Constrictive pericarditis

Introduction Constrictive pericarditis is caused by chronic pericardial inflammation leading to pericardial thickening, adhesion and even calcification, which makes the heart diastolic, contraction limited, cardiac function decline, and causes symptoms of systemic blood circulation disorder. Constrictive pericarditis is a progressively exacerbating chronic disease that is often disabling or dying due to exhaustion, peritoneal effusion and peripheral edema or severe cardiac complications. If a complete pericardial dissection is performed early, most patients may Satisfactory results. Constrictive pericarditis is secondary to acute pericarditis, and its etiology is still the most common in China.

Cause

Constrictive pericarditis is secondary to acute pericarditis. The cause of tuberculosis is still the most common in China. Secondly, it is also seen in patients with pericardial trauma or rheumatoid arthritis. Mold or viral infections are not treated in time, and can also lead to the disease. Many patients with constrictive pericarditis cannot determine the cause of the disease despite pericardial pathology. Pericardial tumors and radiation therapy can occasionally cause the disease.

an examination

Related inspection

Cardiovascular angiography, pericardial effusion, electrocardiogram

First, X-ray inspection

The size of the heart shadow is normal or slightly larger. The heart enlargement may be due to pericardial thickening or pericardial effusion. The normal arc of the left and right heart disappears. It is flat and stiff, the heart beats weakly, and the superior vena cava is obviously widened. Some patients have pericardium. There is an calcification in the form of an eggshell, and in addition, an atrial enlargement is seen.

Second, the ECG

Most have low voltage, sinus tachycardia, a few may have atrial fibrillation, and multiple lead T waves are flat or inverted. Sometimes the P wave is broadened or increased in a "mitral-valve P-wave" or "lung-type P-wave", which shows left and right atrial enlargement, as well as right ventricular hypertrophy.

Third, echocardiography

It can be seen that the amplitude of the posterior wall of the right ventricle or the posterior wall of the left ventricle becomes smaller. If there is a pericardial effusion, the degree of thickening of the pericardial wall layer can be found.

Fourth, cardiac catheterization

The mean pressure in the right atrium increased, the pressure curve showed an "M" shape or a "W" shape, and the right ventricle pressure increased. The pressure curve showed a pattern of early diastolic dilation and late diastolic plateau, and the pulmonary capillary wedge pressure was also increased.

Differential diagnosis

Differential diagnosis of constrictive pericarditis:

Constrictive pericarditis is easily misdiagnosed when clinically diagnosed. Due to the fibrosis and calcification of the pericardium, the heart is restrained and the function of the heart is affected. Finally, a series of clinical symptoms appear with circulatory disorders or liver and kidney dysfunction, and the subclinical type of the disease is more than the clinical type, secondary more than the primary, the clinical manifestations of secondary patients are easy to be the primary disease Covering is the main cause of misdiagnosis and missed diagnosis. The collection of medical history is not comprehensive, the physical examination is not careful, and some important signs are missed, especially the special performance of the heart compression is not enough, or other related examinations are not carried out in time, so it is easy to cause misdiagnosis. Therefore, in the diagnosis, differential diagnosis should be strictly carried out with various possible diseases. Clinically, it is mainly related to cirrhosis, congestive heart failure, and tuberculous peritonitis. The clinical manifestations and hemodynamics of constrictive pericarditis are similar to those of restrictive cardiomyopathy. If necessary, endocardial biopsy can be performed. To diagnose.

Cirrhosis: Hepatic sclerosis is a clinically common chronic progressive liver disease with diffuse liver damage caused by long-term or repeated action of one or more causes. Histopathology has extensive hepatocyte necrosis, residual hepatocyte nodular regeneration, connective tissue hyperplasia and fibrous septum formation, leading to structural destruction of the hepatic lobule and formation of pseudolobules. The liver gradually deforms and hardens and develops into cirrhosis. Clinically, liver function damage and portal hypertension are the main manifestations, and multiple systems are involved. In the advanced stage, complications such as upper gastrointestinal bleeding, hepatic encephalopathy, and secondary infection often occur.

Congestive heart failure: Congestive heart failure refers to the blood supply that the heart can't beat at the same time as the venous return and body tissue metabolism. Often, the ability of the heart muscle to contract is weakened by various diseases, so that the blood output of the heart is reduced, which is insufficient to meet the needs of the body, and thus a series of symptoms and signs are generated. Heart valve disease, coronary arteriosclerosis, hypertension, endocrine disorders, bacterial toxins, acute pulmonary infarction, emphysema or other chronic lung disorders can cause heart failure and produce heart failure. Pregnancy, fatigue, rapid intravenous rehydration, etc. can aggravate the burden of the diseased heart and induce myocardial failure.

Tuberculous peritonitis: Tuberculous peritonitis is a chronic diffuse peritoneal infection caused by Mycobacterium tuberculosis. It is more common in children and young adults. The woman is slightly more than the male, 1.2~2.0:1. The main clinical manifestations are burnout, fever, abdominal pain and bloating, which can cause complications such as intestinal obstruction, intestinal perforation and fistula formation.

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