Hemodynamic and Tissue Doppler correlates in Constrictive Pericarditis.

Selvam, S (2008) Hemodynamic and Tissue Doppler correlates in Constrictive Pericarditis. Masters thesis, Madras Medical College, Chennai.


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Constrictive pericarditis was recognized in the 19th century and its surgical treatment was developed early in the 20th century. Paul Dudley White in his 1935 St Cyres lecture, described a “chronic fibrous or callous thickening of the wall of the pericardial sac that is so contracted that the normal diastolic filling of the heart is prevented . . . There may or may not be calcification . . . Parietal pericardium or epicardium may be preponderantly involved . . . one area may be involved, other areas free . . . associated heart disease is extremely rare . . . insidious evolution makes diagnosis more difficult than that of active constrictive pericarditis”. A history of several years duration and a predominant clinical feature of ascites, simulating liver disease, were notable in White's series. In constrictive pericarditis the easily distensible, thin, parietal and visceral pericardium linings become inflamed, thickened, and fused. Because of these changes, the potential space between the linings is obliterated. Venous return to the heart becomes limited and ventricular filling is reduced. One of the distinguishing characteristics of this disease is the equally elevated left and right ventricular end-diastolic pressures. Symptoms consistent with congestive heart failure (CHF), especially right-sided heart failure, develop as a result of the inability of the heart to increase stroke volume. Cardiac output gradually becomes inadequate, at first with exercise and then at rest. Systolic function is rarely affected until late in the course of the disease, presumably secondary to infiltrative processes that affect the myocardium, atrophy, or scarring/ fibrosis of the myocardium from the overlying adjacent pericardial disease. Haemodynamic features delineated in the 1940s and '50s included the narrow pulse pressure in the right ventricle with normal systolic pressure and greatly increased diastolic pressure, a prominent early diastolic dip and later diastolic plateau in right ventricular pressure waveforms, and an additional prominent systolic dip in the right atrial waveform, giving a “W” atrial waveform. Comments on the difficulty of distinguishing constrictive pericarditis from restrictive cardiomyopathy began to appear in the medical literature only after the pressure recordings from cardiac catheterization began to be used in the diagnosis of constrictive pericarditis. One may suspect that cardiac catheterization data in the two conditions were more similar than the clinical features. In contrast to coronary artery disease, heart failure, valvular disease, and other topics in the field of cardiology, there are few data from randomized trials to guide physicians in the management of pericardial diseases. Although there are no American Heart Association/American College of Cardiology guidelines on this topic, the European Society of Cardiology has recently published useful guidelines for the diagnosis and management of pericardial diseases. In this scenario, an attempt to investigate the hemodynamic changes in constrictive pericarditis in the era of advanced echocardiography especially Tissue doppler analysis seemed prudent in delineating this condition which mainly manifests as a pathophysiological condition AIM OF THE STUDY In constrictive pericarditis no physical sign or procedure is diagnostic. A constellation of clinical features along with chest radiography, echocardiography, CT scan and cardiac catheterization is often necessary in confirming the diagnosis. CONCLUSION: Patients with clinically suspected constrictive pericarditis who have classic findings on Doppler echocardiography can now undergo pericardiectomy without the need for cardiac catheterization. Only the patients in whom there have been equivocal findings either on clinical presentation or on noninvasive testing then undergo further hemodynamic assessment. Echocardiography has replaced invasive cardiac catheterization for various hemodynamic assessments. Of all of the hemodynamic measurements used in daily clinical practice, LV filling pressure is one of the most frequently used. With the advent of TDI and other recent developments in the field echocardiography, it has become a truly versatile and reliable hemodynamic imaging tool. And, echocardiography has become a noninvasive Swan-Ganz catheter.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Hemodynamic ; Tissue Doppler ; Correlates ; Constrictive Pericarditis.
Subjects: MEDICAL > Cardiology
Depositing User: Kambaraman B
Date Deposited: 04 Jul 2017 03:50
Last Modified: 04 Jul 2017 03:50
URI: http://repository-tnmgrmu.ac.in/id/eprint/869

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