Does your heart feel like it's constricting? It could be Constrictive Pericarditis!

Have you ever thought about how precious our heart is and how delicate it works? Sometimes, not just the heart itself, but the protective covering that surrounds it can interfere with the functioning of the entire heart. That is the condition we are going to talk about today, called `(Constrictive Pericarditis)`. Don't worry, let's talk about this simply.

What is this (Constrictive Pericarditis)? Doctor?

Simply put, your heart is surrounded by a thin membrane, like a pillow, that protects it. We call it the pericardium. In this case, instead of being normally flexible, the pericardium thickens and becomes stiff. Think of it like a pump, the heart needs to be able to expand and contract to pump blood. But when this pericardium becomes stiff, the heart doesn't have enough room to expand and fill with blood. That's when the problems start. This is a serious condition that can even lead to heart failure . But the good news is that it can often be treated and cured, especially if it's caught early .

What is really happening in this situation?

We talked about the pericardium. It has two layers, and there is a fluid in between. This fluid is what cushions the heart, in case of any accident. Normally, this pericardium is very elastic and flexible. Therefore, there is no obstacle to filling it with blood while the heart beats.

But in someone with Constrictive Pericarditis, the pericardium becomes thick and stiff. It's like an old rubber band, and it doesn't stretch. Then the heart doesn't get the chance to fill with enough blood.

When the heart cannot fill with blood properly, it has difficulty pumping enough blood to the body. To compensate, the pressure inside the heart increases. If this continues, it can lead to heart failure . Some people also call this `(Restrictive Pericarditis)`, but now the name `(Constrictive Pericarditis)` is more commonly used. Both are the same condition.

Who is most likely to get this disease?

Although anyone can develop this condition (Constrictive Pericarditis), some people are at higher risk.

• For those who have previously undergone heart surgery .
• For those who have received radiation therapy to the heart area.
• For those who have inflammation of the pericardium for which no cause can be found (we call it ``idiopathic pericarditis``) or who have had inflammation of the pericardium due to a viral infection (``viral pericarditis``).
• In developing countries, like our country for example, tuberculosis (TB) is the leading cause.

It is two to three times more likely to develop in men than in women. It is also very rare in young children.

How common is this condition?

Constrictive Pericarditis is actually a very rare condition . It occurs in about 9% of people with acute pericarditis. And that acute pericarditis is seen in about 5% of people who come to the emergency room with chest pain. So you can imagine how rare it is.

What are the symptoms of this disease?

The symptoms of this disease appear gradually. Sometimes they can come on suddenly. The main symptoms that are seen are:

• Difficulty breathing (dyspnea): Feeling short of breath when you are slightly tired, or even just standing still.
• Chest pain : A squeezing, squeezing pain.
• Fatigue, fatigue : Feeling so tired that you can't do anything.
• Dizziness : Feels like your head is spinning, sometimes like you're about to lose consciousness.
• Swelling : Fluid accumulates and swells, especially in areas like the abdomen and legs (around the ankles).
• Muscle weakness and wasting : The body is losing muscle mass.
• Loss of appetite and feeling full even after eating a little : You don't feel like eating, but you feel full even after eating a little.

Are there different types of this disease?

Yes, there are several different subtypes of `(Constrictive Pericarditis)`. Let's see what they are:

• Acute type : In this type, scarring of the pericardium occurs very quickly, within a few days.
• Subacute type : This is similar to the acute type, but the symptoms are not as severe.
• Effusive-constrictive pericarditis : This type of pericarditis is caused by fluid accumulating inside the pericardium (pericardial effusion). As this fluid builds up, it puts pressure on the heart. This is called cardiac tamponade. Think of it like a balloon inside a balloon, and if you fill the outer balloon with water, the inner balloon will become compressed. Eventually, the heart may stop beating. If the extra fluid is removed but the pressure inside the heart remains high, this is called effusive constriction.
• Transient constrictive pericarditis : This is usually an acute form of pericarditis, which is a condition in which the pericardium becomes inflamed and constricted. It can be treated with anti- inflammatory medications .
• Occult constrictive pericarditis : In medicine, the word "occult" means "hidden." This name comes from the fact that this type is difficult to detect. It is often discovered incidentally during other tests.

