Constrictive Pericarditis

Need Care for Constrictive Pericarditis? Orange County Relies on Hoag for Advanced Cardiac Treatment

Constrictive pericarditis is a rare cardiac condition, with only a relative handful of cases diagnosed in the U.S. each year. That can make it hard to find the answers and treatment options patients with pericardial disease can rely on, even here in Southern California.

Hoag’s Jeffrey M. Carlton Heart and Vascular Institute stands ready to help patients with rarely-seen cardiac issues, including those with constrictive pericarditis. Our team of cardiovascular specialists have experience that can make a world of difference in your level of care.

That dedication is why U.S. News & World Report rated Hoag among the best hospitals in the nation for Heart Failure in 2023-2024.

Read on for what you need to know about constrictive pericarditis, including symptoms, causes, risk factors and ways to potentially reduce your risk. And if you need treatment for pericarditis in Huntington Beach, Newport Beach, Fountain Valley, Irvine or other communities across Orange County, remember: advanced and patient-focused cardiac care is just a short drive away, at Hoag. Contact us today through our online form or by calling 949-764-5384.

What is Constrictive Pericarditis?

Constrictive pericarditis, also called restrictive pericarditis, is a medical condition in which the pericardium — the tough, fluid-filled sac that surrounds and protects the heart and holds it in place — becomes abnormally stiffened and thick.

Normally, the pericardial sac is very elastic, with fluid inside acting as a protective cushion for the heart. In people with constrictive pericarditis, the stiffening and thickening of the pericardial sac makes the pericardium less able to stretch as the heart fills with blood during beats.

That can begin to squeeze the heart muscle — the “constriction” in constrictive pericarditis — preventing the heart from pumping enough blood to properly supply the organs and tissues. Consequently, constrictive pericarditis can contribute or lead to a range of serious complications, including severe chest pain, heart failure and heart attack.

Pericarditis vs. Constrictive Pericarditis

Constrictive pericarditis is a severe or very advanced complication of pericarditis and pericardial disease.

Pericarditis is a condition in which the pericardium, for a variety of reasons, becomes inflamed and swollen. As the pericardium swells, the two tough, thin layers that make up the pericardial sac begin to rub together, which can cause tissue irritation, severe chest pain and excess fluid buildup in the pericardial space — an issue called pericardial effusion.

In some cases, the long-term inflammation caused by chronic pericarditis can eventually cause the pericardium to develop scar tissue or granulation tissue that can make the pericardium inflexible, thickened and stiff. That can cause constrictive pericarditis, keeping the heart from expanding enough to fully fill with blood and reducing the heart’s ability to provide oxygen and nutrients to organs and tissues of the body.

What Causes Constrictive Pericarditis?

There are several conditions and medical issues that can cause constrictive pericarditis. These can include:

Infectious Causes

• Bacterial infection: Tuberculosis is the leading cause of constrictive pericarditis globally, with most cases occurring in developing countries.
• Viral infection: While rare, viral pericarditis is more common in the U.S., with coxsackievirus, echovirus, hepatitis B and adenovirus often playing a role.
• Fungal and parasitic infection: In very rare cases, a fungus or parasitic infection can contribute to the development of pericarditis and/or constrictive pericarditis.

Non-infectious Causes

• Pericarditis: The inflammation associated with untreated or poorly treated cases of acute pericarditis can eventually lead to scarring that causes the stiffening and inflexibility that is characteristic of constrictive pericarditis.
• Previous heart surgery: Scar tissue that forms in the pericardium after heart surgery can sometimes contribute to constrictive pericarditis.
• Previous radiation therapy: Radiation to the chest during cancer treatments can sometimes lead to pericardial thickening and contribute to constrictive pericarditis.
• Certain cancers: In extremely rare cases, certain types of cancer can contribute to constrictive pericarditis, including lung cancer, breast cancer and melanoma. In rare cases, mesothelioma, an uncommon cancer that affects the tissues that line the lungs and abdomen, can spread to the pericardium and cause a condition called Primary Pericardial Mesothelioma (PPM). Common symptoms of PPM include constrictive pericarditis, pericardial effusion and congestive heart failure. Visit this link to learn more about constrictive pericarditis and PPM from the National Institutes of Health.
• Idiopathic: Some cases of constrictive pericarditis are idiopathic, meaning they occur for no known reason.
• Autoimmune diseases: Conditions like lupus, rheumatoid arthritis, and scleroderma can trigger inflammation in the pericardium and lead to stiffening of the pericardium.
• Chest trauma: Surviving trauma to the chest from blunt-force accidents, gunfire or stab wounds can cause pericardial scar tissue or inflammation of the pericardium that leads to the formation of scar tissue. That can cause constrictive pericarditis.
• Sarcoidosis: In rare cases, constrictive pericarditis can be caused by sarcoidosis, which is an inflammatory disease that causes small, fleshy nodules called granulomas to occur in various tissues of the body, including the lungs, eyes, heart and pericardium.

