Pericardial Constriction and Restrictive Cardiomyopathy

Abstract

Despite being different disease processes, pericardial constriction and restrictive cardiomyopathy are often discussed together due to their similar clinical and hemodynamic features. Physiologically, both processes lead to impaired diastolic filling via different mechanisms; a rigid, adherent pericardium is noted in constriction while abnormal myocardium is the culprit in restriction. Pericardial constriction (or constrictive pericarditis) usually is a chronic process, and variant forms do exist (effusive-constrictive, subacute, transient, occult) which share many of the clinical findings, but have subtle clinical nuances that distinguish each type. Restrictive cardiomyopathy is associated with a normal pericardium, but is often associated with infiltrative diseases such as amyloidosis, hemochromatosis, and sarcoidosis. Given the spectrum of disease and the various clinical manifestations of pericardial constriction and cardiac restriction, initial history and physical findings along with hemodynamic considerations and newer non-invasive imaging criteria now lead the way in making the diagnosis. However, using all available data in distinguishing between the two processes becomes important, as the treatment for each is very different.