Constrictive pericarditis

Constrictive pericarditis refers to the gradual formation of thick scar tissue in the pericardium after acute pericarditis, which compresses the heart and great vessels, resulting in restricted ventricular diastole and a series of circulatory disturbances. The common etiologies include tuberculous, purulent, nonspecific, and traumatic causes. Constrictive pericarditis caused by tuberculous infection was more common in the past; over the past thirty years, due to the effectiveness of tuberculosis prevention and treatment efforts, its incidence has significantly declined. Purulent pericarditis, traumatic or other causes of hemopericardium, as well as pericardial viral infection, fungal infection, parasitic disease, tumors, radiation exposure, chylopericardium, uremia, rheumatoid arthritis, systemic lupus erythematosus, and other conditions can also cause constrictive pericarditis. The formation process of constrictive pericarditis is slow, and clinical symptoms of constrictive pericarditis usually appear months or years after acute pericarditis. Common early symptoms include fatigue, easy tiredness, palpitations, dizziness, decreased appetite, weight loss, and dyspnea of varying degrees. As the disease progresses, hepatomegaly, ascites, pleural effusion, lower extremity edema, and pulmonary congestion develop. Ascites and pleural effusion further reduce pulmonary gas exchange, worsening dyspnea, and orthopnea may occur in severe cases. Constrictive pericarditis is a chronic disease with progressive worsening of pericardial thickening and hemodynamic disturbances, often leading to disability or death due to debilitation, ascites and peripheral edema, or severe cardiac complications. If thorough pericardial decortication surgery is performed early, most patients can achieve satisfactory results. A minority of patients with a longer disease course and significant myocardial atrophy and cardiogenic cirrhosis have a poor prognosis.