Medical Care:
" Curative therapy for hemodynamically compromising effusive-constrictive pericarditis is surgical intervention. However, medical management directed at the underlying etiology may be effective, as dictated by clinical circumstances.
" No randomized, blinded clinical trials have been completed to guide therapy.
" Medical therapy is primarily supportive.
o Depending on putative etiology, steroids, nonsteroidal anti-inflammatory agents, or antibiotics may be needed.
o Euvolumia is a goal.
o Salt restriction may be indicated.
Surgical Care:
" Pericardiocentesis or surgical drainage of effusion is performed as dictated by patient's clinical situation. These procedures are undertaken in circumstances of tamponade or hemodynamic compromise, when a purulent effusion is suspected, or in cases with a large persistent effusion.
" The most effective therapy for effusive-constrictive pericarditis is pericardiectomy with complete removal of the parietal and visceral membranes. The perioperative mortality rate with this procedure can be high. Surgery can be risky and requires considerable thought before it can be recommended. Difficulties include the length of the procedure, infection potential, technical expertise required, morbidity secondary to the wide exposure required, and the other medical problems often present in these patients that increase operative risk.
" In patients who may have a high mortality rate with thoracotomy yet have a significant chance of effusion recurrence with needle drainage alone, a pericardial-peritoneal window is an effective treatment for recurrent pericardial effusions.
Consultations:
" A cardiologist can assist with echocardiographic interpretation, pericardiocentesis (see Pericardiocentesis), and invasive hemodynamics.
" A cardiothoracic surgeon may help when a pericardial window or pericardiectomy is being considered.
" In complicated cases, such as those involving tuberculosis pericarditis or purulent uremic pericarditis, multidisciplinary involvement may be required. Specialists in infectious disease, nephrology, cardiology, and/or cardiothoracic surgery may be consulted.
Diet:
" No specific dietary changes are recommended.
" Often, these patients have chronic underlying diseases for which adequate nutrition is especially important.
Activity:
" Activity generally is limited by the underlying disease or the decreased cardiac output that may occur with effusive-constriction.
" No specific prohibitions exist.
No specific medical therapy exists. Whenever possible, treatment is directed at the underlying cause. Intravascular volume status must not be decreased excessively in the presence of tamponade physiology; diuretics must not be applied indiscriminately. On the other hand, after pericardial drainage, diuretics may be useful with constrictive physiology and evidence of volume overload.