Restriction vs Constriction

Clinical presentations of dyspnea, pedal edema, enlarged liver, and jugular venous distention may require differentiating constrictive pericardial disease (CPD) from restrictive cardiomyopathy (RCM). Differentiation the pathophysiology is paramount importance to invasive cardiologist because they are often called sort out a confusing clinical picture. The surgical treatment constriction not only can be life changing for patient but also involves considerable risk. Therefore, an accurate hemodynamic echocardiographic evaluation required, which will lead patient’s care along proper road; erroneous diagnosis could dead end, futile treatment, or harm omission correct therapy. Using hemodynamics differentiate various forms right atrial hypertension has been ongoing decades.1Bloomfield R.A. Lauson H.D. Cournand A. Breed E.S. Richards D.W. Recording heart pressures in normal subjects patients with chronic pulmonary types cardio-circulatory disease.J Clin Invest. 1946; 25: 639-664https://doi.org/10.1172/JCI101746Crossref Scopus (51) Google Scholar, 2Hurrell D.G. Nishimura Higano S.T. et al.Value dynamic respiratory changes left ventricular pericarditis.Circulation. 1996; 93: 2007-2013Crossref PubMed 3Taireja D.R. Oh J.K. Holmes Constrictive pericarditis modern era: novel criteria cardiac catheterization laboratory.J Am Coll Cardiol. 2008; 51: 315-319Crossref (173) 4Goldstein J.A. Kern M.J. Hemodynamics cardiomyopathy.Catheter Cardiovasc Interv. 2020; 95: 1240-1248https://doi.org/10.1002/ccd.28692Crossref (9) Scholar As previously discussed,5Dean L.S. Getting A C: pressure waves graphic display interpretation.J 2022; 1100034https://doi.org/10.1016/j.jscai.2022.100034Abstract Full Text PDF initial steps avoiding wrong include properly setting up measurement system. Key points success as follows:1.Correctly flushed tubing zeroed transducers2.Appropriate catheter selection3.Simultaneous measurements4.Interpretation results Now, we cover each more detail. set was addressed detail,5Dean fundaments measurements cannot overlooked. Transducers should at same level midchest. Otherwise, subtle differences (RV) (LV) pressures, such equivalent end diastolic lost misinterpreted. Because constrictive/restrictive physiology depends on simultaneous LV RV when possible, catheters equal length, similar compliance, fidelity. standard balloon-tipped artery provide fidelity required characteristics high compliance small lumen generate artifacts amplification waveforms due single-end hole design. Q: What ideal fluid-filled catheter?•One multiple holes. Example: pigtail multipurpose side catheter•One large lumen. Example >6F Wedge (not Swan-Ganz multilumen catheter) A: Properly placed both ventricles. Both CPD RCM impair filling through different mechanisms. encases heart, fixed, one ventricle fills expense other. relationship during respiration termed interdependence, demonstrating this phenomenon highest sensitivity specificity compared historical findings purported useful RCM. One famous wave form exaggerated rapid wave, followed by flat period diastasis, seen “dip plateau,” commonly known square root sign. Unfortunately, sign sensitive nor specific noted congestive failure, bradycardia, infarction. After placing second ventricle, RV/LV measured sinus rhythm paced if underlying fibrillation.2Hurrell Then, continuous spontaneously breathing reviewd. During inspiratory phase respiration, rising falling together (ventricular concordance) elevated, then systolic concordance most consistent (Figure 1A). On contrary, increases, wheras decreases (called discordant interdependence), finding 1B). Ventricular interdependence that far exceeds any other pressure/RV ratio.2Hurrell Scholar,3Taireja •Appropriate used, inspiration expiration.•In fibrillation, assessment paced.•Elevated vary (ie, strongly considered RCM.•Elevated synchrony discordant), wherein increases would support CPD. author(s) declared no potential conflicts interest respect research, authorship, and/or publication article.