Chronic Constrictive Pericarditis


  • Due to progressive thickening, fibrosis and calcification of the pericardium, causing a restricting filling and ejection defect of the myocardium.
  • Often a consequence of TB pericarditis, but can also be caused by/secondary to
  • Can be idiopathic

Clinical features

  • Signs of right heart failure e.g. hepatomegaly, splenomegaly and ascites are common
    • NB Breathlessness is rare (lungs rarely congested)
    • Fatigue is also common
  • The JVP is abnormal
    • Raised with abrupt waveform descents (y > x).  May rise further (paradoxically) with inspiration (as in tamponade- Kussmaul’s sign)
  • Paradoxical Pulse (abnormal decrease in pulse strength (SBP) during inspiration); pulse will usually be rapid and low
  • Auscultation may reveal a ‘pericardial knock’ (early S3).
  • A friction rub is actually relatively rare (cf acute disease)


  • Pericardial calcification may be seen on CXR.  There may also be left and right atrial enlargement.
  • Echocardiography (heart function)

NB Can be difficult to differentiate from restrictive cardiomyopathy and further testing e.g. doppler echo or catheter tests may be required to do this


  • Pericardectomy is the only definitive treatment.  However, mortality and complication rate is high and it may not benefit every patient.
  • Otherwise, treatment is largely supportive

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