Pediatricsadvanced
Arrange the pathophysiological steps of constrictive pericarditis in chronological order, starting from the initial structural change to the development of systemic venous congestion.
Answer
Pericardium becomes scarred, thickened, and fibrotic, Ventricular expansion and diastolic filling are mechanically restricted, Systemic venous pressures rise while cardiac output declines, Clinical signs of systemic venous congestion (e.g., jugular venous distension, ascites, peripheral edema) develop
Explanation
The sequence begins with a scarred, thickened pericardium that may also be calcified. This rigid covering restricts expansion and filling during diastole. The reduced filling compromises cardiac output and is associated with raised systemic venous pressure. Clinical consequences then include jugular venous distension, ascites, hepatic congestion, and peripheral oedema. **Key takeaway:** Structural pericardial restriction produces the haemodynamic changes that lead to congestion and low-output symptoms. **Glossary:** **Diastolic filling**: entry of blood into the heart during relaxation. **Oedema**: excess fluid accumulating in tissues.
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