Chronic Effusive-Constrictive Pericarditis Epidemiology The prevalence of Effusive Constrictive Pericarditis ranges from 2.4 to 14.

8%, with an average of 4.5%. Sixty-five per cent of patients required pericardiectomy regardless of the etiology of the disease. The combined death rate across recent studies was 22%. Etiology and Pathophysiology *See attached table Constrictive pericarditis and cardiac tamponade both restrict filling of the cardiac chambers, thereby increasing systemic and pulmonary filling pressures. In tamponade, single forward flow occurs during systole, whereas in constriction, a biphasic pressure tracing is greater during diastole. Patients with effusive-constrictive pericarditis may have tamponade-like pressure tracings, which change to constrictive-like tracings after pericardiocentesis. This is because the visceral, rather than the parietal, pericardium is constrictive. Almost any form of chronic pericardial effusion has the potential to organize into an effusive-constrictive state even though the absolute number of cases is relatively low. Effusiveconstrictive pericarditis may be part of a clinical continuum. Stages of infective pericarditis have been observed that range from acute pericarditis and tamponade with effusion to constrictive pericarditis without effusion. Effusive-constrictive pericarditis is likely a middle phase in this evolution. Therefore, suspicion for this entity should be high in cases of indolent, subacute pericarditis, as well in cases of chronic pericardial effusion. Large effusions are common with neoplastic, tuberculous, cholesterol, uremic pericarditis, myxedema, and parasitoses. Symptoms Symptoms are usually mild and related to the degree of cardiac compression and pericardial inflammation. angina dyspnea palpitations fatigue orthopnea cough dysphagia unconsciousness Physical Signs Classic Beck Triad: 1. hypotension 2. jugular venous distension 3. diminished heart sounds Other physical signs: Pulsus paradoxus (paradoxical pulse), jugular venous pulse with a prominent x descent and absent y descent, tachycardia, tachypnea, hepatomegaly, ascites, peripheral edema, pleural effusion, renal dysfunction, liver dysfunction and auscultation of a pericardial friction rub

Diagnostic Tests and Expected Results *See table Additionally, the detection of the curable causes such as tuberculosis, toxoplasmosis, myxedema, autoimmune diseases and systemic diseases allows for specific therapy. Basic Treatment medical management directed at the underlying etiology steroids nonsteroidal anti-inflammatory agents antibiotics pericardial drainage diuretics surgical intervention: pericardiectomy Surgical approach is only recommended in patients with very large chronic effusion in whom repeated pericardiocentesis and/or intrapericardial therapy were not successful. Bibliography
1. D Dirk Bonnema. Constrictive-Effusive Pericarditis. 3 May 2012. Medscape. 26 November 2012. http://emedicine.medscape.com/article/157216-overview#showall 2. Guidelines on the Diagnosis and Management of Pericardial Diseases Executive Summary: The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology. The European Heart Journal (2004) 25(7): 587-610 26 November 2012. <http://eurheartj.oxfordjournals.org/content/25/7/587.full> 3. Ntsekhe M, Shey Wiysonge C, Commerford PJ, Mayosi BM. The prevalence and outcome of effusive constrictive pericarditis: a systematic review of the literature. Carldiovascular Journal of Africa. June 2012. 23(5):281-5. 26 November 2012. <http://www.ncbi.nlm.nih.gov/pubmed/22240903>