2: Constrictive Pericarditis | Pathology USMLE Step 1 

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Constrictive Pericarditis
Definition and Pathophysiology
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Constrictive pericarditis is a condition characterized by the fibrotic thickening and calcification of the pericardium, leading to impaired diastolic filling of the heart. The thickened pericardium restricts cardiac expansion during diastole, resulting in impaired ventricular filling and decreased cardiac output. Chronic inflammation, often secondary to prior episodes of pericarditis, leads to fibrosis and calcification of the pericardial layers.
Etiology
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Idiopathic: In many cases, the exact cause remains unknown.
Post-inflammatory: Follows episodes of acute pericarditis, viral infections, tuberculosis, or radiation therapy.
Iatrogenic: Secondary to cardiac surgery or pericardial interventions.
Autoimmune diseases: Conditions such as systemic lupus erythematosus (SLE) or rheumatoid arthritis may lead to constrictive pericarditis.
Clinical Features
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Fatigue and exercise intolerance due to decreased cardiac output.
Peripheral edema and ascites from right-sided heart failure.
Kussmaul's sign: Paradoxical rise in jugular venous pressure during inspiration.
Hepatomegaly and hepatic congestion.
Pericardial knock: Early diastolic sound due to abrupt cessation of ventricular filling.
Diagnosis
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Echocardiography: May reveal thickened pericardium and abnormal septal motion.
Chest X-ray: Pericardial calcifications ("pericardial calcification halo").
Cardiac catheterization: Shows equalization of pressures in all cardiac chambers during diastole.
MRI or CT scan: Provides detailed imaging of pericardial thickening and calcifications.
Treatment
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Diuretics: Provide symptomatic relief by reducing fluid overload.
Pericardiectomy: Surgical removal of the thickened pericardium is the definitive treatment, leading to improved cardiac function and symptom resolution.
Anti-inflammatory medications: Used cautiously in select cases to reduce inflammation and fibrosis.
Prognosis
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Prognosis depends on the underlying etiology and timely intervention.
Pericardiectomy can lead to significant improvement in symptoms and outcomes.
Without treatment, constrictive pericarditis may lead to progressive heart failure and significant morbidity.
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