Constrictive pericarditis is a complication of acute pericarditis. This leads to a scarred remodeling of the pericardium.
What is constrictive pericarditis?
In medicine, constrictive pericarditis is also known as constrictive pericarditis or armored heart. What is meant by this is a thickening and hardening of the heart sac (pericardium) due to increased connective tissue formation (fibrosis). This process is often the result of acute inflammation of the pericardium (pericarditis).
Due to the thickening, the heart can no longer easily expand during its filling phase. Normally, the pericardium is a flexible, connective tissue-like sac that surrounds the human heart. It fulfills the function of protecting the heart from overstretching. In addition, a thin film of fluid is formed inside the pericardium, which allows the important organ to slide smoothly. See electronicsencyclopedia for Slang Diabetes Insipidus.
Causes of a pericarditis constrictiva are often recurring inflammations. The formation of scars is caused by germs such as bacteria or an immune reaction of the organism. In addition, connective tissue is formed at the same time.
Furthermore, calcium accumulates in the pericardium. Over time, the multiple occurrences of inflammation cause the pericardium to thicken, which in turn has a negative effect on its elasticity. Because the pericardium can hardly move, the heart is trapped as if in a tank, which led to the term “armoured heart”.
This leads to disturbances in cardiac activity. The causes of pericarditis cannot always be found. In about 30 percent of all affected people, however, tuberculosis is the trigger for constrictive pericarditis.
Other possible reasons are tumor diseases, radiation of the chest, chronic kidney diseases such as uraemic pericarditis and autoimmune diseases such as lupus erythematosus. Preoperative interventions are also possible triggers for the inflammation.
Symptoms, Ailments & Signs
Since the diastolic filling of the ventricle is affected in constrictive pericarditis, this results in signs of inflow congestion. Upper and lower inflow congestion is considered typical of the disease. Other symptoms can include accumulation of water in the body (edema), an enlargement of the liver (hepatomegaly), which is often associated with a bloated stomach (ascites).
Kidney congestion is also possible, with water accumulating in the limbs. Kidney congestion is caused by a lack of protein. The frequently occurring complaints also include shortness of breath, poor performance, severe protrusion of the veins in the neck and a bluish discoloration of the lips.
The reason for the congestion is the immobility of the pericardium, as a result of which the ventricles no longer receive enough blood and the venous blood accumulates. The reduced filling in the heart chambers causes the body to receive insufficient oxygen. For this reason, the heart often beats in a certain gallop rhythm.
A pulsus paradoxus can also occur. Another typical feature of constrictive pericarditis are the signs of right heart failure (right heart weakness).
Diagnosis & course of disease
If constrictive pericarditis is suspected, an examination by a doctor is recommended. As part of the examination, the doctor takes an EKG. With its help, the constrictive pericarditis can be determined by non-specific changes.
First and foremost, negative effects on the T-wave are noticeable. In the case of extensive scarring, low voltage may also be present. When listening to the heart sounds, the doctor usually perceives a third additional sound. This creates the impression of a gallop rhythm. Responsible for this heartbeat is the abrupt stop of filling within the ventricles.
With an echocardiography, an increased echo can be detected in the scarred areas of the pericardium. Reduced cardiac mobility can also be determined in real-time monitoring. This causes ventricular filling to stop prematurely during diastole.
An X-ray examination makes it possible to detect calcifications. Computed tomography (CT) and magnetic resonance imaging (MRT) are other helpful examination methods. Computed tomography can be used to determine the thickness of the pericardium, while magnetic resonance imaging provides information about the changes in the pericardium.
The course of constrictive pericarditis depends on when surgery is performed. If this is done too late and the disease is already well advanced, the prognosis is considered negative.
As a rule, constrictive pericarditis is a direct complication. In the worst case, however, this can lead to the death of the person concerned if left untreated. Those affected primarily suffer from severe water retention due to constrictive pericarditis. These can occur in different places and also reduce the aesthetics of the patient.
It is also not uncommon for an enlarged liver to occur, whereby the affected region of the body usually also hurts. A water belly also usually occurs in constrictive pericarditis. Furthermore, the kidneys are irreversibly damaged by the disease. Due to the reduced supply of oxygen, the skin and lips also turn blue and the internal organs are damaged, which is usually irreversible.
If the constrictive pericarditis is not treated, cardiac insufficiency occurs, which usually leads to the death of the patient. The treatment of constrictive pericarditis can take place with the help of medication and is usually successful. As a rule, however, an operation is necessary to completely resolve the symptoms of this disease.
