Pericardial constriction

Introduction Chronic constrictive pericarditis is a disease caused by chronic pericardial inflammation, which causes pericardial thickening, adhesion and even calcification, which causes diastole, limited contraction, and decreased heart function, causing systemic blood circulation disorders. Chronic constrictive pericarditis is mostly caused by tuberculous pericarditis. Acute suppurative pericarditis is about 10% of the prolonged unhealed, others can be caused by rheumatism, trauma, mediastinal radiotherapy, etc., accounting for a very small number. The most common cause of inflammation in China is tuberculosis and suppurative infection followed by mold or viral infection.

Cause

Constrictive pericarditis is secondary to acute pericarditis. The cause of tuberculosis is still the most common in China, followed by 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

Electrocardiogram two-dimensional echocardiography Doppler echocardiography molybdenum target X-ray examination

(1) X-ray examination: the heart shadow size is normal or slightly larger, the heart enlargement may be due to pericardial thickening or pericardial effusion, the left and right heart edge normal arc arch disappears, is flat and stiff, the heart beats weakened, the superior vena cava Significantly widened, some patients have calcification in the pericardium and eggshell shape. In addition, the atrial enlargement is seen.

(2) Electrocardiogram: 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.

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

(4) Cardiac catheterization: the mean pressure of the right atrium is elevated, the pressure curve is "M" or "W", the right ventricle pressure is increased, and the pressure curve is a pattern of early diastolic dilation and late diastolic plateau, pulmonary capillary wedge The inlay pressure is also raised.

Differential diagnosis

diagnosis

Typical constrictive pericarditis is not difficult to diagnose based on clinical manifestations and laboratory tests.

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 medical history is not comprehensive, the physical examination is not careful, some important signs are missing, especially the special performance of the heart compression is not enough, or other relevant inspections are not carried out in time. Therefore, 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.

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