features distinguishing constrictive pericarditis

Introduction

Differential diagnsosis:

• constrictive pericarditis
  • signs/symptoms
    • pulsus paradoxus generally absent
    • jugular venous distension
      • prominent x & y descent*
        • wave form does not fall, but may increase with inspiration (Kussmaul's sign)*
    • 3rd heart sound generally absent
    • pericardial knock often present difficult to distinguish from 3rd heart sound
  • laboratory
    • serum BNP: mean value 130 pg/mL*
  • electrocardiogram
    • ECG voltage may be low
    • no electrical alternans
    • no distinguishing features from restrictive cardiomyopathy
  • echocardiogram
    • thickened pericardium
    • pericardial calcifications often present*
    • no pericardial effusion
    • right ventricular size generally normal
    • myocardial thickness generally normal*
    • no right atrial & right ventricular diastolic collapse
    • early mitral flow velocity increased
    • exaggerated respiratory variation in flow velocity*
  • computed tomography (CT)/magnetic resonance imaging (MRI)
    • thickened calcific pericardium*
  • cardiac catheterization
    • equalization* of diastolic pressures generally present
  • biopsy not helpful
• restrictive cardiomyopathy
  • signs/symptoms
    • pulsus paradoxus is rare
    • jugular vein
      • prominent y descent is rare*
      • prominent x descent is generally present
    • Kussmaul's sign is absent*
    • 3rd heart sound is rare
    • no pericardial knock
  • laboratory
    • serum BNP: mean value > 800 pg/mL*
  • electrocardiogram
    • ECG voltage may be low
    • no electrical alternans
    • no distinguishing features from constrictive pericarditis
  • echocardiogram
    • no thickened pericardium
    • no pericardial calcifications
    • no pericardial effusion
    • right ventricular size generally normal
    • myocardial thickness generally increased*
    • no right atrial & right ventricular diastolic collapse
    • early mitral flow velocity increased
    • normal respiratory variation in flow velocity*
  • computed tomography (CT)/magnetic resonance imaging (MRI)
    • no thickened calcific pericardium*
• cardiac catheterization
  • no equalization of diastolic pressures in all 4 cardiac chambers*
  • biopsy may be helpful*
• pericardial tamponade
  • signs/symptoms
    • pulsus paradoxus is common
    • jugular vein
      • no prominent y descent
      • prominent x descent
    • Kussmaul's sign is absent
    • 3rd heart sound is absent
    • no pericardial knock
  • electrocardiogram
    • ECG voltage may be low
    • electrical alternans may be present
  • echocardiogram
    • no thickened pericardium
    • no pericardial calcifications
    • pericardial effusion
    • right ventricular size generally small
    • myocardial thickness generally normal
    • right atrial & right ventricular diastolic collapse
    • early mitral flow velocity normal
    • exaggerated respiratory variation in flow velocity
  • computed tomography (CT)/magnetic resonance imaging (MRI)
    • no thickened calcific pericardium
  • cardiac catheterization
    • equalization of diastolic pressures in all 4 cardiac chambers generally present
  • biopsy not helpful
• right ventricular myocardial infarction
  • signs/symptoms
    • pulsus paradoxus is rare
    • jugular vein
      • prominent y descent is rare
      • prominent x descent is rare
    • Kussmaul's sign is absent
    • 3rd heart sound may be present
    • no pericardial knock
  • electrocardiogram
    • ECG voltage is normal
    • no electrical alternans
  • echocardiogram
    • no thickened pericardium
    • no pericardial calcifications
    • no pericardial effusion
    • enlarged right ventricular size
    • normal myocardial thickness
    • no right atrial & right ventricular diastolic collapse
    • early mitral flow velocity may be increased
    • normal respiratory variation in flow velocity
  • computed tomography (CT)/magnetic resonance imaging (MRI)
    • no thickened calcific pericardium
  • cardiac catheterization
    • equalization* of diastolic pressures is variable
  • biopsy not helpful

* distinguishing features of restrictive cardiomyopathy & constrictive pericarditis

Additional terms

• constrictive pericarditis