When should you go to the doctor?
Constrictive pericarditis must always be treated by a doctor. If no treatment is initiated, the patient usually dies. The earlier the disease is diagnosed and treated, the higher the chance of a complete cure. As a rule, constrictive pericarditis is manifested by excessive accumulation of water in the body.
Should these accumulations occur without any particular reason and relatively suddenly, a doctor should always be consulted. A water belly or a strong enlargement of the liver also indicate constrictive pericarditis and should be examined by a doctor. Shortness of breath and a lack of protein also occur. Those affected feel tired and weak and can no longer easily participate in everyday life.
Constrictive pericarditis can be diagnosed by an internist or a cardiologist. Further treatment requires an operation. It cannot generally be predicted whether constrictive pericarditis will lead to a reduced life expectancy for the patient.
Treatment & Therapy
Diuretics are often used to treat constrictive pericarditis. Taking these diuretic drugs dehydrates the body, which can relieve the heart. However, since the actual cause of the disease remains untreated with this approach, there is only a limited effect.
On the other hand, an operation to free the heart from the scarred pericardium is considered more sensible. The procedure is called a pericardiectomy. During this procedure, the surgeon removes most of the pericardium. The pericardiectomy can usually be performed without a heart-lung machine.
However, it is important that the operation takes place before the heart muscle is directly damaged. Also, look out for irreversible damage to the liver and kidneys due to congestion. After the procedure, the patient has to remain in the intensive care unit for a few days so that the heart can get used to the new processes. In addition, there is still a risk of heart failure after the operation.
Outlook & Forecast
In the case of constrictive pericarditis, the further course of the disease depends very much on the time of diagnosis and treatment. Therefore, a general prediction and prognosis cannot usually be made, so that the person affected by this disease should first and foremost consult a doctor very early on.
However, if constrictive pericarditis is not treated, it cannot heal on its own. This leads to heart problems and, in the worst case, to the death of the person concerned due to an infarction or another heart problem. For this reason, treatment by a doctor is always necessary for this disease. The disease can usually be alleviated by surgery. There are usually no complications or other symptoms and the person concerned can continue to live without symptoms. However, if the procedure is delayed, there may still be a risk of heart failure after the procedure . Therefore, this should be done as early as possible.
Since constrictive pericarditis can also have a negative effect on other organs, these must also be examined. The affected person can also pay attention to a healthy lifestyle in order to alleviate the symptoms of this disease and also to relieve the heart.
Preventive measures against constrictive pericarditis are not known. In many cases, no concrete triggering cause can be found.
In most cases of constrictive pericarditis, those affected only have a few or only limited direct follow-up measures available. In the case of this disease, a quick diagnosis with subsequent treatment is very important in the first place in order to prevent further complications and symptoms. It cannot heal on its own, and if left untreated, constrictive pericarditis can lead to the death of the affected person in the worst case.
In most cases, constrictive pericarditis is treated by taking various medications. Those affected should always ensure regular intake and the right dosage in order to relieve the symptoms permanently and finally. If there are any questions or ambiguities, patients should contact a doctor.
In many cases, surgical interventions are also necessary. After such an operation, the person concerned should definitely rest and rest. Efforts or stressful and physical activities should be avoided in order not to unnecessarily burden the body. However, in many cases, despite treatment, the disease leads to a significantly reduced life expectancy of those affected.
You can do that yourself
Because this condition is generally fatal, doctors will recommend surgery. In most cases, this operation is successful and the constrictive pericarditis heals. But depending on how quickly it was recognized and treated, the risk of heart failure remains.
The patient is therefore advised to take the medication prescribed by the doctor according to the prescriptions. Possibly existing obesity or remaining water retention should be reduced. A low-salt, low-calorie diet makes sense. Supplemented with fruit and vegetables rich in vitamins, whole grain products and little red meat, this diet can also stabilize the patient’s overall physical condition. In the course of convalescence, the doctor will also recommend regular exercise, especially endurance exercises with a low pulse rate. We recommend longer walks or hikes on flat surfaces, as well as moderate bike rides or swimming.
A little stress and relaxation are good for allowing the patient to calm down. Yoga or Reiki can be used for this. Jacobson’s progressive muscle relaxation or meditation with breathing exercises are also good opportunities to reduce stress and calm the heart. Even new, alternative forms of therapy such as laughter yoga, music therapy or EFT tapping therapy can prove to be an enrichment for people who have suffered from constrictive pericarditis.