chronic constrictive

8/2/2019 Chronic Constrictive

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The heart is enclosed within a delicated fibrous sacknown as the pericardium.

The outer wall fibrous or parietal pericardium

The inner wall visceral pericardium or epicardium

The two pericardial wall is seperated by a space linedwith a mesothelium.

The attachments of the pericardium:

Anteriorely- posterior surface of the sternumposteriorly & superiorly great vessels & looseconnective tissues within the post. Mediastinum

Inferiorly fused with cental tendon of thediaphragm


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It is the condition in which the

pericardium becomes thickened, fibrosed

& calcified. The pericardial cavity is

obliterated by dense scar tissue. Theheart is infact is confined in a rigid

inelastic case preventing it from its

proper functioning.


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The pathological effect of this condition is

that it prevents ventricles from filling in diastole. This

causes decreased cardiac output. A compensatory

tachycardia is seen. There is corresponding increase inright atrial pressure and right ventricular pressure. There

is also elevation of cental venous pressure. This

hypertension may produce periferal oedema, hepatic

enlergement and ascites.


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Tubercolosis

Pyogenic pericarditis


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Acute benign pericarditis

Following hemopericardium

Connective tissue diseases

Radiation therapy to chest

Uremic

Idiopathic

RA


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A. Due to impaired filling of RIGHT side of

heart

B. Due to impaired filling of LEFT side ofheart


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A. Due to impaired filling of RIGHT side of heart

1. Raised venous pressure

Kussmauls signFriedreichs sign

2. Cardiac signs

Palpation:

Systolic retardation of the apex beat

diastolic shock

Auscultation:

Loud early 3rd sound


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Due to impaired filling of left heart

1. syncope on exertion

2. dyspnoea


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1. Chest radiograph

Calcification of pericardium

Dilated superior vena cava

2. ECG

T terminal negativityMay be atrial fibrillation

3. Echocardiography

Small ventricles & enlarged atria

The pericardium single or double dense

Immobile heart

Inferior vena cava & hepatic veins largely dilated

4. MRI

Thickened pericardium


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1. Restrictive cardiomyopathy

2. Cirrhosis of liver

3. Congestive cardiomyopathy

4. Tricuspid valve disease 5. RV infarction


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Aim Realive the constriction

PERICARIOCTOMMY

The heart is approched through a

median sternotomy and pericardium is

carefully stripped off the left ventricle,

followed by the right ventricle. Sometimescardiopulmonary bypass may be required .


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Day 0. No treatment

Day 1. Arm & leg exercises in half lying, Breathingexercises

Day 2. First walk

Day 3. Increased walking

Day 4. Walking about 100 yards with no shortness ofbreath, begin stair climbing

Day 5. trunk exercises, increase stair climbing & walking

Day 7. breathing exercises, neck, trunk, shouldergirdleexercises, teaching home exercises

Pt. Will advised that he should not drive for 6weeks & sexualrelations should be avoided for 4 weeksafter leaving hospital.


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THANK U......

chronic constrictive

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