DEFINITION

The pericardium becomes gradually fibrosed, thickened and inelastic. It acts as a rigid case, encasing the heart. It interferes with the diastolic relaxation of heart and hence ventricular filling. The net result is a reduction in cardiac output and elevation of systemic venous pressure.

ETIOLOGY

• TB
• Hemopericardium and cardiac surgery.
• Mediastinal irradiation
• Rheumatoid arthritis
• SLE
• Acute pericarditis.

CLINICAL FEATURES

• Weakness, fatigue, weight loss and anorexia.
• Patient appears emaciated with a protuberant abdomen.
• Pulse is of low volume and pulsus paradoxus may be present.
• Neck veins are engorged.
• Kussmauls signs may be positive. This is rise in height of JVP during inspiration.
• Heart sounds may be muffled.
• Pericardial knock may be audible.
• Congestive hepatomegaly.
• Ascites.

INVESTIGATIONS

• Chest radiography: Heart size is normal or reduced.
• Pericardial calcification.
• Fluoroscopy shows reduced cardiac pulsations.
• Echocardiography can confirm pericardium thickening and calcification.
• ECG show low voltage QRS complex and T wave changes.
• MRI.

TREATMENT

Pericardiectomy is the only definitive treatment.