Constrictive pericarditis Puns

I have never been able to tell the difference. Is constrictive peri a TYPE of restrictive cardiomyopathy or am I wrong here? How to tell difference in a question or on test day

In cardiac tamponade, the inter ventricular septum can deviate such that it increases right ventricular space at the expense of left ventricular space in inspiration—hence the lack of kussmaul’s sign. Why can’t the interventricular septum do the same thing in constrictive pericarditis?

Thank you.

Can someone please help clear up the overlap & differences between these two? Need help delineating the two when it comes to questions, but also in terms of the pathophys & how it relates to the same, but different presentations.

tamponade- hypotension, distended neck veins, muffled heart sounds

constrictive pericarditis- JVD/increased JVP, Kussmaul sign, pulsus paradoxus, friction rub?

- Isn't distended neck veins (classically describing tamponade) the same as JVD/ increased JVP (describing pericarditis)?

- Is Kussmaul sign the same as pulsus paradoxus? FA lists constrictive pericarditis as a cause of Kussmaul sign but not tamponade. If Kussmaul sign is a result of increased JVP, then shouldn't it be seen in both tamponade & constrictive pericarditis?

- Aren't they both the result of fluid collection within the pericardial space therefore symptoms should be pretty much the same?

- Why is there a prominent y descent in constrictive pericarditis but not tamponade?

Listed some pointers from which my confusion arises- any help addressing any of them would be greatly appreciated!

JVP

Cardiac tamponade and right ventricle:

• pulsus paradoxus
• JVD
• No Kussmaul sign
• No sharp Y descent on JV tracing

Constrictive pericarditis and right ventricle:

• JVD
• No pulses paradoxus
• Kussmaul sign
• Sharp Y descent on JV tracing

Mechanistically:

• Why won't we have pulsus paradoxus in constrictive pericarditis? Why does it seem like the right ventricle is somehow "more affected" in constrictive pericarditis?

Thank you.

We've learned that constrictive pericarditis leads to normal sized ventricles and dilated atria. It seems like atria are also covered by pericardium. Then, why would the supposedly uniformly stiffened pericardium allow for atrial dilation?

Thank you.

DOI/PMID/ISBN: 10.1136/heartjnl-2020-316664

[URL]( https://heart.bmj.com/content/early/2021/01/15/heartjnl-2020-316664 )

A lot UW questions take this into account to predict the physiologic alterations that occur in these conditions. However i have no idea of why the RIGHT side is affected more significantly than the left.

Hey! Can someone please explain why there is rapid y descent in constrictive pericarditis?

I can see how there would be a sudden stop in the filling of the ventricle because the pericardium is stiff so it can only allow a certain amount of expansion of the ventricle but why is the relaxation rapid at the beginning?

And, how is this different than cardiac tamponade? In cardiac tamponade, the y descent is blunted b/c of the fluid in the pericardium that stops the ventricles from expanding so why isn't this the case with constrictive pericarditis since the pericardium is stiff?

Thanks!!

Thanks!

I got into a car accident in October 2018 , an elderly couple had rear ended me ,and about 2 months after that the left side of my chest began to hurt more and more and I had lost about twenty pounds. I ended up getting a cat scan and an initial diagnosis of idiopathic pericarditis. When I went to my cardiologist he told me he believed it to be caused by my accident. I always unfortunately am experiencing chest tightness, heart fluttering,my heart in general feeling like it is just going to burst , and I’ve noticed when I’m at work, ( I work in a green house) if I get too warm in the lights or am standing for long I feel faint and nauseous , lately it’s been worse and I feel like it’s only relieved when I burp? As well as I get this reoccurring twitch that goes from my collar bone to my armpit to my shoulder(left side). I am wondering should I go to an emergency room ? unfortunately I am in between insurances at the moment so I cannot just make an appointment but I legitimately think A few times a day the last week that I may be at risk for having a heart attack. My mother has cardio myopathy as well so I’m not sure if I could be later diagnosed with that or if that’s maybe what I have instead? Because my pericardium still has fluid on it as of this past November which was my last echocardiogram.

I am trying to wrap my head around why constrictive pericarditis more commonly causes right heart failure. Since constrictive pericarditis doesn't allow any of the pressure changes in the respiratory cycle to be transmitted to the heart, shouldn't both sides of the heart be affected the same?

Don't all of these pathologies "constrict" the ventricle and make it harder for blood to enter? So why is the y descent (atrial emptying phase) different between them?

