Constrictive pericarditis is long-term (chronic) inflammation of the sac-like covering of the heart (the pericardium) with thickening, scarring, and muscle tightening (
Pericarditis after heart attack
Causes, incidence, and risk factors
Constrictive pericarditis is most commonly caused by conditions or events that cause inflammation to develop around the heart, including:
Radiation therapyto the chest
Less common causes include:
Abnormal fluid buildup in the covering of the heart due to bacterial or viral infection or surgical complications
Constrictive pericarditis may also develop without apparent cause.
The inflammation causes the covering of the heart to become thick and rigid, making it hard for the heart to stretch properly when it beats. As a result, the heart chambers don’t fill up with enough blood. Blood backs up behind the heart, causing heart swelling and other symptoms of heart failure.
The condition is relatively rare in children.
Symptoms of chronic constrictive pericarditis include:
Difficulty breathing (
dyspnea) that develops slowly and gets worse Fatigue, excessive tiredness
- Long-term swelling (
edema) of the legs and ankles Swollen abdomen Weakness
Signs and tests
Constrictive pericarditis is very difficult to diagnose. Signs and symptoms are similar to
A physical exam may show that your neck veins stick out, suggesting increased blood pressure in the area. This is called Kussmaul’s sign. The doctor may note weak or distant heart sounds when listening to your chest with a stethoscope.
The physical exam may also reveal liver swelling and fluid in the belly area.
The following tests may be ordered:
Chest MRI Chest CT scan Chest x-ray Coronary angiographyor cardiac catheterization ECG Echocardiogram
The goal of treatment is to improve heart function. The cause must be identified and treated. This may include antibiotics, antituberculosis medications, or other treatments.
Diuretics (“water pills”) are commonly prescribed in small doses to help the body remove excess fluid.
Decreased activity may be recommended for some patients.
A low-sodium diet may also be recommended.
The definitive treatment is a type of surgery called a pericardiectomy. This involves cutting or removing the scarring and part of the sac-like covering of the heart.
Constrictive pericarditis may be life threatening if untreated.
However, surgery to treat the condition is associated with a relatively high complication rate and is usually reserved for patients who have severe symptoms.
- Cardiac tamponade
- Damage to the coronary arteries
Heart failure Pulmonary edema
- Scarring of the heart muscle
Calling your health care provider
Call your health care provider if you have symptoms of constrictive pericarditis.
Constrictive pericarditis in some cases is not preventable.
However, conditions that can lead to constrictive pericarditis should be adequately treated.