Pediatric Constrictive Pericarditis Clinical Presentation

  • Author: Brian D Soriano; Chief Editor: Stuart Berger, MD   more...
 
Updated: May 11, 2012
 

History

Symptoms are usually similar to those associated with right-sided congestive heart failure.

  • Chest pain
  • Dyspnea
  • Easy fatigability
  • Fever
  • Tachycardia
  • Abdominal fullness
  • Palpitations
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Diaphoresis

In a single-center review of pediatric patients who underwent pericardiectomy from 1978-2008, 11 patients underwent surgery for pericardial constriction. Presenting complaints included chest pain in 4 (36%), shortness or breath in 2 (18%), and heart failure symptoms in 3 (27%).[2]

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Physical

Unlike other forms of pericardial disease, such as acute pericarditis, a friction rub is usually not found. A protodiastolic knock, usually heard along the left sternal border, corresponds to the abrupt cessation of ventricular filling during diastole.

Systemic venous pressures become elevated, and the following features are consistent with right-sided heart failure:

  • Neck vein distention with Kussmaul sign (absence of a drop in jugular venous pulsations during inspiration)
  • Hepatojugular reflux
  • Hepatomegaly
  • Ascites
  • Peripheral (dependent) edema
  • Pulsus paradoxus (rare)
  • A prominent third heart sound
  • Diminished pulse volume
  • Hepatic dysfunction
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Causes

Chronic constrictive pericarditis is a disease with multiple etiologies that is associated with variable clinical findings, depending on the acuity of development.

  • Chronic constrictive pericarditis: This condition develops insidiously; an etiology is often never determined.
  • Acute pericarditis: In some (approximately 10%) patients, an antecedent acute pericarditis is present. Other cases of constriction are postulated to have been preceded by a subclinical, or occult, form of pericarditis.
  • Tuberculosis: Tuberculosis is the most frequently known infectious cause of chronic constrictive pericarditis. Other causal organisms include (among others) staphylococci, streptococci, and fungi such as histoplasmosis.
  • Rheumatoid disease
  • Sarcoidosis
  • Mediastinal radiation
  • Trauma (hemopericardium)
  • Status post–cardiac surgery (postpericardiotomy syndrome)
  • Uremia
  • Neoplastic disease
  • Postinfectious (bacterial) pericarditis
  • Various metabolic and genetic disorders
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Contributor Information and Disclosures
Author

Brian D Soriano  MD, Assistant Professor of Pediatrics, Cardiology Division, University of Washington School of Medicine; Attending Physician, Pediatric Cardiology and Cardiac Imaging, Seattle Children's Hospital

Brian D Soriano is a member of the following medical societies: American Heart Association, American Medical Association, and American Society of Echocardiography

Disclosure: Nothing to disclose.

Coauthor(s)

Charles I Berul, MD  Professor of Pediatrics and Integrative Systems Biology, George Washington University School of Medicine; Chief, Division of Cardiology, Children's National Medical Center

Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society, and Society for Pediatric Research

Disclosure: Johnson & Johnson Consulting fee Consulting

Renee E Margossian, MD  Instructor, Department of Cardiology, Children's Hospital, Harvard University; Consulting Staff, Department of Cardiology, Boston Medical Center and Brigham and Women's Hospital

Renee E Margossian, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Society of Echocardiography, and Heart Failure Society of America

Disclosure: Nothing to disclose.

Kurt Pflieger, MD, FAAP  Active Staff, Department of Pediatrics, Lake Pointe Medical Center

Kurt Pflieger, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Christopher Johnsrude, MD, MS  Chief, Division of Pediatric Cardiology, University of Louisville School of Medicine; Director, Congenital Heart Center, Kosair Children's Hospital

Christopher Johnsrude, MD, MS is a member of the following medical societies: American Academy of Pediatrics and American College of Cardiology

Disclosure: St Jude Medical Honoraria Speaking and teaching

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Hugh D Allen, MD  Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

The authors would like to thank Kurt Pflieger, MD, FAAP for his significant contributions and original work for this article.

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MRI image of constrictive pericarditis in a 13-year-old and an otherwise structurally normal heart. Infectious workup was negative. (Image courtesy of Tal Geva, M.D.)
Left ventricular volume curve in constrictive pericarditis.
 
 
 
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