Chronic Constrictive Pericarditis


  • Due to progressive thickening, fibrosis and calcification of the pericardium, causing a restrictive cardiac filling defect.
    • Fibrosis may also spread into the myocardium to cause impairment of heart contraction also


  • The risk factors/causes for chronic pericarditis are essentially the same as in acute disease but the course is prolonged
    • Risk is significantly higher in bacterial (particularly TB) pericarditis
    • Post-pericardectomy syndromes/systemic inflammatory conditions carry a small (but increased) risk
    • Risk for developing chronic pericarditis is low following viral pericarditis
  • NB Often, there will be no underlying insult found


  • NB Difficult diagnosis based on clinical findings alone.
  • Signs of venous congestion e.g. elevated JVP (can be markedly high; classically with a rapid y descent; also can rise with inspiration- Kussmaul’s sign); hepatomegaly; ascites; peripheral oedema
    • Signs of venous congestion without an enlarged heart or valvular disease (i.e. no murmurs) should suggest the possibility of constrictive pericarditis
  • Fatigue
  • Pulse: may be rapid, low-volume
  • BP: may show pulsus paradoxicus (a paradoxical and excessive fall in BP with inspiration)
  • NOTE: Chest pain and breathlessness are uncommon in these patients


  • CXR- may show calcification of the pericardium
  • Echocardiogram is often diagnostic
  • Other imaging studies and ECG may be helpful


  • If there is an identifiable and treatable underlying cause, treat this in the first instance.
  • Pericardectomy may be required in patients with severe disease.  However, this is a very risky procedure and results are variable

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