Constrictive pericarditis medical therapy

Jump to: navigation, search

Constrictive Pericarditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Constrictive Pericarditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Future or Investigational Therapies

Case Studies

Case #1

Constrictive pericarditis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Google Images

American Roentgen Ray Society Images of Constrictive pericarditis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Constrictive pericarditis medical therapy

CDC on Constrictive pericarditis medical therapy

Constrictive pericarditis medical therapy in the news

Blogs on Constrictive pericarditis medical therapy

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Constrictive pericarditis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor in Chief: M.Umer Tariq [2]

Overview

Pericardial constriction is a progressive disease without spontaneous reversal of the pericardial thickening. Some patients can be medically managed for several years. Edema can be controlled with diuretics and slowing of the heart rate can maximize the diastolic filling time. Most patients eventually develop significant debility from impaired cardiac output and elevated right and left sided filling pressures.

Medical Therapy

A few case series since 1987 have mentioned transient constrictive pericarditis that appears to be associated with pericardial inflammation. The use of cardiac MRI has made it possible to identify pericardial inflammation with the use of late gadolinium enhancement. This particular type of constrictive pericarditis can be treated with anti-inflammatory therapy and prevent its progression to irreversible disease requiring pericardiectomy

Transient pericarditis can be treated medically by:

  • NSAIDS
  • Steroids
  • Heart failure management
  • Chemotherapy

If medical therapy fails, transient pericarditis can be treated by pericardiectomy

Chronic constrictive pericarditis:

  • Complete pericardiectomy
  • Pericardiectomy is associated with 5-10% peri-operative mortality

2015 ESC Guidelines for the management of pericardial diseases: (DO NOT EDIT) [1]

Recommendations for therapy of constrictive pericarditis:

Class I
"1. The mainstay of treatment of chronic permanent constriction is pericardiectomy" "1. (Level of Evidence: C)"
"2. Medical therapy of specific pericarditis (i.e tuberculous pericarditis) is recommended to prevent the progression of constriction (Level of Evidence: C)"


Class IIb
"1. Empiric anti-inflammatory therapy may be considered in cases with transient or new diagnosis of constriction with concomitant evidence of pericardial inflammation (i.e. CRP elevation or pericardial inflammation (i.e. CRP elevation or pericardial enhancement on CT/CMR) (Level of Evidence: C )"

Sources

  • 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS)[1]

References

  1. 1.0 1.1 Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J; et al. (2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS)". Eur Heart J. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. PMID 26320112.



Linked-in.jpg