Imazio et reported 3 main syndromes associated with constrictive pericarditis.
Syndromes:
(1) transient
(2) effusive-constrictive
(3) chronic
In transient constriction the constriction is reversible (spontaneous or after medical therapy).
In effusive-constrictive pericarditis there is a pericardial effusion in addition to the constricted pericardium. It is associated with a failure of the right atrial pressure to fall sufficiently after pericardiocentesis. It is diagnosed if the right atrial pressure does not fall by >= 50% OR fall below 10 mm Hg.
In chronic constriction the constriction persists for > 3 months. It may be associated with pericardial calcifications. It may be complicated by cachexia, atrial fibrillation, protein-losing enteropathy, low cardiac output and chronic hepatic dysfunction.
Medical therapy consists of 8-12 weeks of therapy with empiric anti-inflammatory drugs, with or without pericardiocentesis. Surgery (pericardiectomy) may be needed for severe or chronic constriction. In constrictive pericarditis it may be necessary perform a visceral pericardiectomy, a procedure that requires expertise and careful patient management.
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