chronic constrictive
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The heart is enclosed within a delicated fibrous sacknown as the pericardium.
The outer wall fibrous or parietal pericardium
The inner wall visceral pericardium or epicardium
The two pericardial wall is seperated by a space linedwith a mesothelium.
The attachments of the pericardium:
Anteriorely- posterior surface of the sternumposteriorly & superiorly great vessels & looseconnective tissues within the post. Mediastinum
Inferiorly fused with cental tendon of thediaphragm
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It is the condition in which the
pericardium becomes thickened, fibrosed
& calcified. The pericardial cavity is
obliterated by dense scar tissue. Theheart is infact is confined in a rigid
inelastic case preventing it from its
proper functioning.
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The pathological effect of this condition is
that it prevents ventricles from filling in diastole. This
causes decreased cardiac output. A compensatory
tachycardia is seen. There is corresponding increase inright atrial pressure and right ventricular pressure. There
is also elevation of cental venous pressure. This
hypertension may produce periferal oedema, hepatic
enlergement and ascites.
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Tubercolosis
Pyogenic pericarditis
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Acute benign pericarditis
Following hemopericardium
Connective tissue diseases
Radiation therapy to chest
Uremic
Idiopathic
RA
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A. Due to impaired filling of RIGHT side of
heart
B. Due to impaired filling of LEFT side ofheart
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A. Due to impaired filling of RIGHT side of heart
1. Raised venous pressure
Kussmauls signFriedreichs sign
2. Cardiac signs
Palpation:
Systolic retardation of the apex beat
diastolic shock
Auscultation:
Loud early 3rd sound
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Due to impaired filling of left heart
1. syncope on exertion
2. dyspnoea
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1. Chest radiograph
Calcification of pericardium
Dilated superior vena cava
2. ECG
T terminal negativityMay be atrial fibrillation
3. Echocardiography
Small ventricles & enlarged atria
The pericardium single or double dense
Immobile heart
Inferior vena cava & hepatic veins largely dilated
4. MRI
Thickened pericardium
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1. Restrictive cardiomyopathy
2. Cirrhosis of liver
3. Congestive cardiomyopathy
4. Tricuspid valve disease 5. RV infarction
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Aim Realive the constriction
PERICARIOCTOMMY
The heart is approched through a
median sternotomy and pericardium is
carefully stripped off the left ventricle,
followed by the right ventricle. Sometimescardiopulmonary bypass may be required .
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Day 0. No treatment
Day 1. Arm & leg exercises in half lying, Breathingexercises
Day 2. First walk
Day 3. Increased walking
Day 4. Walking about 100 yards with no shortness ofbreath, begin stair climbing
Day 5. trunk exercises, increase stair climbing & walking
Day 7. breathing exercises, neck, trunk, shouldergirdleexercises, teaching home exercises
Pt. Will advised that he should not drive for 6weeks & sexualrelations should be avoided for 4 weeksafter leaving hospital.
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THANK U......