Diastolic Heart Failure: Restrictive Cardiomyopathy, Constrictive Pericarditis, and Cardiac Tamponade: Clinical and Echocardiographic Evaluation

Abstract Background Constrictive pericarditis (CP) is a disease characterized by inflammation, progressive fibrosis, and thickening of the pericardium. Constrictive pericarditis after heart transplantation (HT) is a rare phenomenon, with a reported incidence of 1.4–3.9%. It is an important clinical problem which shares similar clinical features with entities such as restrictive cardiomyopathy. Therefore, it poses diagnostic challenges and therapeutic dilemmas even for experienced clinicians. Case summary A 53-year-old patient developed a zoster infection with pericardial effusion 9 months after HT for idiopathic dilated cardiomyopathy. Two months later, he presented with leg oedema and ascites and was treated by diuretics for volume overload. He was readmitted 8 months later with features of right heart failure. Multimodal imaging investigations were suggestive of CP. He successfully recovered after a radical pericardiectomy. Discussion Constrictive pericarditis is a rare complication in HT. Heart transplant recipients (HTR) with a history of post-operative pericardial effusion, or with rejection episodes are at high risk of developing CP. Differentiating CP from other conditions that cause apparent congestive heart failure in HTR is challenging. Management of CP is mainly surgical pericardiectomy.

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Successful management of diastolic heart failure in a patient with restrictive cardiomyopathy following an anterior communicating artery aneurysm clipping

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/jnacc-jnacc-9.17 ◽

2017 ◽

Vol 04 (02) ◽

pp. 120-123

Author(s):

Rajasekar Arumugam ◽

Georgene Singh ◽

Krishnaprabhu Raju ◽

Ramamani Mariappan

Keyword(s):

Heart Failure ◽

Diastolic Heart Failure ◽

Artery Aneurysm ◽

Restrictive Cardiomyopathy ◽

Anterior Communicating Artery ◽

Aneurysmal Subarachnoid Haemorrhage ◽

Successful Management ◽

Aneurysm Clipping ◽

Anterior Communicating Artery Aneurysm ◽

Neurosurgical Patients

AbstractPerioperative management of neurosurgical patients with an underlying myocardial dysfunction poses a unique challenge to the neuroanaesthesiologist and the neurointensivist. Sudden catecholamine surge during the aneurysmal subarachnoid haemorrhage (SAH) can cause severe cardiac dysfunction such as myocardial ischaemia and cardiomyopathy. SAH in a patient with restrictive cardiomyopathy could be hazardous to the myocardium leading to severe cardiac morbidity. We report the successful management of an acute post-operative diastolic heart failure with a milrinone infusion in a patient with restrictive cardiomyopathy, following anterior communicating artery aneurysm clipping. We have discussed the ‘dual beneficial’ role of milrinone on the heart and the brain in this clinical setting. In addition, the importance of peri-operative utilisation of transoesophageal echocardiography and transthoracic echocardiography for the successful management of diastolic heart failure is highlighted.

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Cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy

Current Problems in Cardiology ◽

10.1016/j.cpcardiol.2004.03.002 ◽

2004 ◽

Vol 29 (9) ◽

pp. 503-567 ◽

Cited By ~ 66

Author(s):

James A. Goldstein

Keyword(s):

Cardiac Tamponade ◽

Constrictive Pericarditis ◽

Restrictive Cardiomyopathy

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Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis

Clinical Medicine Insights Case Reports ◽

10.1177/1179547617723643 ◽

2017 ◽

Vol 10 ◽

pp. 117954761772364 ◽

Cited By ~ 6

Author(s):

Amit Alam ◽

Shankar Thampi ◽

Shahryar G Saba ◽

Rita Jermyn

Keyword(s):

Heart Failure ◽

Surgical Intervention ◽

Diastolic Heart Failure ◽

Treatment Options ◽

Hypereosinophilic Syndrome ◽

Restrictive Cardiomyopathy ◽

Endomyocardial Fibrosis ◽

History Of ◽

The Right ◽

Loeffler Endocarditis

Loeffler endocarditis is a rare restrictive cardiomyopathy caused by abnormal endomyocardial infiltration of eosinophils, with subsequent tissue damage from degranulation, eventually leading to fibrosis. Although an uncommon entity, it is still a disease with significant morbidity and mortality. Often identified only at late stages, treatment options are limited once fibrosis occurs, usually requiring heart failure medications or surgical intervention. We present a unique case of a woman with remote history of hypereosinophilic syndrome, attributed to treatment of rheumatoid arthritis with infliximab, who presented with symptoms of heart failure refractory to medical management and was found to have Loeffler endocarditis. The severe progression of the disease required surgical intervention with endocardial stripping to treat the right-sided diastolic heart failure.

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Invasive Hemodynamics of Constrictive Pericarditis, Restrictive Cardiomyopathy, and Cardiac Tamponade

Cardiology Clinics ◽

10.1016/j.ccl.2011.01.003 ◽

2011 ◽

Vol 29 (2) ◽

pp. 191-199 ◽

Cited By ~ 17

Author(s):

Paul Sorajja

Keyword(s):

Cardiac Tamponade ◽

Constrictive Pericarditis ◽

Restrictive Cardiomyopathy ◽

Invasive Hemodynamics

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Salvation to Hearts in Distress under Shells of Stress: Subtotal Pericardiectomy in a Series of 9 Patients with Constrictive Pericarditis

RA Journal Of Applied Research ◽

10.47191/rajar/v7i9.06 ◽

2021 ◽

Vol 07 (09) ◽

Author(s):

S. Faid ◽

Keyword(s):

Heart Failure ◽

Cardiac Catheterization ◽

Constrictive Pericarditis ◽

Cardiac Mri ◽

Diastolic Heart Failure ◽

Rare Condition ◽

Right Heart Failure ◽

Right Heart ◽

Pericardial Thickening

Objective: Chronic constrictive pericarditis (CCP) is a rare entity responsible of diastolic heart failure. The true prevalence is yet to be defined. The purpose of this study was to describe the clinical and para-clinical characteristics of patients with CCP, the therapeutic management, the outcomes and impacting factors. Materials and Methods: We conducted a retrospective descriptive study from 2017 to 2020 including 9 patients hospitalized for CCP in our cardiovascular surgery department. Results: The mean age was of 32.6 years. Majority were men (n=7). Dyspnea was the most common sign. Peripheral signs were dominated by signs of right heart failure. Cardiac ultrasonography showed pericardial thickening and calcifications with Doppler adiastolic signs in 90% of cases. Thoracic CT was performed in 7 patients, cardiac MRI in one patient, showing calcifications and measuring the pericardial thickening. Cardiac catheterization performed in 6 patients showed the aspect of Dip plateau. Tuberculosis etiology was retained in 55.6%; post-radiation origin in one patient and 33.4 % of cases were idiopathic. All of patients benefited from subtotal pericardiectomy with good results in the medium and long term. Two deaths occurred, the first patient died following multi-visceral failure, the second died 3 years later from neoplasia. Conclusion: The CCP is a rare condition with poor prognosis. The diagnosis should be raised when there are signs of right heart failure associated with signs of hemodynamic adiastolia. The echocardiography, with computed tomography or cardiac MRI and especially cardiac catheterization confirm the diagnosis and also etiological orientation. Tuberculosis and idiopathic etiologies were the most common at our country. Medical treatment options are limited. Pericardiectomy remains the only radical treatment with good results in immediate, medium and long term.

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