restrictive cardiomyopathy VS constrictive pericarditis

[faisal 2000]

how can we differentiate B\W restrictive cardiomyopathy and constrictive pericarditis?
they have similar signs and symptoms. but i do not know if they have similar pahtophysiology or not.
another thing will we see increase and end equalization of all end diastolic pressure in constrictive pericarditis as it occurs in restrictive cardiomyopathy

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[iBS1972]

Good question, indeed the two can be very confusing, as both cause impaired diastole.

Restrictive cardiomyopathy is used to describe pathology of the myocardium. Diseases include amyloidosis, hemachromatosis, and sarcoidosis. In other words, things that kind of fill up the cardiac myocytes with junk, impairing its ability to stretch.

Constrictive pericarditis on the otherhand is when there's inflammation of the pericardium. Causes are often infectious: TB, fungal, post-viral.

Both cause diastolic heart failure, but different etiologies.

Differences:
Restrictive CMP: thickened ventricular walls. septal shift during inspiration. Tend to be chronic. Treatment is preload (diuretics) and afterload (beta-blockers, ACE-i) optimization.
Constrictive pericarditis: pericardial knock, equalization of EDP. Treatment is surgery (pericardial stripping).

Hope this helps!

 

[Jabbed]

how can we differentiate B\W restrictive cardiomyopathy and constrictive pericarditis?
they have similar signs and symptoms. but i do not know if they have similar pahtophysiology or not.
another thing will we see increase and end equalization of all end diastolic pressure in constrictive pericarditis as it occurs in restrictive cardiomyopathy

Diastolic pressure equalization occurs with cardiac tamponade, not necessarily with constrictive pericarditis.

History:
Both present with CHF (classically)
TB, recurrent pericarditis, hx of heart surgery = constrictive pericarditis
Sarcoid, amyloid, hemochromatosis = restrictive cardiomyopathy
Radiation injury can be either

Exam:
Both have Kussmaul sign, congestive hepatomegaly. Pericardial knock is constrictive pericarditis.

Clinical:
Increased RA/LA volume with nml ventricles = RCM.
"Speckled" appearance of myocardium on ECHO = RCM d/t amyloid
"Square root sign" or rapid x and y descent on cardiac cath = constrictive pericarditis
Cardiac MRI can look at pericardial thickness

Definitive dx requires endocardial biopsy

 

[faisal 2000]

Diastolic pressure equalization occurs with cardiac tamponade, not necessarily with constrictive pericarditis.

History:
Both present with CHF (classically)
TB, recurrent pericarditis, hx of heart surgery = constrictive pericarditis
Sarcoid, amyloid, hemochromatosis = restrictive cardiomyopathy
Radiation injury can be either

Exam:
Both have Kussmaul sign, congestive hepatomegaly. Pericardial knock is constrictive pericarditis.

Clinical:
Increased RA/LA volume with nml ventricles = RCM.
"Speckled" appearance of myocardium on ECHO = RCM d/t amyloid
"Square root sign" or rapid x and y descent on cardiac cath = constrictive pericarditis
Cardiac MRI can look at pericardial thickness

Definitive dx requires endocardial biopsy

so definitive diagnosis for both constrictive pericarditis and restrictive cardiomyopathy by biopsy ??

 

[faisal 2000]

@Phloston

 

[Instatewaiter]

so definitive diagnosis for both constrictive pericarditis and restrictive cardiomyopathy by biopsy ??

Biopsy has very little to do in the differentiation of restriction and constriction. It can help diagnose amyloid and HCM but isn't used for sarcoid and won't differentiate restriction/constriction. .

Truly it is differentiated by left and right heart cath which shows the classic ventricular interdependence. When you take a deep breath in, the venous return increases. In constriction the RV pressure rises but the pericardium prevents the LV from filling so the pressure goes down. When you expire the opposite happens (ventricular interdependence or ventricular dyscordance)

In restriction, you inspire, the RV pressure rises and fills the LV better so the LV pressure rises as well (ventricular concordance)