1 ΚΑΡΔΙΟΛΟΓΟΣ EUROPEAN ACCREDITATION IN TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY
2 Constrictive pericarditis (CP) is characterized by impaired ventricular filling due to a stiffened or noncompliant pericardium Early rapid filling and elevation and and equalisation of diastolic pressures in all four cardiac champers
CLINICAL PRESENTATION 3 FLUID OVERLOAD DECREASED CARDIAC OUTPUT Elevated jugular venous pressure dyspnea Pleural effusion hepatomegaly ascites edema
PATHOPHYSIOLOGY 4 Disossociation of intrathoracic and intracardiac pressures Exaggerated ventricular interdependence
DIFFERENTIAL DIAGNOSIS 5 Consider the possibility of constrictive pericarditis when evaluating patients with the clinical diagnosis of heart failure with normal EFs Patients with right heart failure and findings of elevated venous pressure in the absence of severe left heart disease and severe pulmonary hypertension Restrictive cardiomyopathy Chronic obstructive lung diseases Cardiac tamponade TV disease Atrial myxoma Acute dilatation of the heart Pulmonary embolism Right ventricular infarction Pleural effusion Liver disease Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography, JASE 2009 Heart 2009;95:1449-1454, Pericardial Guidelines 2004 J Am Coll Cardiol 2008;51:315 9,
CONSTRICTION VERSUS RESTRICTION 6 Both disease processes limit diastolic filling and result in diastolic heart failure
CONSTRICTION VERSUS RESTRICTION 7 Heart 2001 86: 343-349
CONSTRICTION VERSUS RESTRICTION CP 8 RCM Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography, JASE 2009
9 CONSTRICTION VERSUS RESTRICTION Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography, JASE 2009
CONSTRICTION 10 VERSUS RESTRICTION
11 CONSTRICTION VERSUS RESTRICTION NORMAL Preserved tissue Doppler imaging (both e and S) Annulus reversus CP RCM European Journal of Echocardiography (2009) 10, 372 375 Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography, JASE 2009 J Am Soc Echocardiogr 2009;22:24-33
12 CONSTRICTION VERSUS RESTRICTION CP RCM Heart 2001 86: 343-349 J Am Coll Cardiol 2008;51:315 9)
Similar Respiratory variation in mitral flow Acute dilatation of the heart Pulmonary embolism RV infarction Pleural effusion Pericardial tamponade Obesity Asthma Obstructive airway disease Lack of respiratory variation in CP Increase in atrial pressures Mixed Constiction and Restriction Atrial Fibrillation 13 Uncomon patterns of Constriction Effusive-constrictive pericarditis Transient Occult Localised Mitral annulus velocity MV replacement Infarction Annular calicification BEFORE AFTER
CONSTRICTION VERSUS CHRONIC OBSTRUCTIVE PULMONARY DISEASE COPD Mitral inflow velocities are not restrictive 14 CP COPD Highest mitral E occurs to the end of expiration Systolic SVC flow is markedly increased with inspiration ( 20cm/sec)
CONSTRICTION VERSUS LIVER DISEASE 15 Consider constriction in patients with unexplained chronic liver disease Jugular venous pressure is normal or slightly elevated Echo should be undertaken if there is suspicion of heart disease BMJ 1999 Vol 318:585-6
CONSTRICTION CONSTRICTION VERSUS VERSUS 16 RESTRICTION RESTRICTION MILLET MILLET VERSUS VERSUS VAN VAN GOGH GOGH ΤHANKS YOU YOU
CONSTRICTION VERSUS RESTRICTION 17