The pericardium is the membranous sac that encloses the heart, serving to protect and support this vital organ. It is composed of two main layers: the outer fibrous pericardium, which provides structural integrity and protection, and the inner serous pericardium. The serous pericardium, in turn, consists of two layers connected at the root of the great vessels: the outer parietal layer, which lines the fibrous pericardium, and the inner visceral layer, which covers the entire surface of the heart. Between these serous layers, a small amount of serous fluid is present, which acts as a lubricant, allowing the heart to move smoothly within the pericardial sac and reducing friction.
Chronic inflammation of the pericardium, a condition known as pericarditis, can lead to structural changes in the pericardium, potentially affecting ventricular relaxation during the heart's diastolic phase. This inflammation can impact the heart's function and overall health.
Pathophysiology and etiology
If the inflammation has occurred in the pericardium layers, it will lead to calcification, fibrosis, and scarring that results in the thickening and fusion of the pericardium layers and loss of the inflation ability of the heart during the filling of ventricles. Consequently, venous return will be limited as ventricular pressure is increased while preload and ventricular filling are decreased after early normal ventricular filling that is maintained through the normal myocardium of ventricles.
If pericardium infection spreads to the myocardium and leads to structural changes, the systolic function of the ventricles will be affected, so the cardiac output will be reduced progressively.
Constrictive pericarditis major causes include:
Clinical Presentation
Constrictive pericarditis may be associated with various clinical symptoms that usually develop over years and are related to the pathogenesis and complications of constrictive pericarditis. These symptoms may include:
Diagnostic Considerations
I) A physical examination may reveal several findings that may involve the following:
II) Laboratory tests may show disease complications or an underlying cause.
III) Chest radiography usually has low specificity and sensitivity but may be able to detect severe pericardial calcification.
IV) Echocardiography findings are not usually remarkable but may detect any thickness in the pericardium, vein distention, and ventricular dysfunction.
V) Computed tomography and magnetic resonance imaging can prclearly visualizehe the pericardium.
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