Constrictive pericarditis

The diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics mimic restrictive cardiomyopathy. Variou s diagnostic advances over the years enable us to differentiate between the se two conditions. This review begins with a case report of constrictive pe ricarditis, followed by a brief history and discussions of etiologies. Clin ical features, radiologic, electrocardiographic, angiographic findings, and hemodynamics of constrictive pericarditis are reviewed. The echocardiograp hic findings are detailed and the recent advances in Doppler flow velocity patterns of pulmonary, mitral, tricuspid valves and hepatic veins are repor ted. Nuclear ventriculograms depict rapid ventricular filling in constricti ve pericarditis and differentiate it from restrictive cardiomyopathy. Endom yocardial biopsy helps further in recognizing the various types of restrict ive cardiomyopathies. Computed tomography and magnetic resonance imaging de lineate abnormal pericardial thickness in constrictive pericarditis. Associ ation of characteristic hemodynamic changes and abnormal pericardial thickn ess > 3 mm usually confirms the diagnosis of constrictive pericarditis. Eff usive and occult varieties of constrictive pericarditis are briefly describ ed. This review concludes with emphasizing the importance of pericardial re section.