What causes this?

Constrictive Pericarditis is a condition in which the pericardium becomes thickened and stiff. This is mainly caused by scar tissue from previous medical conditions. There are several reasons why this pericardium can become stiff:

• Infections : In developing countries, tuberculosis is the most common bacterial infection. About 20% to 30% of cases of tuberculosis-related pericarditis can progress to this condition. In developed countries, viral infections are more common.
• Heart disease and circulatory system problems : Heart attacks or other conditions that affect the large blood vessels near the heart.
• Trauma : Inflammation caused by injuries to the chest (such as a blow, a stab wound, or a gunshot wound) can later turn into scars.
• Immune system diseases or inflammatory conditions : For example, diseases like `(Lupus)`, `(Rheumatoid arthritis)`, or `(Sjögren's syndrome)`.
• Medical causes : The pericardium can thicken and scar after heart surgery, radiation therapy for cancer, or as a side effect of some medications.
• Cancer : Cancer of the pericardium itself or cancer that has spread from elsewhere in the body.
• Other causes : Sometimes, no cause can be found for ``Constrictive Pericarditis.'' Doctors often think that these are caused by a viral infection, or they group unknown causes and viral causes together in statistics.

Is this contagious?

No. Although Constrictive Pericarditis can be caused by infections (some of which are contagious), the condition itself is not contagious .

How do doctors detect this?

A doctor can diagnose this condition by looking at your symptoms, your medical history (such as previous illnesses, surgeries), a physical exam, and some specialized tests. It can sometimes be difficult to diagnose, especially if your symptoms are not severe or if you have other conditions that have similar symptoms.

What tests are being done for this?

If a doctor suspects you have Constrictive Pericarditis, they may do the following tests:

• Tests for Tuberculosis .
• Blood tests to check for immune system diseases .
• Echocardiogram (like an ultrasound scan of the heart).
• Electrocardiogram (ECG) (a test that checks the electrical activity of the heart).
• Chest X-ray .
• Heart computerized tomography (CT scan) .
• Heart magnetic resonance imaging (MRI) scan .
• Left and right heart catheterization (a test that measures pressure by passing a thin tube into the heart).

How can this be treated? Can it be cured?

This condition is usually treatable , and often curable.

In most cases, two main principles are followed to cure this:

• Reducing the pressure on the heart due to the inability of the heart to contract.
• Treating underlying causes or associated symptoms.

What are the medications and treatments for this?

Often, the following are the treatments for this condition:

• Surgery : A surgery called a pericardiectomy removes the entire pericardium. This is the most effective way to treat the condition. Pericardiectomy is not necessary for you to survive . Most people recover from the surgery without any complications or long-term effects.
• Medication : Depending on the underlying cause and symptoms, various medications can be used to treat the symptoms of this condition directly, or to try to cure it by stopping the cause. In some cases, it can be treated with medication alone without the need for surgery, or for those who cannot have surgery, medications can help control symptoms.

What kind of medications are used?

The most commonly used medications to treat this condition are:

• Diuretics : These medications help your kidneys remove extra fluid from your body.
• NSAIDs (Non-steroidal anti-inflammatory drugs) : These reduce inflammation and relieve pain. Examples include `(Ibuprofen)` or `(Naproxen)`.
• Steroids : The anti-inflammatory properties of these medications help treat this condition.
• Specific medications for the cause : For example, antibiotics for bacterial infections such as tuberculosis.

What are the complications or side effects of the treatment?

Possible complications vary depending on the treatment and medication. The cause or type of Constrictive Pericarditis also affects this. Your doctor is the best person to talk to you about possible side effects or complications, especially with medications. This is because he or she can give you information tailored to your specific condition and situation. He or she will also tell you what to expect, how to manage these problems, and what you can do to prevent them altogether.

