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Constrictive pericarditis is a severe complication of pericarditis. It is a condition characterized by long-term inflammation of the pericardium, the outer protective layer of the heart. As the pericardium remains inflamed, its two layers keep rubbing together causing pain, muscle tightening and scarring.

Though on its own, pericarditis is not always a very serious medical condition and may be completely treated with medications, constrictive pericarditis is not only severe but can be life threatening as well if not detected and treated on time. Constrictive pericarditis may not always be treated with the help of medications alone and may require surgical removal of the effusion as well as removal or part of the pericardium. Constrictive pericarditis is often associated with recurrent pericarditis.

Causes

Constrictive pericarditis is caused due to infections or underlying conditions that may cause inflammation around the heart. Some of the conditions that may cause constrictive pericarditis include heart surgery, tuberculosis, bacterial and viral infections, radiation therapy – usually given for treatment of cancer, and autoimmune disorders as well as immunological diseases.

Although these are the most common causes of pericarditis, in some cases the disease could develop without any apparent causes. As the inflammation around the heart increases, it causes the pericardium to become hard and thick, impeding normal beating of the heart. When the pericardium is thick and scarred, the heart muscles are not able to stretch properly when the heart beats, and the four chambers do not completely fill up. As a result of this, bloods begin pooling and backing up behind the heart. The heart then swells and the patient experiences severe symptoms mimicking heart failure.

Symptoms

Some of the most common symptoms of this condition include:

• Pain in the chest which also radiates to the shoulders and arms.
• Difficulty in taking deep breaths.
• Excessive fatigue and tiredness.
• Swelling in the abdomen, ankles and legs.
• General weakness and malaise.

The symptoms of heart failure are often present in this condition, and the patient may often feel as if they are having a heart attack, especially when they get up or sit. It is best to consult a doctor as soon as you experience any of the above symptoms.

Tests and Diagnosis

It is very hard to diagnose constrictive pericarditis. Since the signs and symptoms of the condition are very similar to those of restrictive cardiomyopathy and even heart failure, the doctors resort to various tests for a final diagnosis. The doctor would first take a brief history of your symptoms and then proceed to give you a thorough physical examination. After that, the doctor also recommends some other tests such as chest X-rays, MRIs, CT scans and a coronary angiography. Other tests include ECG and echocardiogram. Some of these tests are especially required when the doctor suspects effusive pericarditis.

Treatment

The goal of treatment in pericarditis is to reduce the symptoms associated with the condition and improve the functioning of the heart. However, to do that, the doctor has to first identify the underlying condition which is causing the pericarditis. If the condition is caused due to infections, the doctor prescribes antibiotics and medications for the infection. If there is effusion, the doctor may also prescribe diuretics. Other medications include pain killers and analgesics. Patients may also be advised bed rest. Since this is a heart condition, the doctor may also recommend a low-sodium diet to control blood pressure.

If there are complications and the pericarditis recurs, doctors may resort to surgery for removal of the effusion and medications such as colchicines. The patient may also require life long treatment for the condition.

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