Can anyone explain why/suggest a resource that explains it well? You would think they both would have an absent descent because no blood can flow from RA to the RV.

Thanks.

As I understand it, the factors in cardiac tamponade that contribute to pulsus paradoxus are:

1. The increased venous return during inspiration is accommodated by the heart (which is actually the reason for the lack of Kussmaul sign).

2. Cardiac tamponade leading to pressure equilibration in all chambers, allowing the right ventricle to be pushed into the left ventricle owing to the increased inspiratory venous return as mentioned above.

What I don’t understand is why we see pulsus paradoxus in constrictive pericarditis when firstly the heart does not accomodate any excess venous return during inspiration (Kussmaul sign), and secondly the left ventricular pressure remains higher than that of the right ventricle? What is the mechanism here?

So my understanding is as follows:

 

In cardiac tamponade, there is fluid in the pericardial space that restricts the expansion of the heart. But, the change in intrathoracic pressure on inspiration is still transmitted into the heart which causes this interventricular septum to bulge to the left as a result of increased venous return to the right heart. This reduces left heart systolic volume and hence pressure, leading to the >10mmHg systolic pressure decrease we would see in pulsus paradoxus.

 

In constrictive pericarditis, the pericardium has become fibrotic and less compliant so again we have a restriction to the expansion of the heart. This time, however, changes to intrathoracic pressure brought about by inspiration only transmitted to the left atrium while the left ventricle is insulated from them. At this point my understanding stops. UpToDate continues: "Thus, inspiration lowers the pulmonary capillary wedge pressure, and presumably left atrial pressure, but not left ventricular diastolic pressure, thereby decreasing the pressure gradient for ventricular filling. The less favorable filling pressure gradient during inspiration explains the decline in filling velocity. Reciprocal changes occur in the velocity of right ventricular filling." Wouldn't this suggest that the right heart fills more rapidly and there would be a decrease in JVP on inspiration, the opposite of Kussmaul sign? Any help understanding would be appreciated.

hi all, there's a UW question on constrictive pericarditis, which is, in the answers, explained as scarring/loss of elasticity that occurs weeks to months post-MI. Is this the same pathology as Dressler?

Thanks.

Hey guys,

I'm not too sure if this subreddit frowns upon threads like this but I could really use some help here. I've been cracking my head trying to reason the differences in clinical presentation between the two.

JVP: Cardiac tamponade (Absent Y descent) Constrictive pericarditis (X + Y present)

Pulsus paradoxus: Cardiac tamponade (Present) Constrictive pericarditis(Absent)

Kussmaul's sign: Cardiac tamponade (Rare) Constrictive pericarditis (Present)

Many sources online are contradictory. Hmm, do let me know if posts like this are not allowed :)

I know people are immediately going to be like “go to a doctor”. But just hear me out, I just want some thoughts and feedback here.

(And this is not some trolling post I swear, read my bottom paragraph).

I got the first two vaccines (pfizer) and was fine, maybe a little tiredness and soreness was the only symptom I experienced.

I got the booster shot and flu shot together last Thursday (so 5 days ago now?).

About 30 minutes after the shots, I got really tired. It was noticeable because I was having a pretty good day up until tht moment. This was midday and I actually just wanted to go lay down and sleep, I remember I felt tired and even kind of dizzy.

No worries, I thought. That’s normal. And the next two days or so were kind of like this, I was normal but maybe a bit more tired and sleeping more.

The past couple of days, I noticed I felt a tightness in my chest. It wasn’t that noticeable but it was there. A sometimes like a little pang around the area of my heart.

This morning I woke up.. very sleepy even though I slept like 9 hours. When I got out of bed I noticed that my chest area felt like… sore. By like a muscle soreness. Almost felt like the muscles in my rib cage had been exercised or something, it was weird.

I walked around a little bit in the morning before work. And, here I really felt it, my chest is tight, I felt like just walking was the limit of exertion, I was short of breath, it just felt like it’s swollen around my heart area.

I had felt this before momentarily since last Thursday but today it is unmistakeable.

I forgot about it during my work day at the computer, but once I got up to leave, yep, there it is. It feels tight and constricted. If I take a deep breath it’s like I’m pushing up against something. And I’m just like, out of it today. Head isn’t in the right place, I feel sluggish and slow.

I’m not going to go to a doctor at this point. I’m not sure what they would do and I don’t think it’s severe enough yet. If the symptoms persist like this or get worse maybe at that point it’ll become s good idea to go.

