It is a disease of heart muscle characterized by progressive thickening, fibrosis and calcification of pericardium.
Commonly, involves right side of the heart.
• Infection—TB and coxsackie B infection.
• Haemopericardium (which may be due to trauma, myocardial rupture after infarction and
• Collagen disease (rheumatoid arthritis).
• Cardiac operation.
• Mediastinal irradiation.
• Fungal infection (histoplasmosis).
• Rarely, after acute purulent pericarditis.
Most features are due to systemic venous congestion.
• Cough, breathlessness on exertion, may be orthopnoea, paroxysmal nocturnal dyspnoea.
• Weakness, dizziness, giddiness, anorexia, nausea, and vomiting.
• Abdominal swelling, later ankle swelling.
• Tachycardia, low volume pulse. Pulsus paradoxus may be present.
• JVP—raised, fall of Y descent (Friedrich sign). Kussmaul sign positive (raised JVP on inspiration).
• Pericardial knock (a third heart sound due to rapid ventricular filling).
• Enlarged tender liver.
• Peripheral oedema later on.
NB: Calcification commonly involves right side of the heart and can be seen by fluoroscopy.
Calcification does not always means constriction. RF does not causes chronic constrictive
Complications of Chronic Constrictive Pericarditis
• Atrial fibrillation (in 30% cases).
• Myocardial fibrosis.
• Chest X-ray (PA and lateral view)—Relatively small heart, pericardial calcification in 50%
• ECG—low-voltage tracing, tachycardia, and T inversion.
• CT scan or CMR.
• Cardiac catheterisation shows that diastolic pressure is equal in all chambers (left and right
ventricles), end- diastolic pressure (EDP) is equal in left and right atrium.
• Other investigations according to suspicion of cause (e.g. MT, RA, ANA, etc.).
• Endomyocardial biopsy—may be necessary to differentiate from restrictive cardiomyopathy
in difficult cases.
Treatment of Chronic Constrictive Pericarditis
• Surgery—Complete resection of pericardium (helpful in 50% cases).
• Treatment of primary cause should be done.
• After surgery, persistent constriction and myocardial fibrosis may be present. AF may occur
after full recovery