From the Guidelines
Yes, transient constrictive pericarditis in a patient with a connective tissue disorder can present with transient narrow pulse pressure and hypotension. This occurs because the inflamed and thickened pericardium restricts normal cardiac filling during diastole, leading to decreased stroke volume and cardiac output. The narrow pulse pressure (the difference between systolic and diastolic blood pressure) results from reduced ventricular filling and subsequent decreased stroke volume. Hypotension develops as a consequence of the compromised cardiac output. In patients with connective tissue disorders such as systemic lupus erythematosus, rheumatoid arthritis, or scleroderma, pericardial inflammation can be part of the systemic inflammatory process. The transient nature of these hemodynamic changes may correspond to flares in the underlying connective tissue disease or response to anti-inflammatory treatment. Management typically involves treating the underlying connective tissue disorder with appropriate immunosuppressive therapy, along with supportive care including careful fluid management, anti-inflammatory medications such as NSAIDs or colchicine (0.5-0.6 mg once or twice daily), and in some cases, corticosteroids like prednisone (starting at 0.25-0.5 mg/kg/day and tapering based on response) 1.
Some key points to consider in the management of transient constrictive pericarditis include:
- The detection of elevated CRP and imaging evidence of pericardial inflammation by contrast enhancement on CT and/or CMR may be helpful to identify patients with potentially reversible forms of constriction where empiric anti-inflammatory therapy should be considered and may prevent the need for pericardiectomy 1.
- Medical therapy may have a role in at least three conditions: treatment of specific aetiologies, resolution of transient constriction, and supportive care in advanced cases 1.
- The 2015 ESC guidelines for the diagnosis and management of pericardial diseases provide a comprehensive approach to the management of transient constrictive pericarditis, including the use of anti-inflammatory therapy and supportive care 1.
It is essential to prioritize the patient's morbidity, mortality, and quality of life when making management decisions, and to consider the most recent and highest quality evidence available 1.
From the Research
Presentation of Transient Constrictive Pericarditis
- Transient constrictive pericarditis in a patient with a connective tissue disorder can present with various symptoms, including transient narrow pulse pressure and hypotension 2.
- The condition is characterized by a transient inflammation or thickening of the pericardium, which can be caused by viral, bacterial, or immunologically mediated pericarditis 2.
- Patients with constrictive pericarditis may exhibit symptoms of right-sided heart failure, such as dyspnea and peripheral edema, due to the rigid pericardium encasing the heart and impairing diastolic filling 3.
Diagnostic Features
- Doppler echocardiography can be used to diagnose transient constrictive pericarditis, with characteristic respiratory changes in Doppler flow velocities 2.
- Cardiac magnetic resonance imaging (CMR) can also be used to diagnose constrictive pericarditis, as it can show pericardial thickening and other characteristic features 3.
- Invasive biventricular pressure measurements can also be used to diagnose constrictive pericarditis, as they can show equalization of diastolic pressures in the two ventricles 3.
Clinical Implications
- Awareness of the possible transient nature of constrictive pericarditis has important clinical implications when pericardiectomy is considered 2.
- Transient constrictive pericarditis can resolve spontaneously or with medical treatment, such as nonsteroidal anti-inflammatory agents, corticosteroids, and antibiotics 2.
- Pericardiectomy is the standard treatment for patients with chronic constrictive pericarditis who have persistent symptoms, but it can lead to transient right ventricular dysfunction after the procedure 4.