In constrictive pericarditis, the pericardium becomes fibrotic and thickened due to prolonged inflammation, thereby forming a hardened enclosure around the heart. This limits adequate cardiac relaxation, thus greatly reducing end diastolic volume and therefore, the stroke volume.
Symptoms include easy fatigability, dyspnea, abdominal and leg swelling, as well as symptoms of the underlying cause. Clinical signs that may be elicited include a pericardial knock, Kussmaul's sign and signs associated with the underlying cause.
Causes include, but are not limited to, tuberculosis (common in developing countries and immunocompromised individuals), chronic pericarditis (viral, fungal, or parasitic), post-surgical pericarditis, and ionizing radiation-induced pericarditis.
Treatment is by subtotal or radical pericardiectomy.
Pericardiectomy is the surgical removal of the pericardium; this is typically performed when the latter is diseased and fibrosed, thereby impairing adequate expansion of the heart chambers. The procedure is the mainstay of treatment for constrictive pericarditis and may be either subtotal or radical.
A pericardiotomy is quite different; it is an incision made into the pericardial space. This is most often performed to gain access to the heart during heart surgery; it may also be used to create a window through which to drain excess pericardial fluid.
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