands and constrictive physiology

  • Persistence of elevated intracardiac filling pressures after pericardiocentesis with constrictive features

  • The most identifiable cause is uremia, although any cause of pericarditis can produce this condition

GENERAL CONSIDERATIONS

  • Effusive-constrictive pericarditis combines features of pericardial effusion and constrictive pericarditis

  • The syndrome is dynamic and may represent an intermediate stage of constrictive pericarditis

  • No diagnostic criteria exist

  • Etiology varies because of geographic variation in causes of pericardial disease

  • Common causes are uremia, malignancy, radiation, and tuberculosis

  • Although pericardiocentesis may be associated with symptomatic improvement, some patients require pericardiectomy

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

  • Fatigue

  • Dyspnea

  • Increased abdominal girth

  • Edema

  • Malabsorptive diarrhea

  • Chest pain

  • Dizziness

PHYSICAL EXAM FINDINGS

  • Markedly elevated jugular venous pressure with x and y troughs that are more prominent than the a and v peaks

  • Pulsus paradoxus

  • Kussmaul sign (lack of inspiratory decline in jugular venous pressure) in some

  • Abdominal distention with fluid wave from ascites

  • Pulsatile hepatomegaly

  • Cachexia

  • Edema/anasarca

DIFFERENTIAL DIAGNOSIS

  • Cardiac tamponade

  • Constrictive pericarditis

  • Restrictive cardiomyopathy with incidental pericardial effusion

DIAGNOSTIC EVALUATION

LABORATORY TESTS

  • Antinuclear antibody titer

  • Rheumatoid factor

  • Tuberculin skin test

ELECTROCARDIOGRAPHY

  • Nonspecific ST- and T-wave changes

  • Low-voltage QRS

  • Atrial fibrillation

IMAGING STUDIES

  • Chest x-ray:

    • – The cardiac silhouette may be small, normal, or enlarged

    • – Pericardial calcification is uncommon

  • Echocardiography:

    • – Usually shows a small- to moderate-sized effusion with strands of solid material between the visceral and parietal pericardium

    • – Pericardial thickening and/or adhesions may be apparent

    • – Doppler evidence of exaggerated respirophasic variation in mitral E velocity may be present

    • – The inferior vena cava may be dilated

DIAGNOSTIC PROCEDURES

  • Right heart catheterization during or after pericardiocentesis establishes the diagnosis

  • After the effusion is drained, elevation of intracardiac filling pressures persists and the recorded waveforms may exhibit the classic appearance of constriction

TREATMENT

CARDIOLOGY REFERRAL

  • Heart failure

  • Chronic pericardial disease

  • Persistent symptoms or evidence of right heart failure after pericardial fluid drainage

HOSPITALIZATION CRITERIA

  • Decompensated heart failure

  • Evidence of cardiac tamponade

MEDICATIONS

  • Treat underlying cause if known

THERAPEUTIC PROCEDURES

  • Pericardiocentesis alone may produce at least temporary relief of symptoms in most patients

SURGERY

  • Pericardial resection of the visceral pericardium is often required

MONITORING

  • ECG monitoring

  • Vital signs

DIET AND ACTIVITY

  • Low-sodium ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.