The last of the topic of pericardial disease is one in
which I need you to think of it is being a continuation.
You won’t underestimate this lecture nor do
you overestimate it. You get the fundamentals
and once you do, then you’ll understand
the concept of constrictive pericarditis.
How many times have you thought yourself, “My goodness,
this seems like a restrictive cardiomyopathy
or a restricted type of disease". But then, you have
choices of whether it being constrictive or not?
Well, let’s make sure that we’re completely clear
about your diagnosis of constrictive versus restrictive.
And what that actually means?
So, whats constrictive? What is it?
Point being chronicity.
If it’s a number one thing that you take out of this
entire lecture for constrictive pericarditis. Chronicity.
What do you mean chronicity?
A chronicity, well, remember when we talk
about rheumatic heart disease.
Remember when we talk about cirrhosis.
Remember when we talk about the concept the fibrosis.
What does that mean Dr. Raj? It means the following.
When we had rheumatic heart disease, initially, early on,
you had vegetation’s that results in working of
valvular heart diseases on the left side most commonly.
Early on, acutely, It was regurge. And it was regurge.
Vegetations. But then, what happen chronically?
While you introducing damaged, goods.
And so therefore, when something it’s damage,
what happens? You have to go through repair process.
Tell me about cirrhosis. With cirrhosis, well, cirrhosis
end stage of liver disease. Maybe it was alcohol.
Maybe it was autoimmune. Maybe it was viral.
Maybe it was not alcoholic. Right?
And so therefore, anyone of those at some point results
in a chronic type of condition of fibrosis of the liver.
Or if its honeycomb appearance of youlongo on
chest x-ray, what does that mean?
Increased fibrotic deposition of the septa, right?
So, when you say chronicity, and when there’s
initial damage, you are going to start depositing
more, more of your college of resulting
increase fibrosis. Is that clear? As far add bengay?
Concept: once you do, then you’ll understand
Because you can’t bring in constrictive immediately
if you don’t have the fibrosis.
Maybe you can have restrictive granted, alright? So there’s
certain amount of restriction that might be taking place.
But still not fully fibrotic, not fully calcified.
Once that occurs in its fully calcified on fibrotic,
now, what is the description?
It’s a fact that, oh my goodness, you have a chick
in an egg that want’s to now explode.
It’s ready to come out into the world. Okay. But, it’s in
an egg. Okay granted. You want that egg to break
So that, you know, the creature has freedom.
But that’s not how the heart works.
There has to be proper expansion granted.
My goodness, it should never be in eggshell.
Do you get the point. So think of the heart encased in a
inexpendable eggshell. That is not a good feeling.
In addition, think of the eggshell was being white, so that
you’ll understand that is severe, severe constriction.
That’s a lot of fibrosis and calcification.
How incredibly convenient that its calcium and its white.
Let’s continue. The scarred or calcified pericardium
squeezes, constricts the heart.
Is it restrictive. Of course it is. But clinically speaking,
you must diagnose as just being what? Constrictive.
Are we seeing these now?
So as I said earlier, how much attention
do you pay for this lecture?
While, quite a bit so that you understand the concept.
But once you do, then it becomes a very
easy diagnosis as you can see.
Talk about constrictive. So what these errors
are showing are those parts of the pericardium
in which it is undergoing pericardial calcification?
You see how incredibly white opaque is the pericardium
has now become? This is constrictive.
Did this occur acutely? No, no, no. Chronicity.
With chronic, chronic build-up of fibrosis and
calcification, dystrophic, right. Damage first
then accumulation of calcium. You’re going to find
that increased opacity as we see here in our chest x-ray.
You have the basically AP view don’t you?
Anterior, posterior view.