What are the Symptoms of Constrictive Pericarditis?

In the early stages of the disease, the symptoms of constrictive pericarditis can be mild. Some people with the condition may experience no symptoms at all.

However, as the disease progresses, the reduced blood flow and cardiac restriction that is characteristic of constrictive pericarditis can cause a range of serious symptoms. These may include:

• Shortness of breath (dyspnea): One of the most common symptoms of constrictive pericarditis, shortness of breath is caused by the inability of the heart to fully expand and pump enough blood.
• Weakness and fatigue: Also caused by reduced blood flow and compromised heart function, which can lead to a general feeling of tiredness and lack of energy.
• Elevated jugular venous pressure: Most patients with constrictive pericarditis are found to have elevated blood pressure in the jugular vein during a physical examination by physicians.
• Swelling in the legs and ankles: The impaired heart function can also cause peripheral edema, which is fluid buildup in the legs and ankles.
• Abdominal swelling: Ascites is swelling or distention of the abdomen that can be caused by cardiac dysfunction. Ascites can sometimes compress the stomach, leading to a feeling of fullness even after only a light meal.
• Cardiac tamponade: Cardiac tamponade is a serious and potentially life-threatening condition in which excess fluid fills the pericardium, which prevents the heart from fully filling with blood during beats.
• Pericardial rub: Usually heard during an examination by a physician, pericardial rub is a sound created by the pericardium rubbing against the heart because the heart is constricted by the stiff, inflexible pericardium.
• Liver issues, including liver enlargement.
• Pericardial knock: Another cardiac sound used by physicians during diagnosis of constrictive pericarditis, pericardial knock is a high-pitched sound caused by the heart being unable to fill up with blood.
• Chest pain, neck or left shoulder pain: Dull, aching or sharp pain in the upper chest occurs in many patients with the condition. In some cases, the pain lessens when patients sit upright or lean forward, and gets worse if they take a deep breath or lie down.
• Heart Palpitations, which can feel like a fluttering, rapid or irregular heartbeat.
• Pleural effusion, which is a buildup of fluid in the layers of the pleura, the thin membranes that line the lungs and the inner walls of the chest cavity.

What are the Risk Factors for Constrictive Pericarditis?

In some cases, constrictive pericarditis can occur for no reason at all. However, there are a number of medical conditions, lifestyle choices and other factors that are believed to put a person at greater risk of developing the condition. These include:

• Certain infectious diseases, including tuberculosis, hepatitis B, coxsackievirus and adenovirus
• A history of untreated or poorly treated pericarditis
• Prior heart surgery, which can lead to inflammation and scar tissue that can cause pericardial diseases
• Autoimmune diseases, including lupus, rheumatoid arthritis and scleroderma
• Chest trauma, especially if a person experienced blunt force or penetrating injuries to the chest
• Radiation therapy to the chest
• Mesothelioma
• Being older, as middle-aged adults are most likely to develop the condition, though it can occur at any age.
• A compromised immune system, which can increase the risk of having an infection that can cause pericarditis and potentially constrictive pericarditis
• Being in poor overall health due to factors like smoking, being obese, not getting enough exercise and other issues

Is There Any Way I Can Reduce My Risk of Developing Constrictive Pericarditis?

There is no definitive way to prevent a person from developing constrictive pericarditis, and the only definitive treatment is pericardiectomy, which is a surgical procedure to completely remove the pericardium.

However, there are certain steps you can take to potentially avoid the condition. These include:

• If you have been diagnosed with pericarditis or pericardial disease, follow your physician’s advice exactly, including taking any prescribed medications, to keep the disease from developing into constrictive pericarditis.
• If you have tuberculosis, adenovirus, coxsackievirus, echovirus, hepatitis B or other infectious diseases that can cause constrictive pericarditis, seek treatment and consult with a cardiac specialist to evaluate the health of your pericardium.
• Keep your immune system and cardiovascular system healthy by getting plenty of exercise, eating a healthy diet, not smoking and managing your stress.

Need Pericarditis Treatment in Orange County? For Advanced Cardiac Care, There’s No Place Like Hoag.

For years now, Hoag’s Jeffrey M. Carlton Heart and Vascular Institute has been setting the standard for advanced, patient-focused cardiac care in Orange County, including care for rare heart conditions such as constrictive pericarditis.

For our patients, for our community, Hoag’s multidisciplinary team of cardiovascular specialists delivers world-class skill and next-generation treatment options. That dedication is why U.S. News & World Report rated Hoag among the best hospitals in the nation for Heart Failure in 2023-2024.

Looking for next-generation treatment for constrictive pericarditis in Fountain Valley, Huntington Beach, Laguna Niguel, Newport Beach, Irvine or Mission Viejo? You’ll find it here. So don’t wait, contact Hoag through our online form or call 949-764-5384.