I read online that it’s a very rare effect but it mostly happens in males under 30 (which I am), and more during a second vaccination than a first (this is my third). That most cases resolve within a week and need no medical treatment.

I have an immune regulated disease (eosinophilic esophagitus) and also my brother has chronic idiopathic pericarditis (he thinks it was initially triggered by Lyme disease

I just want to preface this post by letting everyone know that I was not an antivaxxer by any means. I was a little anxious about my second jab but had no major overall concerns:

This is a day to day list of what has happened to me since I have my second Pfizer jab on 8/11/21. I had no reactions to the first jab. I find what’s happening to me (and many others) regarding the “rare” symptoms disconcerting, and am shocked at the eagerness by doctors, medical staff, peers and friends to disregard them as being nothing more than anxiety, coincidence, or “bad luck”.

It’s currently been 1 week since my jab and I’ll continue to keep people posted on what happens in the future. If that brings peace to people who are enduring the same thing then my mission is accomplished. Otherwise, it can be educational for those who are curious. Obvious to note this is anecdotal, but my experience has been true and reflects the same story spoken by many others.

This is my daily journal of what has occurred so far:

I am a 29yo male. Very healthy. Quite fit.

8/11: Jab on 8/11 at 4pm Slight headache and fatigue that night

9/11: Slight fatigue in the morning. 1pm got headaches and slight body aches and apparent chest tightness/pain. Thought it was anxiety/stress. Heart beat felt slightly irregular. Tightness became a little worse at night, body aches and headache subsided. No trouble sleeping.

10/11: Woke up not having any tightness of chest. Chest pain/tightness came back at around 11am and was present all day. Feels like it’s right on my sternum, like someone is pressing on it quite hard. Became worse at night. Slept fine (better when lying down). General lethargy, particularly at night.

11/11: Woke up with chest pain/tightness. Called doctor and got in to see them at 10am. Heart rate was fine and no initial irregularities. Had blood tests and an ECG. Told to take ibuprofen and that they would contact me the next morning with results. Said it could be pericarditis but most likely not, that it could have been classified as “muscle soreness”. The lady at pathology said she had lots of people coming through for ECG’s for the same issue. The lady who took blood said her husband had bad side effects to the jab also and that he was ok after 2 weeks. Took painkillers and went to work. Felt a faint chest pain/pressure all day. It got much worse at night again, after I stopped work and sat down. Chest felt constricted, particularly when sitting. Slept fine, feels better when lyi

I don't want to step on anybody's toes here, but the amount of non-dad jokes here in this subreddit really annoys me. First of all, dad jokes CAN be NSFW, it clearly says so in the sub rules. Secondly, it doesn't automatically make it a dad joke if it's from a conversation between you and your child. Most importantly, the jokes that your CHILDREN tell YOU are not dad jokes. The point of a dad joke is that it's so cheesy only a dad who's trying to be funny would make such a joke. That's it. They are stupid plays on words, lame puns and so on. There has to be a clever pun or wordplay for it to be considered a dad joke.

Again, to all the fellow dads, I apologise if I'm sounding too harsh. But I just needed to get it off my chest.

Do your worst!

I'm surprised it hasn't decade.

For context I'm a Refuse Driver (Garbage man) & today I was on food waste. After I'd tipped I was checking the wagon for any defects when I spotted a lone pea balanced on the lifts.

I said "hey look, an escaPEA"

No one near me but it didn't half make me laugh for a good hour or so!

Edit: I can't believe how much this has blown up. Thank you everyone I've had a blast reading through the replies 😂

It really does, I swear!

Because she wanted to see the task manager.

Heard they've been doing some shady business.

BamBOO!

They’re on standbi

Pilot on me!!

Christopher Walken

Nothing, he was gladiator.

In cardiac tamponade, the inter ventricular septum can deviate such that it increases right ventricular space at the expense of left ventricular space in inspiration—hence the lack of kussmaul’s sign. Why can’t the interventricular septum do the same thing in constrictive pericarditis?

In cardiac tamponade, the inter ventricular septum can deviate such that it increases right ventricular space at the expense of left ventricular space in inspiration—hence the lack of kussmaul’s sign. Why can’t the interventricular septum do the same thing in constrictive pericarditis?

Can someone please explain the jvp changes seen in contrictive pericarditis and cardiac tamponade and do they differ?