The pericardium is composed of two layers, an outer fibrous layer and an inner serous layer. Constrictive pericarditis is a chronic condition characterized by thickening of the outer fibrous layer. This forms a hard shell around the heart which limits diastolic filling, or the heart’s ability to expand when blood enters it. The main causes of constrictive pericarditis are due to processes that cause inflammation to develop around the heart. Such processes include heart surgery, radiation and tuberculosis, in regions where it is common.

Symptoms of constrictive pericarditis include dyspnea, fatigue, edema, ascites and weakness. On physical exam, elevated jugular venous pressure is present in almost all patients. The jugular venous pulse has a pronounced X descent.

Restrictive pericarditis involves the inner serous layer in addition to the outer fibrous layer. Patients present similarly to those with constrictive pericarditis, with dyspnea, edema, and ascites. However, the jugular venous pulse shows a steep Y descent.

Constrictive pericarditis can be differentiated from restrictive pericarditis based on the following diagnostic criteria:

Constrictive pericarditis Restrictive pericarditis
Short IVRT (isovolumic relaxation time) _ +
Sensitivity to respiration +
Short E wave deceleration time +
E/A ratio >1.0 +/- +
Peak pressure <50 mmHg +
RV ED/peak pressure >0.33 +

Definitive care for both constrictive and restrictive pericarditis is primarily surgical (ie, pericardiectomy). Operative therapy typically leads to rapid hemodynamic and symptomatic improvements. Patients with restrictive pericarditis may have a poorer response to pericardectomy than those with constrictive pericarditis because of the involvement of the serous layer.

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