Some of the complications that can occur from surgery are:

• Heart failure .
• Irregular heartbeats (`Arrhythmias`) .
• Infections and sepsis (blood poisoning).
• Death (this is very rare).

How can I manage symptoms if I don't take care of myself?

Constrictive Pericarditis is not something you should treat or manage on your own , as tests and scans are essential to diagnose it. This is especially important because some of the symptoms of this condition can also occur with life-threatening conditions such as cardiac tamponade or heart attack. Therefore, you should first talk to a doctor and get guidance on what you can do about this condition.

How soon will I feel better after treatment?

Depending on the cause of the condition and the treatment you receive, it may take a few days or a few weeks for you to feel better. If you have surgery, you will need to add the recovery time from the surgery to the time it takes for you to feel better. Most people feel better within three months , but some people may take several months to fully recover.

Can I prevent this or reduce the risk?

Constrictive Pericarditis is a condition that occurs unexpectedly, so it cannot be prevented. The only thing you can do to reduce your risk of developing this condition is to avoid situations that can lead to it. For example, if you have a bacterial infection, seek treatment as soon as possible. Another is to limit the damage to your pericardium by the medical staff if you are receiving radiation therapy.

What can I expect if I have this condition? Can this be cured?

Your outlook in this case depends on the cause, the severity of your condition, treatment, and other health conditions you have. Your doctor is the best person to tell you what to expect from this condition and what your outlook will be.

Because this condition often occurs with or is caused by serious or life-threatening illnesses, the outlook can be negative. This is especially true if it is caused by radiation therapy, or if you also have:

• Advanced kidney disease or kidney failure .
• Heart failure .
• Liver disease .
• Pulmonary hypertension .

Because of these risks, the best outcomes are achieved with early diagnosis and treatment . Even in the transient form, good outcomes are more likely. Even then, about 5% - 10% of people who undergo surgery may not survive (outcomes are generally better in hospitals specializing in heart disease).

However, many people recover and do well . About 80% of people who have surgery for this condition live at least five years, and about 60% live at least ten years.

How long will this last? When will I be able to resume my normal activities?

How long this condition lasts depends on the type, cause, and treatment you receive. In some cases, this condition will resolve on its own or with medication. It usually takes a few weeks to a few months. The more severe the condition or cause, the longer it will usually take for you to recover.

How do I take care of myself?

If you have this condition, it is very important to follow your doctor's instructions. This includes:

• Take medication as prescribed : The medication prescribed for this condition should be taken as prescribed, and it is not a good idea to stop halfway just because you feel better.
• Follow dietary advice : Many people will need to limit their salt intake. The sodium in salt can cause fluid retention in the body, which can make this condition worse.
• Limit physical activity if necessary : ​​This helps reduce the strain on your heart and prevent and limit damage to the heart muscle.

When should I see my doctor? When should I seek medical help?

Most people will need to continue seeing their doctor until they recover from this condition. As your condition improves, your doctor will often recommend reducing the number of visits you have.

If you feel your symptoms coming back, or if your symptoms change and start to affect your normal activities, you should call your doctor or make an appointment.

When should I go to the Emergency Department (ETU) ?

Many of the symptoms of this disease can also occur with life-threatening medical emergencies. Therefore, you should seek immediate medical attention if you have any of the following symptoms:

• Difficulty breathing (Dyspnea) .
• Chest pain .
• Dizziness or feeling light-headed .
• Fainting or passing out .

Finally, things to remember

Constrictive Pericarditis is a rare and unpredictable disease. Its symptoms are similar to many other diseases, so it can sometimes be difficult to diagnose. Fortunately, with the advancement of medical science and technology, it is now easier to diagnose this disease with certain scans. Treatments for this disease have also improved greatly. This means that in many cases, this disease can be treated, and sometimes even completely cured. Therefore, if you have these symptoms, it is best to see a doctor and seek advice without fear.

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