Ĭlinical features of constrictive pericarditis are due to left and right-sided heart failure and elevated filling pressures. Diastolic dysfunction in constrictive pericarditis leads to most of the ventricular filling in the second phase of diastole with minimum ventricular filling in the third and fourth phases of diastole. Systole is usually unimpaired, however, marked diastolic dysfunction occurs. Equalization of end-diastolic pressures in all four cardiac chambers then occurs and is a hallmark feature of constrictive pericarditis. This results in decreased ventricular compliance and thus inhibits adequate diastolic ventricular filling leading to increased venous pressures with decreased stroke volume. Thickening and fibrous scarring with adhesions of the two pericardial layers leads to obliteration of the pericardial cavity and makes the pericardium rigid and thickened. Neoplastic diseases, mainly breast cancer, lung cancer, lymphoma, mesothelioma, and melanoma, are uncommon causes. Idiopathic or post-viral pericarditis is the most common cause followed by postpericardiotomy, radiation-induced causes. It is a late complication of cardiac surgery such as valvular surgery or coronary artery bypass graft. Risk factors leading to post-cardiac surgery constrictive pericarditis are intraoperative hemorrhage into the pericardium, postpericardiotomy syndrome, and postoperative pericarditis. Radiation-induced constrictive pericarditis may have associated radiation damage to the myocardium contrary to other causes of constrictive pericarditis where the myocardium is structurally and functionally normal. Constrictive pericarditis as a late complication of radiation therapy usually occurs several years after radiation therapy. Fungal and parasitic agents are less common causes of infectious etiology. Commonly, idiopathic cases of constrictive pericarditis are likely infectious in etiology, secondary to viral infections by viruses such as coxsackievirus and echovirus. The incidence of constrictive pericarditis secondary to tuberculosis has dropped precipitously in the United States due to effective antitubercular medications. Bacterial infections are another cause of constrictive pericarditis in the developing world but there is a very low number of cases in the United States from bacterial causes due to antibiotics or drainage procedures. Tuberculosis is the most common cause of constrictive pericarditis in developing regions of the world. Chronic pericardial inflammation can result in constrictive pericarditis.
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