- Due to progressive thickening, fibrosis and calcification of the pericardium, causing a restricting filling and ejection defect of the myocardium.
- Often a consequence of TB pericarditis, but can also be caused by/secondary to
- Viral pericarditis
- Purulent pericarditis
- Rheumatoid arthritis
- Can be idiopathic
- Signs of right heart failure e.g. hepatomegaly, splenomegaly and ascites are common
- NB Breathlessness is rare (lungs rarely congested)
- Fatigue is also common
- The JVP is abnormal
- Raised with abrupt waveform descents (y > x). May rise further (paradoxically) with inspiration (as in tamponade- Kussmaul’s sign)
- Paradoxical Pulse (abnormal decrease in pulse strength (SBP) during inspiration); pulse will usually be rapid and low
- Auscultation may reveal a ‘pericardial knock’ (early S3).
- A friction rub is actually relatively rare (cf acute disease)
- Pericardial calcification may be seen on CXR. There may also be left and right atrial enlargement.
- Echocardiography (heart function)
NB Can be difficult to differentiate from restrictive cardiomyopathy and further testing e.g. doppler echo or catheter tests may be required to do this
- Pericardectomy is the only definitive treatment. However, mortality and complication rate is high and it may not benefit every patient.
- Otherwise, treatment is largely supportive