What is the clinical presentation of constrictive pericarditis in pulmonary artery catheterization (PAC)?

Updated: Dec 22, 2017
  • Author: Bojan Paunovic, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
  • Print
Answer

Constrictive pericarditis

Thickening of the pericardial sac creates an indolent process that may lead to constrictive pericarditis. This can occur in patients with rheumatic diseases, tuberculosis, metastatic cancer, or prior chest radiation or open-heart surgery. Idiopathic cases also occur. Early diastolic filling is normal until limited by the rigid pericardial shell. Once this occurs, ventricular filling is stopped abruptly, creating a plateau in the RV pressure, which is typical of constrictive pericarditis. This is called the "dip and plateau" pattern or square root sign; the RAP waveform has a characteristic configuration suggestive of an M or W. A and V waves are accentuated with rapid X and Y descents, in contrast to pericardial tamponade, above. PCWP may be as high as 20-25 mm Hg, and usually appears similar to the RA waveform. Pulsus paradoxus is present much less commonly with constrictive pericarditis than with pericardial tamponade (see images below).

Simultaneous recordings of pulmonary capillary wed Simultaneous recordings of pulmonary capillary wedge pressure and left ventricular pressure waveforms in a patient with constrictive pericarditis. Note the equalization of diastolic pressures and "square root sign" or "dip and plateau sign" of the left ventricular waveforms, which are confirmatory of the diagnosis of constrictive pericarditis.
Right atrial pressure waveform of a patient with c Right atrial pressure waveform of a patient with constrictive pericarditis. Please note rapid X and Y descents, and elevated A and V waves. This gives an impression of the letter "M" or "W" and is confirmatory of the diagnosis of constrictive pericarditis.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!