From the Guidelines
Tuberculous pericarditis is the most significant type of pericarditis that leads to constrictive pericarditis later, particularly in developing countries where TB is endemic 1.
Causes of Constrictive Pericarditis
The development of constrictive pericarditis is often associated with infectious pericarditis, including:
- Tuberculous pericarditis
- Bacterial pericarditis
- Purulent pericarditis Other causes include radiation therapy, cardiac surgery, autoimmune disorders, and malignancies involving the pericardium.
Risk of Progression
The risk of progression from acute to constrictive pericarditis is higher in cases with more severe or recurrent inflammation 1. Early identification and aggressive treatment of the underlying cause of pericarditis may help prevent progression to constrictive pericarditis.
Treatment and Prevention
Standard anti-TB drugs for 6 months are recommended for the prevention of tuberculous pericardial constriction 1. Additionally, adjunctive corticosteroid therapy with prednisolone may reduce the incidence of constrictive pericarditis 1.
Key Considerations
- Tuberculous pericarditis has a high mortality rate, ranging from 17-40% at 6 months after diagnosis 1.
- Constrictive pericarditis can develop within 6 months of presentation with effusive pericarditis 1.
- Pericardiectomy may be recommended if the patient's condition is not improving or is deteriorating after 4-8 weeks of antituberculosis therapy 1.
From the Research
Types of Pericarditis Leading to Constrictive Pericarditis
- Tuberculous pericarditis is a leading cause of constrictive pericarditis, especially in nonindustrialized countries 2, 3, 4
- The development of constrictive pericarditis is a severe complication of tuberculous pericardial disease, occurring in a significant proportion of cases after tuberculous pericardial effusion 4
- Other types of pericarditis, such as idiopathic or viral pericarditis, can also lead to constrictive pericarditis, although the risk is lower compared to tuberculous pericarditis 5
Risk of Constrictive Pericarditis
- The risk of constrictive pericarditis is higher in patients with tuberculous pericarditis, with a mortality rate of 17% to 40% if left untreated 4
- Early diagnosis and institution of appropriate therapy are critical to prevent mortality and reduce the risk of constrictive pericarditis 4
- The use of antituberculous therapy, with or without corticosteroids, can reduce the risk of constrictive pericarditis in patients with tuberculous pericarditis 2, 4, 6
Diagnosis and Treatment
- Diagnosis of tuberculous pericarditis is based on demonstration of tubercle bacilli in pericardial fluid or on histologic section of the pericardium, or proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis 2, 4
- Treatment of tuberculous pericarditis consists of 4-drug therapy (isoniazid, rifampin, pyrazinamide, and ethambutol) for 2 months followed by 2 drugs (isoniazid and rifampin) for 4 months, with or without corticosteroids 2, 4, 6
- Surgical resection of the pericardium may be indicated for patients with calcific constrictive pericarditis or with persistent signs of constriction after a trial of antituberculosis treatment 2, 4, 6