Effusive constrictive pericarditis

 Symptoms and objective findings due to variable mixtures of pericardial effusion or tamponade accompanied by constriction of vesceral pericardium  Typical hemodynamic findings of pericardial constriction persisted after the pericardial effusion was drained

etiology  Idiopathic  Radiation  Neoplasia  Chemotherapy  Infection (Tuberculosis …)  Postsurgical pericardial disease

Echocardiography in CP  2D-echo  pericardial thickening  septal "baunce"  respiratory septal shift-  Rt-> Lt. in inspiration  Lt->Rt. In expiration  RA enlargement  dilated IVC with plethora

 M-mode  respiratory septal shift

 Dopper  high E, short DT and small A in MV inflow  Decreased of E velocity over 25 % in inspiration than in expiration  Increase of IVRT over 20% in inspiration

catherization  prominent X and Y in RA pr.  increased atrial pressure  square root or dip and plateau pattern  early rapid rise in ventricular diastolic pr.  sudden stop of rise of diastolic pr.  rapid early diastolic filling of the ventricle, followed by lack of additional filling due to compression in mid and late diastole  greater inspiratory fall in PCWP  equalization of end-diastolic pressure of all chamber

DDx from CP  After pericardiocentesis  Lowering of the pericardial pressure to near zero  Persistence of elevated Rt. Atrial pressure  Defined by failure of the right atrial pressure to fall by 50 % or to a level below 10 mmHg