Overview
Definition
A thickened, fibrotic, and often calcified pericardium that restricts diastolic filling of the heart.
Epidemiology
Often presents months to years after an initial pericardial insult.
Etiology & Risk Factors
- Idiopathic or Post-viral (most common in developed countries)
- Tuberculosis (most common worldwide)
- Post-cardiac surgery or post-radiation
Clinical Symptoms
- Signs of right heart failure: Peripheral edema, ascites, hepatomegaly
- Fatigue / Dyspnea on exertion
- Elevated Jugular Venous Pressure (JVP)
Clinical Approach
Diagnosis
- Echocardiogram (pericardial thickening, septal bounce)
- Chest X-ray or CT (Pericardial calcification)
- Right Heart Catheterization (equalization of end-diastolic pressures in all 4 chambers, 'square root' sign)
- Kussmaul's sign (paradoxical rise in JVP on inspiration)
Management
- Diuretics for volume overload symptom relief
- Pericardiectomy (surgical stripping of the pericardium) is the only definitive cure
Complications
- Cardiac cirrhosis (from chronic hepatic congestion)
- Severe, irreversible heart failure