Difference Between Constrictive Pericarditis and Tamponade

Both tamponade and constrictive pericarditis (sometimes called cardiac or pericardial tamponade) are disorders affecting the pericardium. It might be difficult to tell the difference between these two pericardial illnesses since they have many similar symptoms. However, some diagnostic tests and treatments can give a more certain diagnosis of the problem.

What is Constrictive Pericarditis?

In constrictive pericarditis, the pericardium gradually becomes thickened and causes the heart to become enlarged. The pericardium, the sac that surrounds the heart, loses its suppleness as a result of this thickening, limiting the heart's ability to expand completely with each breath.

Because the ventricular chambers of the heart are less able to relax under the effects of constriction, diastolic pressures rise, and ventricular pressures rise more quickly. As an added bonus, the typical drop in intrathoracic pressure (chest pressure) that occurs during inspiration (breathing in) does not translate to a similar drop in cardiac pressure. The outcome is a decrease in the volume of the left ventricle's stroke on inspiration due to a decrease in pulmonary venous pressure.

Potential Causes − It might be difficult to determine what is causing constrictive pericarditis. Common reasons include radiation therapy to the chest, persistent infections like TB, and cardiac surgery or damage to the heart (such as a heart attack). Bacterial and viral infections, autoimmune disease complications, medication-related side effects, and some forms of cancer are all possible causes, though they are far less prevalent.

Symptoms − There are some distinctions between the symptoms of constrictive pericarditis and cardiac tamponade, however, the two conditions generally present with very similar signs.

Those who suffer from constrictive pericarditis typically show the following signs and symptoms −

• Chronic respiratory difficulties that worsen over time.

• Heightened weariness and frailty.

• abdominal edema and significant swelling below the ankles.

• Mild fever.

• Intense discomfort in the chest.

Diagnosis − Diagnosing restrictive pericarditis can be difficult since its symptoms are similar to those of other cardiac disorders. Because of this difficulty, doctors usually begin by ruling out other possible causes of cardiac problems. Many patients with constrictive pericarditis exhibit indicators (in addition to the aforementioned symptoms), the most prominent of which is Kussmaul's sign. The bulging of the veins in the neck, known as Kussmaul's sign, is a symptom of hypertension. Swollen liver, fluid accumulation, and weak heart sounds are further symptoms.

Additionally, tests are conducted to obtain a diagnosis. The following are some of them −

• Scans and X-rays (to identify any blood clots and a thick pericardium)

• Cardiac catheterization (to take samples directly from the heart tissue and perform measurements)

• Electrocardiogram (to detect electrical irregularities coming from the heart)

Treatment − Early-stage constrictive pericarditis can be treated with diuretics (to eliminate excess fluid), painkillers, anti-inflammatory drugs, corticosteroids, activity reduction, and colchicine. In extreme cases, a pericardiectomy might be done to remove the hard portions of the pericardium.

What is Tamponade?

The abnormal accumulation of fluid in the pericardium, known as cardiac tamponade, is a life- threatening emergency (or pericardial sac). An abnormal accumulation of fluid is considered a medical emergency because it puts pressure on the heart muscle. Compression of the heart caused by cardiac tamponade reduces diastolic filling function, further reducing cardiac output.

Potential Causes − Cardiac tamponade is typically brought on by sudden, severe illness or injury. Pericardial injuries (from firearms or knives), chest trauma, pericarditis, hyperthyroidism, renal failure consequence, autoimmune illnesses, radiation therapy, and certain malignancies are all examples of this.

Symptoms − Those experiencing cardiac tamponade typically exhibit the following symptoms −

• Fainting, dizziness, and/or passing out due to low blood pressure.

• Vigorous and quick respiration.

• Stress and a lack of sleep.

• Inability to take deep breaths or difficulty doing so.

• Relief from back pain whether bending over or sitting up straight.

• Pain in the chest that spreads to the back, jaw, and shoulders.

Diagnosis − Beck's triad is commonly used to diagnose cardiac tamponade. The three key indications that makeup Beck's triad are hypotension, prominent veins in the neck, and a fast heartbeat with muffled heart sounds.

The following tests are conducted to help make a correct diagnosis −

• Scans of the chest (to look for accumulated fluid in the pericardium)

• An angiogram (to see the blood flow within the heart)

• Electrocardiogram (to detect electrical irregularities coming from the heart)

Treatment − As a standard treatment, needle drainage of accumulated fluid from the pericardial sac is used to relieve cardiac tamponade. If the situation is severe, surgery to remove clots and fluid and maybe cut away sections of the pericardium to reduce pressure may be necessary.

Differences between Constrictive Pericarditis and Tamponade

The following table highlights the major differences between Constrictive Pericarditis and Tamponade −

Characteristics	Constrictive Pericarditis	Tamponade
State of the pericardium	Thickened or rigid pericardium	Accumulated fluid in the pericardial sac
Primary sign	Kussmaul's sign	Beck's triad
Time of onset	Mostly chronic	Mostly acute
Treatment	Medications (early onset) Surgery (severe stage)	Drainage Surgery

Conclusion

Initial physical examination symptoms of constrictive pericarditis and cardiac tamponade are frequently identical. Cardiac tamponade is characterised by fluid buildup inside the pericardial sac, whereas constrictive pericarditis is characterised by a thicker and hard pericardium.

Differentiating between the two illnesses is essential for a proper diagnosis and subsequent therapy.