Pericarditis constrictiva is a complication of acute pericarditis. This involves scarring of the pericardium.
What is pericarditis constrictiva?
In medicine, pericarditis constrictiva is also known as constrictive pericarditis or armored heart. This refers to a thickening and hardening of the pericardium due to increased connective tissue formation (fibrosis). This process is often the consequence of an acute inflammation of the pericardium (pericarditis). Due to the thickening, the heart can no longer expand easily during its filling phase. Normally, the pericardium is a connective tissue-like flexible sac surrounding the human heart. Its function is to prevent the heart from over-expanding. In addition, a narrow film of fluid is formed inside the pericardium, which allows the important organ to glide smoothly.
Causes
Originators of pericarditis constrictiva are often repeated inflammations. In this case, germs such as bacteria or an immune reaction of the organism cause the formation of scars. In addition, connective tissue is increasingly formed at the same time. Furthermore, calcium accumulates in the pericardium. Over time, the multiple inflammations 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 name “tank heart”. This leads to disturbances in the heart’s activity. The causes of pericarditis cannot always be found. However, in about 30 percent of all affected persons, tuberculosis is considered to be the trigger for pericarditis constrictiva. Other possible causes include tumor disease, radiation to the chest, chronic kidney disease such as uremic pericarditis, and autoimmune diseases such as lupus erythematosus. Preoperative procedures are also considered as possible triggers for inflammation.
Symptoms, complaints, and signs
Because diastolic ventricular filling is affected in pericarditis constrictiva, this results in signs of inflow congestion. Upper as well as lower influence congestion is considered typical of the disease. Other symptoms may include water retention in the body (edema), enlargement of the liver (hepatomegaly), which is not infrequently associated with a watery belly (ascites). Kidney congestion is also possible, with water accumulation in the limbs. Kidney congestion is caused by a lack of protein. Other common symptoms include shortness of breath, poor performance, prominent neck veins, and a bluish discoloration of the lips. The reason for the congestion is the immobility of the pericardium, which means that the heart chambers no longer receive enough blood and venous blood accumulates. The decreased filling in the heart chambers causes the body to receive insufficient oxygen. For this reason, the heart often beats in a certain gallop rhythm. In addition, pulsus paradoxus may occur. Another typical feature of pericarditis constrictiva is the signs of right heart failure (right heart weakness).
Diagnosis and course of the disease
If pericarditis constrictiva is suspected, an examination by a physician is recommended. As part of the examination, the physician takes an ECG. With its help, constrictive pericarditis can be detected by nonspecific changes. Primarily, negatives of the T-wave are conspicuous. In the case of extensive scarring, low-voltage may also be present. When listening to the heart sounds, the physician usually notices a third additional sound. This gives the impression of a gallop rhythm. The abrupt stop of filling within the heart chambers is responsible for this heart sound. With echocardiography, an amplified echo can be detected in the scarred areas of the pericardium. Reduced cardiac motility can also be detected during real-time monitoring. This results in premature arrest of ventricular filling within diastole. An X-ray examination offers the possibility of detecting calcifications. Other helpful examination methods are computer tomography (CT) and magnetic resonance imaging (MRI).For example, computed tomography can determine the thickness of the pericardium, while magnetic resonance imaging provides information about the changes in the pericardium. The course of pericarditis constrictiva depends on the time at which surgical intervention is performed. If this is done too late and the disease is already far advanced, the prognosis is considered more likely to be negative.
Complications
As a rule, pericarditis constrictiva is already directly a complication. In the worst case, however, this can lead to the death of the affected person without treatment. Sufferers of pericarditis constrictiva primarily suffer from severe water retention. These can occur in different places and further reduce the aesthetics of the patient. Likewise, it is not uncommon for this to result in an enlarged liver, and the affected region in the body usually also hurts. A watery belly also usually occurs in pericarditis constrictiva. Furthermore, the disease irreversibly damages the kidneys. Due to the reduced supply of oxygen, there is also a blue discoloration of the skin and lips and further damage to the internal organs, which is usually irreversible. If pericarditis constrictiva is not treated, heart failure occurs, which usually leads to the death of the patient. Treatment of pericarditis constrictiva can take place with the help of medications and usually leads to success. However, surgical intervention is usually necessary to completely resolve the symptoms of this condition.
