Constrictive pericarditis vs Restrictive cardiomyopathy
How to tell Constrictive pericarditis and Restrictive cardiomyopathy apart when a board question makes them look alike.
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Marked respiratory variation in mitral inflow with septal bounce points to constrictive pericarditis.
Side by side
Predominant right-sided heart failure with elevated JVP, pericardial knock, and marked respiratory ventricular interdependence from a rigid pericardium.
Progressive diastolic dysfunction from stiff myocardium with biatrial enlargement and reduced tissue Doppler e-prime velocities.
Fibrotic calcified pericardium limits late diastolic filling and couples ventricular filling to respiration.
Infiltrative or fibrotic myocardial disease impairs ventricular compliance despite a normal pericardial envelope.
Echo and hemodynamics show septal bounce, inspiratory increase in tricuspid inflow with >25% respiratory variation in mitral inflow, equalized diastolic pressures, and often pericardial thickening >4 mm on CT.
Echo shows restrictive transmitral filling with little respiratory variation, reduced medial e-prime, biatrial enlargement, and CMR may show diffuse late gadolinium enhancement in infiltrative disease.
The trap
Both disorders cause edema and elevated JVP, but assuming myocardial restriction without checking respiratory Doppler variation misses potentially curable constrictive pericarditis.
The repair move
Next best step: confirm constrictive physiology with Doppler echocardiography and cross-sectional imaging, give diuretics for congestion, and refer for pericardiectomy when persistent symptomatic constriction is confirmed.
Try a free question
CoreA 60-year-old man has progressive edema, ascites, and elevated JVP. Echocardiography shows septal bounce and 28% respiratory variation in transmitral inflow. What is the most likely diagnosis?
Show answer and explanation
Answer: B. Constrictive pericarditis. Septal bounce with marked respiratory filling variation is the hallmark of constrictive pericarditis.
Why the other choices are tempting
- A. Incorrect because restrictive cardiomyopathy typically lacks pronounced respiratory Doppler variation.
- C. Incorrect because dilated cardiomyopathy features systolic dysfunction and chamber dilation rather than this pattern.
- D. Incorrect because isolated tricuspid regurgitation does not create classic septal bounce physiology.
- E. Incorrect because tamponade has pulsus paradoxus and chamber collapse rather than chronic constrictive findings.
Flashcards
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Which echocardiographic hemodynamic pattern most strongly supports constrictive pericarditis over restrictive cardiomyopathy?
Septal bounce plus marked respiratory variation in ventricular filling supports constrictive pericarditis.
What tissue Doppler clue favors restrictive cardiomyopathy?
Reduced medial mitral annular e-prime velocity favors intrinsic myocardial restriction.
Quick answers
What is the fastest way to tell Constrictive pericarditis from Restrictive cardiomyopathy?
Marked respiratory variation in mitral inflow with septal bounce points to constrictive pericarditis.
What is the key clue for Constrictive pericarditis?
Predominant right-sided heart failure with elevated JVP, pericardial knock, and marked respiratory ventricular interdependence from a rigid pericardium.
What is the key clue for Restrictive cardiomyopathy?
Progressive diastolic dysfunction from stiff myocardium with biatrial enlargement and reduced tissue Doppler e-prime velocities.
What is the common trap with Constrictive pericarditis vs Restrictive cardiomyopathy?
Both disorders cause edema and elevated JVP, but assuming myocardial restriction without checking respiratory Doppler variation misses potentially curable constrictive pericarditis.