eMedicine Specialties > Cardiology > Pericardial Disease

Pericarditis, Constrictive-Effusive: Treatment & Medication

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

Treatment

Medical Care

  • Potentially curative therapy for hemodynamically compromising effusive-constrictive pericarditis requires surgical intervention. However, medical management directed at the underlying etiology may be effective, as dictated by clinical circumstances.
  • No randomized, blinded clinical trials have been completed to guide therapy.
  • Medical therapy is primarily supportive.
    • Depending on putative etiology, steroids, nonsteroidal anti-inflammatory agents, or antibiotics may be needed.
    • Euvolumia is a goal.
    • Salt restriction may be indicated.

Surgical Care

  • Pericardiocentesis or surgical drainage of effusion is performed as dictated by patient's clinical situation. These procedures are undertaken in circumstances of tamponade or hemodynamic compromise, when a purulent effusion is suspected, or in cases with a large persistent effusion or diagnostic uncertainty.23
  • The most effective therapy for effusive-constrictive pericarditis is pericardiectomy with complete removal of the parietal and visceral membranes. The perioperative mortality rate with this procedure can be high. Surgery can be risky and requires considerable thought before it can be recommended. Difficulties include the length of the procedure, infection potential, technical expertise required, morbidity secondary to the wide exposure required, and the other medical problems often present in these patients.
  • In patients who may have a high mortality rate with thoracotomy yet have a significant chance of effusion recurrence with needle drainage alone, a pericardial-peritoneal window is an effective treatment for recurrent pericardial effusions.24

Consultations

  • A cardiologist can assist with echocardiographic interpretation, pericardiocentesis (see Pericardiocentesis), and invasive hemodynamics.
  • A cardiothoracic surgeon may help when a pericardial window or pericardiectomy is being considered.
  • In complicated cases, such as those involving tuberculosis pericarditis or purulent uremic pericarditis, multidisciplinary involvement may be required. Specialists in infectious disease, nephrology, cardiology, and/or cardiothoracic surgery may be consulted.

Diet

  • No specific dietary changes are recommended.
  • Often, these patients have chronic underlying diseases for which adequate nutrition is especially important.

Activity

  • Activity is generally limited by the underlying disease or the decreased cardiac output that may occur with effusive-constriction.
  • No specific prohibitions exist.

Medication

No specific medical therapy exists. Whenever possible, treatment is directed at the underlying cause. Intravascular volume status must not be decreased excessively in the presence of tamponade physiology; diuretics must not be applied indiscriminately. On the other hand, after pericardial drainage, diuretics may be useful with constrictive physiology and evidence of volume overload.

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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References

  1. Goldstein JA. Cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy. Curr Probl Cardiol. Sep 2004;29(9):503-67. [Medline].

  2. Little WC, Freeman GL. Pericardial disease. Circulation. Mar 28 2006;113(12):1622-32. [Medline].

  3. Hancock EW. Subacute effusive-constrictive pericarditis. Circulation. Feb 1971;43(2):183-92. [Medline].

  4. Hoit BD. Management of effusive and constrictive pericardial heart disease. Circulation. Jun 25 2002;105(25):2939-42. [Medline].

  5. Lorell BH. Pericardial diseases. In: Brunwald E, ed. Heart Disease. 5th ed. Philadelphia, PA: WB Saunders; 1997:1496-505.

  6. Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet. Feb 28 2004;363(9410):717-27. [Medline].

  7. Spodick DH, Kumar S. Subacute constrictive pericarditis with cardiac tamponade. Dis Chest. Jul 1968;54(1):62-6. [Medline].

  8. Cameron J, Oesterle SN, Baldwin JC, Hancock EW. The etiologic spectrum of constrictive pericarditis. Am Heart J. Feb 1987;113(2 Pt 1):354-60. [Medline].

  9. Hancock EW. A clearer view of effusive-constrictive pericarditis. N Engl J Med. Jan 29 2004;350(5):435-7. [Medline].

  10. Maisch B. Pericardial diseases, with a focus on etiology, pathogenesis, pathophysiology, new diagnostic imaging methods, and treatment. Curr Opin Cardiol. May 1994;9(3):379-88. [Medline].

  11. Wood P. Chronic constrictive pericarditis. Am J Cardiol. Jan 1961;7:48-61. [Medline].

  12. Spodick DH. The Pericardium: A Comprehensive Textbook. New York, NY: Marcel Dekker; 1997:260-452.

  13. Shabetai R. Pericardial Disease: Etiology, Pathophysiology, Clinical Recognition, and Treatment. New York, NY: Churchill Livingstone; 1995:1024-35.

  14. Sagrista-Sauleda J, Angel J, Sanchez A, et al. Effusive-constrictive pericarditis. N Engl J Med. 2004;350(5):469-75. [Medline].

  15. Zagol B, Minderman D, Munir A, D'Cruz I. Effusive constrictive pericarditis: 2D, 3D echocardiography and MRI imaging. Echocardiography. Nov 2007;24(10):1110-4. [Medline].

  16. Akhter MW, Nuño IN, Rahimtoola SH. Constrictive pericarditis masquerading as chronic idiopathic pleural effusion: importance of physical examination. Am J Med. Jul 2006;119(7):e1-4. [Medline].

  17. Rafailidis PI, Prapas SN, Kasiakou SK, Costeas XF, Falagas ME. Effusive-constrictive calcific pericarditis associated with Streptococcus salivarius. Case report and review of the literature. Cardiol Rev. May-Jun 2005;13(3):113-7. [Medline].

  18. Fowler NO, Manitsas GT. Infectious pericarditis. Prog Cardiovasc Dis. Nov-Dec 1973;16(3):323-36. [Medline].

  19. Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmüller R, Adler Y. 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. Eur Heart J. Apr 2004;25(7):587-610. [Medline].

  20. Feigenbaum H, Armstrong W. Pericardial diseases. In: Feigenbaum's Echocardiography. 6th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2004:260-9.

  21. Ha JW, Lee JD, Ko YG, Yun M, Rim SJ, Chung N. Images in cardiovascular medicine. Assessment of pericardial inflammation in a patient with tuberculous effusive constrictive pericarditis with 18F-2-deoxyglucose positron emission tomography. Circulation. Jan 3 2006;113(1):e4-5. [Medline].

  22. Maisch B, Pankuweit S, Brilla C, et al. Intrapericardial treatment of inflammatory and neoplastic pericarditis guided by pericardioscopy and epicardial biopsy: results from a pilot study. Clin Cardiol. Jan 1999;22(1 Suppl 1):I17-22. [Medline].

  23. Olson JE, Ryan MB, Blumenstock DA. Eleven years' experience with pericardial-peritoneal window in the management of malignant and benign pericardial effusions. Ann Surg Oncol. Mar 1995;2(2):165-9. [Medline].

  24. Olsen PS, Sorensen C, Andersen HO. Surgical treatment of large pericardial effusions. Etiology and long- term survival. Eur J Cardiothorac Surg. 1991;5(8):430-2. [Medline].

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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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