Constrictive Pericarditis, Restrictive Cardiomyopathy, Cardiac Tamponade, HOCM

Constrictive Pericarditis

Caused by Viral infections or Radiation or Heart Surgery

Thickening of Pericardium, Pericardial calcification on MRI

Symptoms: SOB, Fatigue

JVP elevated, Ascites, Pedal Edema

Early Diastolic Pericardial Knock

Prominent X and Y descents

Respirophasic Septal Shifting=Bulging of septum to the left on inspiration


Restrictive Cardiomyopathy

Caused by Amyloidosis or Sarcoidosis or Endomyocardial Fibrosis

Ventricle wall thickening and atrial enlargement=Cardiomegaly

Symptoms: SOB, Fatigue

JVP elevated, Ascites, Pedal Edema

3rd heart sound due to heart failure, 4th heart sound due to reduced compliance, Murmurs, heart blocks

Blunting of X descent

Signs of Amyloidosis like Ecchymoses, Petechiae, Purpura etc can be seen if it caused this condition.


Cardiac Tamponade

Caused by Aortic dissection, pulmonary hypertension caused by systemic sclerosis etc.

A fast accumulation of fluid in the pericardium leads to a steep rise in pericardial pressure causing cardiogenic shock, whereas a slow accumulation of fluid takes longer to reach critical or symptomatic pericardial pressure.

Symptoms: SOB, Hypotension, Tachycardia, chest pain, tachypnea.

Muffled heart sounds and elevated jugular venous distention. Lower-extremity edema bilaterally.

Lung sounds are clear.

Pulsus paradoxus [ an exaggerated blood pressure variation with the respiratory cycle.]

Electrocardiography reveals low voltages throughout all leads.

CXR->normal cardiac silhouette until the effusions are at least moderate in size (~200 mL).

Bedside therapeutic pericardiocentesis can precipitate hemodynamic collapse in patients with systemic sclerosis who have uncontrolled PAH.

Pericardiocentesis should be avoided in the setting of aortic dissection leading to cardiac tamponade.


Hypertrophic Obstructive Cardiomyopathy or HOCM

Asymmetric Hypertrophy of Left Ventricle

Diastolic Dysfunction due to reduced compliance

Symptoms: SOB, Fatigue, Sudden death after exercise, Chest pain

Brisk upstroke-Bifid or Trifid pulse [Pulsus Bisferiens]

Murmur increases with less flow/volume with valsalva or standing

Needs Betablocker to slow the heart so that LV fills better reducing the murmur

Defibrillator if patient develops NSVT

Septal Myotomy is treatment.


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