Restrictive cardiac disease. Pericarditis and the myocardiopathies

Abstract

Restriction of the normal range of motion of the myocardium produces a consistent pattern of hemodynamic and clinical events. The features are similar, whether the limited cardiac action results from cardiac tamponade, constrictive pericarditis, or restrictive myocardiopathy. Persistent elevation of systemic venous pressure, prominent jugular x and y waves, and paradoxical arterial pulse may be present with any one of these disorders. Intracardiac pressures may be similar, with narrow pulse pressure in the right ventricle, an early diastolic dip in both ventricles, and approximately equal right atrial and pulmonary wedge pressures. On physical examination, evidence of right or left ventricular hypertrophy, atrial and/or ventricular gallop rhythm, or murmurs of relative mitral or tricuspid insufficiency support a diagnosis of myocardial disease rather than pericardial disease. A diagnosis of myocardiopathy is favored by an electrocardiographic pattern of bundle branch block, Wolff-Parkinson-White syndrome, or left ventricular hypertrophy. Although routine roentgen studies are often of no diagnostic value, contrast studies with cardiac radioisotope scanning, intravenous CO 2, or angiocardiography will usually permit distinction between pericardial and myocardial disease. In rare instances, the diagnostic problem cannot be resolved without resort to exploratory thoracotomy.