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Transcript 
CONSTRICTIVE
PERICARDITIS
Division of Cardiology
Department of Internal Medicine
Tae Kyung Yu
Pericardial Disease

Acute pericarditis

Chronic relapsing pericarditis

Constrictive pericarditis

Cardiac tamponade
Constrictive Pericarditis
 Acute pericarditis나 chronic pericardial
effusion이 healing 되면서 granulation tissue
가 형성되어 pericardium이 두꺼워지고
fibrosis, calcification되어 cardiac filling에 장애
를 초래
 Early diastole 시에는 ventricular filling에 장애
를 받지 않으나 이후에 pericardium의 elastic
limit에 도달하여 심한 ventricular filling의 장애
가 특징
Constrictive Pericarditis의 원인
NEJM 2004;350:5;469-75
Constrictive Pericarditis의 원인
JAMA 2004;43:271-5
Constrictive Pericarditis
 Rarely after an episode of acute idiopathic
pericarditis
 More likely after subacute pericarditis with
effusion that evolve over several weeks
 More frequent after purulent bacterial or
tuberculous pericarditis
Clinical manifestations
 Lung : pleural effusion
 Heart : diastolic pericardial knock
 Abdomen : ascites, pulsatile liver
 Extremities : peripheral edema
 Jugular veins
 Prominent X and Y descent (M shaped contour)
 Kussmaul’s sign
Diagnosis
 Cardiac catheterization
 Square root sign or dip and plateau pattern
: rapid early diastolic filling of the ventricle, followed by
lack of additional filling due to compression in mid and
late diastole
 Echocardiography
Echocardiographic findings
 M-mode and 2D
 Thickened pericardium
 Abnormal ventricular septal motion
(respiratory septal shift Rt-> Lt. in
inspiration, Lt->Rt in expiration)
 Flattening of the LV posterior wall during
diastole
 Respiratory variation in ventricular size
 Dialted IVC
Thickened Pericardium
Dialted IVC
JAMA 2004;43:271-5
Echocardiographic findings
 Two hemodynamic characteristics
1) Dissociation between intrathoracic and
intracardic pr
2) Exaggerated ventricular interdependence in
diastolic filling
Echocardiographic findings
 Doppler echo
 Respiratory variation of 25% or greater in
mitral E velocity
 Increased diastolic flow reversal with
expiration in the hepatic flow
 Increased mitral annulus velocity
Respiratory variation of 25% or
greater in mitral E velocity
↑ diastolic flow reversal with
expiration in the hepatic flow
JAMA 2004;43:271-5
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