Constrictive Pericarditis - Diagnosis

Diagnosis

The diagnosis of constrictive pericarditis is often difficult to make. In particular, restrictive cardiomyopathy has many similar clinical features to constrictive pericarditis, and differentiating them in a particular individual is often a diagnostic dilemma.

• Imaging will demonstrate a thickened pericardium and you will see an increased early diastolic filling with reduced filling in mid-diastole. In contrast, with restrictive cardiomyopathy there is an increased resistance to ventricular filling due to increased myocardial stiffness. Imaging features of restrictive cardiomyopathy demonstrate an increased left ventricular thickness with infiltration of the myocardium.

• Chest X-Ray - pericardial calcification (common but not specific), pleural effusions are common findings.

• Echocardiography - demonstrates reduced end-diastolic volumes and elevated diastolic pressures.

• CT and MRI - useful in select cases.

• BNP Blood Test - (FDA approved in 2002) tests for the existence of the cardiac hormone Brain Natriuretic Peptide which is only present in RCMP but not in CP, and is particularly helpful in determining the specific CHF type.

• Clinical features -

• Kussmaul's sign (raised JVP on inspiration)
• increased JVP (almost universal), rapid descent (prominent diastolic collapse of JVP)
• pericardial knock in around 50% cases
• hepatomegaly and other signs of right heart failure; ascites; fatigue; peripheral edema