Constrictive Pericarditis Medical Slides

Create a systematic comparison table: (1) Echo — constriction shows septal bounce/shift with respiration, annulus paradoxus (high medial e'), normal wall thickness vs restriction with reduced e', myocardial thickening; (2) CT/MRI — pericardial thickening >4 mm and calcification favor constriction; (3) catheterization — ventricular interdependence (discordant ventricular pressure changes with respiration) in constriction vs concordance in restriction. Emphasize that no single test is definitive.

Annulus paradoxus (e' ≥8 cm/s despite elevated filling pressures) is a key differentiator because it seems paradoxical — normally, diastolic dysfunction causes reduced e'. In constriction, the myocardium is intrinsically normal but the rigid pericardium causes exaggerated longitudinal motion (lateral motion is restricted). This single finding on tissue Doppler has high specificity for constriction and is a high-yield teaching point for cardiology fellows.

Include transient constriction as an important teaching entity — up to 17% of constriction cases resolve with anti-inflammatory therapy (NSAIDs, colchicine, corticosteroids) within 3-6 months, avoiding pericardiectomy. Present the 2015 ESC recommendation for a trial of anti-inflammatory therapy before surgical referral in patients with recent pericarditis and constrictive physiology, especially with pericardial enhancement on CMR suggesting active inflammation.