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Differential diagnosis of restrictive cardiomyopathy and constrictive pericarditis
  1. E William Hancock
  1. Stanford University School of Medicine, Stanford, California, USA
  1. E William Hancock MD, Stanford University Medical Center, Division of Cardiovascular Medicine, H-2157, 300 Avenue Louis Pasteur, Stanford, CA 94305-5233, USAwhancock{at}

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The differentiation of restrictive cardiomyopathy and constrictive pericarditis has been a perennial problem in clinical cardiology. Constrictive pericarditis requires surgical treatment and is usually curable, while restrictive cardiomyopathy, short of cardiac transplantation, is treatable only by medical means and often responds unsatisfactorily. The opinion has often been expressed that there are difficult cases in which only an exploratory operation will allow the two conditions to be distinguished. However, such cases were relatively rare in the past and should be extremely so in the present era. Many differences exist between the two conditions, even though no one diagnostic method can be relied upon to make the distinction by itself.

Constrictive pericarditis

Constrictive pericarditis was recognised in the 19th century and its surgical treatment was developed early in the 20th century. Paul Wood noted in 1961 that only details had been added to the picture presented to the English speaking world by Paul Dudley White in his 1935 St Cyres lecture.1 ,2 White described a “chronic fibrous or callous thickening of the wall of the pericardial sac that is so contracted that the normal diastolic filling of the heart is prevented . . . There may or may not be calcification . . . Parietal pericardium or epicardium may be preponderantly involved . . . one area may be involved, other areas free . . . associated heart disease is extremely rare . . . insidious evolution makes diagnosis more difficult than that of active constrictive pericarditis”. A history of several years duration and a predominant clinical feature of ascites, simulating liver disease, were notable in White's series.

Haemodynamic features delineated in the 1940s and '50s included the narrow pulse pressure in the right ventricle with normal systolic pressure and greatly increased diastolic pressure, a prominent early diastolic dip and later diastolic …

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