From the Guidelines
Yes, patients with transient constrictive pericarditis can experience episodes of effusive constriction. This condition is characterized by the coexistence of fluid accumulation in the pericardial space (effusion) and pericardial thickening/constriction, creating a mixed hemodynamic picture where both tamponade-like features and constrictive features may be present simultaneously 1.
Key Points to Consider
- Effusive-constrictive pericarditis represents a clinical entity where both fluid accumulation and pericardial thickening/constriction coexist, which can occur in patients with transient constrictive pericarditis 1.
- The constrictive physiology in transient constrictive pericarditis resolves spontaneously or with anti-inflammatory therapy, but during the active inflammatory phase, patients may develop pericardial effusion alongside the constrictive features 1.
- Management typically involves anti-inflammatory medications such as colchicine, NSAIDs, and sometimes corticosteroids, with pericardiocentesis necessary if significant effusion is causing hemodynamic compromise 1.
- The underlying pathophysiology involves inflammation causing both fluid accumulation and pericardial thickening, with the potential for resolution as inflammation subsides with appropriate treatment 1.
Important Considerations for Management
- Monitoring of intrapericardial pressures, right heart pressures, and systemic arterial blood pressure during elective pericardiocentesis is recommended to diagnose effusive-constrictive pericarditis 1.
- Non-invasive imaging, such as CMR, can be equally useful for diagnosis and provides the opportunity to evaluate pericardial thickness, cardiac morphology, and function 1.
- Pericardiectomy for effusive-constrictive pericarditis should be performed only at centers with experience in pericardiectomy for constrictive pericarditis, and visceral pericardiectomy must be performed 1.
From the Research
Episodes of Effusive Constriction in Patients with Transient Constrictive Pericarditis
- Patients with transient constrictive pericarditis may experience episodes of effusive constriction, as both conditions involve the pericardium and can present with similar symptoms 2.
- Transient constrictive pericarditis is characterized by a temporary loss of pericardial compliance, which can lead to clinical signs of right heart failure 3.
- Effusive constrictive pericarditis is a rare condition that combines features of pericardial effusion and constrictive pericarditis, and can be caused by various factors, including tuberculosis and cardiac surgery 4, 5.
- Some patients with effusive acute idiopathic pericarditis may go through a transient phase of cardiac constriction at the end of the effusive period, which can be subtle and go unrecognized if not specifically sought 2.
- The diagnosis of effusive constrictive pericarditis is typically made when symptoms and right heart pressure elevation persist despite drainage of pericardial effusion, and treatment options include pericardiectomy and medical management with steroids and colchicine 4, 6.