When should you go to the doctor?
Pericarditis constrictiva must always be treated by a physician. If no treatment is initiated, the patient will usually always die. The earlier the disease is diagnosed and treated, the higher the likelihood of complete recovery. As a rule, pericarditis constrictiva is manifested by severe accumulations of water in the body. Therefore, if these accumulations occur without a particular reason and relatively suddenly, a doctor should always be consulted. Also a water belly or a strong enlargement of the liver indicate pericarditis constrictiva and should be examined by a physician. Furthermore, there is shortness of breath and a lack of protein. The affected person feels tired and weakened and can no longer participate easily in everyday life. Pericarditis constrictiva can be diagnosed by an internist or by a cardiologist. Further treatment requires surgical intervention. Whether pericarditis constrictiva thus leads to a decreased life expectancy of the patient cannot be predicted in general.
Treatment and therapy
Diuretics are often used to treat pericarditis constrictiva. By taking these diuretic medications, the body can be dehydrated, allowing relief of the heart. However, since the actual cause of the disease remains untreated with this approach, there is only a limited effect. In contrast, surgery to free the heart from the scarred pericardium is considered more useful. The procedure is called a pericardiectomy. In it, the surgeon removes most of the pericardium. Usually, pericardiectomy can be performed without a heart-lung machine. However, it is important that the surgery takes place before there is any immediate damage to the heart muscle. Furthermore, care must be taken to avoid irreversible damage to the liver and kidneys due to congestion. After the surgery, the patient must remain in the intensive care unit for several days to allow the heart to acclimate to the new procedures. In addition, there is still a risk of heart failure after surgery.
Outlook and prognosis
In pericarditis constrictiva, the further course of the disease is highly dependent on the timing of diagnosis and treatment. Therefore, a general prediction and prognosis can usually not be made, so in the first place, the affected person should see a doctor very early in this disease. However, if pericarditis constrictiva is not treated, it may not heal on its own. It leads to heart problems and in the worst case to the death of the affected person by an infarction or by another problem with the heart. For this reason, treatment by a physician is always necessary for this disease.As a rule, the disease can be well alleviated by surgical intervention. In most cases, there are no complications or other complaints, and the patient can continue to live without symptoms. However, if the operation is delayed, there may still be a risk of heart failure after the operation. Therefore, it should be performed as early as possible. Since pericarditis constrictiva 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 discomfort of this disease and also relieve the heart.
Prevention
Preventive measures against pericarditis constrictiva are not known. Thus, in many cases, no specific triggering cause can be found.
Follow-up
In most cases of pericarditis constrictiva, only a few or limited measures of direct aftercare are available to those affected. In this disease, first and foremost, a rapid diagnosis with subsequent treatment is very important to prevent further complications and discomfort. It is not possible for pericarditis constrictiva to heal on its own. If left untreated, pericarditis constrictiva can lead to the death of the affected person in the worst case. In most cases, pericarditis constrictiva is treated by taking various medications. Patients should always ensure that they take the medication regularly and in the correct dosage to provide lasting and definitive relief from the symptoms. If there are any questions or uncertainties, patients should contact a doctor. Furthermore, surgical interventions are also necessary in many cases. After such an operation, the affected person should in any case rest and take it easy. Efforts or stressful and physical activities should be refrained from in order not to put unnecessary strain on the body. However, in many cases, the disease leads to a significantly reduced life expectancy of the affected person despite treatment.
What you can do yourself
Since this disease is generally fatal, the doctor will advise surgery. In most cases, this surgery is successful and pericarditis constrictiva heals. However, depending on how quickly it was recognized and treated, the risk of heart failure remains. The patient is therefore advised to take the medications prescribed by the doctor according to the prescriptions. Any excess weight or remaining water retention should be reduced. A low-salt and low-calorie diet is recommended. Supplemented with vitamin-rich fruits and vegetables, 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 advise regular exercise, especially endurance exercise at a low pulse rate. Longer walks or hikes on flat surfaces are recommended for this purpose, as well as moderate cycling or swimming. Little stress and relaxation are good to let the patient come to rest. Yoga or Reiki are good options for this. Progressive muscle relaxation according to Jacobson 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 enriching for people who have had pericarditis constrictiva.
