Epidemiology

• Effusion is present in 28% of all pericardial disease cases (including constrictive pericarditis and acute pericarditis)

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Physiology

• Mechanism: elevated systemic capillary and PCWP pressures with transudation of fluid into pleural space
• Development of “Cardiac Cirrhosis”: hepatic vein pressures are typically higher in constrictive pericarditis than those in right-sided congestive heart failure -> increasing probablity of developing hepatic necrosis (and ultimately cardiac cirrhosis)

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Diagnosis

• Echocardiogram: necessary
• Swan: necessary
• Cardiac Catheterization:

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Clinical Manifestations

Cardiac Manifestations

• General Features
  • Elevated Jugular Venous Pressure
  • Kussmaul’s Sign (see Kussmaul’s Sign, [[Kussmauls Sign]]): rise in the jugular venous pressure on inspiration
  • Pericardial Calcification on CXR
  • Pericardial Knock
• Features Characteristic of Fluid Overload-Type Presentation
  • Anasarca
  • Peripheral/Lower Extremity Edema (see Lower Extremity Edema, [[Lower Extremity Edema]])
• Features Characteristic of Low Cardiac Output-Type Presentation
  • Exertional Dyspnea (see Dyspnea, [[Dyspnea]])
  • Fatigue (see XXX)

Gastrointestinal Manifestations

• “Cardiac Cirrhosis” (see Congestive Hepatopathy, [[Congestive Hepatopathy]])
• Congestive Hepatopathy (Passive Hepatic Congestion) (see Congestive Hepatopathy, [[Congestive Hepatopathy]])
  • Absence of Jaundice/Hyperbiliruinemia: often absent in cases due to constrictive pericarditis (for unclear reasons)
  • Ascites
  • Hepatomegaly
  • Peripheral Edema
  • Pulsatile Liver

Pulmonary Manfestations

• Pleural Effusion (See Pleural Effusion-Transudate, [[Pleural Effusion-Transudate]])
  • Pleural effusion is present in 28-60% of cases
  • Can be left, right, or bilateral
• xxx

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Treatment

• xxx

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References

• xxx