eMedicine Specialties > Cardiology > Pericardial Disease

Pericarditis, Constrictive-Effusive: Follow-up

Author: D Dirk Bonnema, MD, Cardiology Fellow, Division of Cardiology, Department of Medicine, Medical University of South Carolina; Research Fellow, Division of Cardiology, 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: Aug 26, 2008

Follow-up

Further Inpatient Care

  • Inpatient care is required to monitor the patient if hemodynamic compromise is possible (see Cardiac Tamponade).
  • Necessary pericardial procedures usually involve hospitalization.

Further Outpatient Care

  • The priorities of outpatient care reflect treating specific etiologies and monitoring patients for signs of worsening constrictive physiology or for the development of cardiac tamponade.

Inpatient & Outpatient Medications

  • In general, patients are given maintenance therapy with a diuretic to maintain euvolumia.
  • Other medications depend on the specific etiology being treated.

Transfer

  • Transfer is required when necessary diagnostic or therapeutic modalities such as echocardiography, pericardiocentesis, or cardiothoracic surgery are not available at the treating facility.

Complications

  • When visceral pericardiectomy is not chosen as the plan of care, the underlying disease may progress and cause recurrent and/or worsening effusive-constriction syndrome or constrictive pericarditis (see Pericarditis, Constrictive).
  • Because effusive-constrictive pericarditis is rare, intrapericardial pressures are not routinely measured during pericardiocentesis in clinical practice. This protocol may result in failure to recognize intrapericardial pressure as near zero. The consequences of this oversight include missing the diagnosis of effusive-constrictive pericarditis.

Prognosis

  • The patient's prognosis depends on the underlying etiology and the rate of progression of the constrictive physiology.
  • Visceral pericardiectomy is a delicate procedure, and only experienced surgeons should undertake this procedure.
  • Because constrictive pericarditis (see Pericarditis, Constrictive) is potentially curable with surgery, the prognosis may be good.

Patient Education

  • Although the symptoms of effusive-constriction are nonspecific, patients should be counseled to report any new or worsened dyspnea, ascites, weight loss or gain, peripheral edema, fever, or chest pain or pressure.

Miscellaneous

Medicolegal Pitfalls

  • The initial potential pitfall is diagnosing a pericardial effusion, which usually is straightforward after echocardiography is performed
  • Failure to establish a potential etiology and to diagnose constriction can worsen outcomes.
  • Failure to consider the development of cardiac tamponade in the differential, which can quickly become life threatening, may be catastrophic.
  • Failure to direct the evaluation of effusive-constrictive pericarditis along the lines of the locally available imaging technology and expertise is a pitfall; referral is required when diagnostic or invasive methods cannot be obtained otherwise.
 
Acknowledgments

Acknowledgment for support for this chapter is given to 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.



More on Pericarditis, Constrictive-Effusive

Overview: Pericarditis, Constrictive-Effusive
Differential Diagnoses & Workup: Pericarditis, Constrictive-Effusive
Treatment & Medication: Pericarditis, Constrictive-Effusive
Follow-up: Pericarditis, Constrictive-Effusive
References
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Further Reading

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Keywords

constrictive-effusive pericarditis, pericarditis, pericardial effusion, pericardial constriction, transudative pericardial effusion, exudative pericardial effusion, sanguineous pericardial effusion, chylous pericardial effusion, chronic effusive pericarditis, chronic pericardial effusion, visceral pericardial constriction, constrictive pericarditis, subacute pericarditis

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Contributor Information and Disclosures

Author

D Dirk Bonnema, MD, Cardiology Fellow, Division of Cardiology, Department of Medicine, Medical University of South Carolina; Research Fellow, Division of Cardiology, Department of Medicine, Medical University of South Carolina
D Dirk Bonnema, MD is a member of the following medical societies: South Carolina Medical Association
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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