What is Constrictive Pericarditis?

Constrictive pericarditis is a condition caused by chronic inflammation of the pericardium, resulting in pericardial thickening, adhesions, and even calcification. These changes restrict both cardiac diastole and systole, leading to impaired cardiac function. But what exactly is constrictive pericarditis? The following section provides a detailed explanation.

What Is Constrictive Pericarditis?

Constrictive pericarditis occurs when inflammation of the pericardium leads to its progressive thickening, stiffening, and fibrosis, thereby encasing the heart in an inflexible, rigid shell. This impairs normal cardiac diastolic and systolic function, reducing ventricular filling and subsequently decreasing cardiac output while elevating venous pressure—manifesting as a constellation of clinical symptoms. This condition most commonly develops as a complication of acute pericarditis. Other etiologies include tuberculous, purulent, and nonspecific pericarditis—with tuberculous pericarditis being the most frequent cause. Additionally, traumatic injury to the pericardium or systemic diseases such as rheumatoid arthritis may also precipitate constrictive pericarditis.

The onset of constrictive pericarditis is typically insidious, often occurring months to years after an episode of acute pericarditis. Clinical manifestations correlate with reduced cardiac output and systemic venous congestion. Patients commonly experience dyspnea of varying severity, decreased exercise tolerance, fatigue, dizziness, weight loss, hepatomegaly, right upper quadrant abdominal pain, pleural effusion, and ascites.

Physical examination may reveal a normal or slightly enlarged cardiac dullness border, diminished or absent apical impulse, and a paradoxical (negative) apical impulse during systole. Sinus rhythm is most common. Some patients may exhibit a pericardial knock—a high-pitched, early-diastolic sound—best heard at the left sternal border, third or fourth intercostal space. Additional arrhythmias—including premature contractions, atrial flutter, and atrial fibrillation—may also occur.

Knowledge Extension: How Is Constrictive Pericarditis Treated?

Once diagnosed, patients with constrictive pericarditis should undergo pericardiectomy as soon as acute symptoms have subsided, to prevent myocardial atrophy—which could compromise surgical outcomes. For patients with active tuberculosis, aggressive anti-tuberculosis therapy must be administered both pre- and postoperatively. In cases of prolonged disease duration and marked impairment of cardiac function, pre- or postoperative administration of positive inotropic agents—such as low-dose digoxin or digitoxin—may be considered to prevent acute heart failure triggered by increased myocardial workload on an already atrophied myocardium. Pericardiectomy is generally contraindicated in patients with severely compromised hepatic or renal function.

The above outlines what constrictive pericarditis is. We hope this information proves helpful to you.