eMedicine Specialties > Cardiology > Pericardial Disease

Pericarditis, Constrictive: Follow-up

Author: Darren S Sidney, MD, MS, Cardiology Fellow, Department of Medicine, Medical University of South Carolina
Coauthor(s): Terrence X O'Brien, MD, FACC, Office of Research and Development, Ralph H Johnson Veterans Affairs Medical Center; Professor, Department of Medicine, Division of Cardiology, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Jul 8, 2008

Follow-up

Further Inpatient Care

  • Given the invasive nature of certain diagnostic procedures, inpatient care is often warranted in the workup.

Further Outpatient Care

  • Outpatient care may be appropriate in the early stages, particularly when the diagnosis is still uncertain and the symptoms are relatively stable.

Inpatient & Outpatient Medications

  • Commonly, diuretics (particularly loop-type) are titrated to optimal clinical volume status.
  • Any other medications used to treat patients with constrictive pericarditis would be specific to the underlying etiology of the pericardial disease.

Transfer

  • If adequate diagnostic or therapeutic modalities are not available, transfer to an appropriate facility is warranted.

Complications

  • Complications arise with failure to diagnose or treat constrictive pericarditis adequately, including any existing underlying etiology. Surgical intervention poses separate and significant complication risks (see Surgical Care).

Prognosis

  • Long-term prognosis with medical therapy alone is poor.
  • With surgery, the long-term outcome of patients with constrictive pericarditis has been shown to be independently less favorable with advanced age, poor renal function, abnormal left ventricular systolic function, high pulmonary artery systolic pressure, lower serum sodium level, worsening NYHA classification, and, most notably, with a postradiation cause. Pericardial calcification has shown no effect on survival.
  • A recent study showed postpericardiectomy survival rates of 71% and 52% at 5 and 10 years, respectively.
  • Long-term survival after pericardiectomy depends on the underlying cause. Of common causes, idiopathic constrictive pericarditis has the best prognosis, followed by constriction due to cardiac surgery.

Patient Education

  • Patients should discuss any unexplained dyspnea, abdominal swelling, or edema with their doctor.

Miscellaneous

Medicolegal Pitfalls

  • Constrictive pericarditis is a potentially curable disease if diagnosed early, but it is potentially fatal if overlooked.
  • The clinician must always keep constrictive pericarditis in the differential of any patient who presents with unexplained dyspnea, gastrointestinal symptoms, ascites, or edema.

Special Concerns

Referral to a specialized center may be required.

 
Acknowledgments

Acknowledgments for this work include support by the Office of Research and Development, Medical Research Service, Ralph H. Johnson Department of Veterans Affairs Medical Center, and the Gazes Cardiac Research Institute, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. Dr. Weems Pennington is also acknowledged for the contributions he made to the previous version of this article. 



More on Pericarditis, Constrictive

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Multimedia: Pericarditis, Constrictive
References
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Further Reading

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Keywords

constrictive pericarditis, pericardium, acute pericarditis, chronic pericarditis, pericarditis, diastolic filling, restrictive cardiomyopathy, calcific constrictive pericarditis, pericardial effusion, pericardial organization, chronic fibrotic scarring, calcification, restricted cardiac filling, idiopathic pericarditis, infectious pericarditis, radiation-induced pericarditis, postsurgical pericarditis, postmyocardial infarction pericarditis, Kussmaul sign, tuberculosis, tuberculous pericarditis, postradiation constrictive pericarditis, cardiac surgery, pericardiectomy, pericardial constriction, viral pericarditis, coxsackievirus A, coxsackievirus B, echoviruses, adenoviruses, purulent pericarditis, coronary artery bypass grafting, neoplasms, uremia, connective tissue disorders, drug-induced pericarditis, chylopericardium, bacterial pericarditis, fungal pericarditis

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Contributor Information and Disclosures

Author

Darren S Sidney, MD, MS, Cardiology Fellow, Department of Medicine, Medical University of South Carolina
Disclosure: Nothing to disclose.

Coauthor(s)

Terrence X O'Brien, MD, FACC, Office of Research and Development, Ralph H Johnson Veterans Affairs Medical Center; Professor, Department of Medicine, Division of Cardiology, Medical University of South Carolina
Terrence X O'Brien, MD, FACC is a member of the following medical societies: American College of Cardiology, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Eric Vanderbush, MD, Chief, Department of Internal Medicine, Division of Cardiology, Clinical Assistant Professor, Harlem Hospital Center and Columbia University
Eric Vanderbush, MD is a member of the following medical societies: American College of Cardiology and American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ronald J Oudiz, MD, Director of Pulmonary Hypertension, Associate Professor, Department of Medicine, Division of Cardiology, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA
Ronald J Oudiz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Heart Association
Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

George A Stouffer III, MD, Henry A Foscue Distinguished Professor of Medicine and Cardiology, Director of Interventional Cardiology, Cardiac Catheterization Laboratory, Chief of Clinical Cardiology, Division of Cardiology, University of North Carolina Medical Center
George A Stouffer III, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, Phi Beta Kappa, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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