Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

Constipation and Fecal Impaction Constrictive Pericarditis 397

Prognosis

■Generally good; if a specific cause is found and removed, constipa-

tion resolves; if not, long-term therapy is needed

■Most patients are satisfied with the results of medical therapy or

surgery and reported a good or improved quality of life

Constrictive Pericarditis...............................

ANDREW D. MICHAELS, MD

history & physical

Signs & Symptoms

■dyspnea, fatigue

■enlarging abdominal girth, lower extremity edema

■elevated neck veins with prominent x and y descents

■Kussmaul’s sign

tests

Chest X-Ray

■pericardial calcification

Echo

■pericardial thickening

■respiratory variation in tricuspid and mitral inflow velocities

MRI

■pericardial thickening

Cardiac Catheterization

■elevated and equalized diastolic pressures in right and left ventricles,

right atrium, wedge

■“dip and plateau” pressure pattern in ventricles

differential diagnosis

■restrictive cardiomyopathy may mimic presentation and hemody-

namics

management

■medical therapy is palliative (salt restriction, diuretics)

specific therapy

■surgical pericardiotomy (pericardial stripping) for highly symp-

tomatic patients

■perioperative mortality 5–15%