Constrictive pericarditis: causes, symptoms and treatment


When a patient suffers from constrictive pericarditis, the walls of the pericardium — the fluid-filled sac that surrounds the heart — become too stiff or too thick. This condition causes the heart to not beat properly and can lead to serious complications in the long run. However, treatment options depend on the severity and cause of the condition and the patient’s overall health.

This blog extensively explains constrictive pericarditis, its causes, symptoms and treatments.

What is Constrictive Pericarditis?

Constrictive pericarditis is a long-term condition or inflammation of the pericardium that causes scarring, thickening, and tightening of the pericardium. The pericardium is a sac-like membrane that surrounds the heart. Over time, the elasticity of the pericardium is lost and it becomes rigid. This condition is rare in adults and rarely in children. If left untreated, a rigid pericardium can cause heart failure and be life-threatening.

What Are the Types of Constrictive Pericarditis?

The subtypes are as follows:

  • Sharp: The patient may develop acute constrictive pericarditis when the pericardium scars rapidly within a few days.
  • Subacute: It is similar to acute constrictive pericarditis but has less severe symptoms.
  • Effusive-constrictive pericarditis: The accumulation of excess fluid in the pericardium is called effusive-constrictive pericarditis. It puts pressure, constricts the heart to beat correctly and results in cardiac tamponade – restricted heart rate due to fluid buildup. If left untreated, the heart may stop functioning.
  • Transient constrictive pericarditisis: Generally, it involves acute pericarditis becoming inflammatory constrictive pericarditis. It can be treated with anti-inflammatory drugs.
  • Occult constrictive pericarditis: In the medical term, “occult” means hidden. As the name suggests, it is not easy to detect. It is only diagnosed accidentally while undergoing other tests and scans.

What Are the Symptoms of Constrictive Pericarditis?

The following are the symptoms of constrictive pericarditis:

  • Swelling (especially in the lower legs and abdomen) due to fluid retention
  • Loss of appetite and feeling of fullness even when little food is consumed
  • fatigue
  • Shortness of breath (dyspnea)
  • chestpain
  • Dizziness
  • Loss of muscle mass

When to seek medical help?

Patients should seek immediate medical attention if they notice any of the above symptoms.

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What Are the Causes of Constrictive Pericarditis?

An inflamed pericardial sac can become so stiff that the heart cannot function properly. It prevents the heart chambers from filling with the right amount of blood and leads to symptoms such as heart failure. The causes of this condition are:

  • Infections, In developed countries, viral infections are more likely to cause constrictive pericarditis. In developing countries, the infections are due to bacteria, especially tuberculosis (constrictive pericarditis occurs in 20-30 percent of tuberculosis-related pericarditis cases).
  • cancerThis includes cancer of the pericardium itself or cancer elsewhere in your body.
  • traumaInjuries to the chest (whether penetration injuries such as knife or bullet wounds or blunt impacts) can cause inflammation that leads to the formation of scar tissue.
  • Heart and circulatory problemsThis includes heart attacks or other conditions that affect the major blood vessels closest to your heart.
  • medical reasonsPericardial thickening or scarring can occur after heart surgery, radiation therapy for cancer, or as a side effect of some medications.
  • Immune system disorders or inflammatory conditionsExamples of these conditions are rheumatoid arthritis, Sjogren’s syndrome or lupus.
  • OthersConstrictive pericarditis can occur for unknown reasons.

What are the possible risk factors for constrictive pericarditis?

The factors that increase the risk of constrictive pericarditis are:

  • pericarditis – If left untreated, it can become chronic.
  • Autoimmune diseases such as systemic lupus and rheumatoid arthritis, can increase the risk of developing constrictive pericarditis.
  • Trauma or injury to the heart – Recent heart surgery or heart attack can increase the chance of developing constrictive pericarditis.
  • Medicines Constrictive pericarditis can be a side effect of certain medications.
  • Gender and age This condition is common in men between the ages of 20 and 50.

How is constrictive pericarditis diagnosed?

The doctor discusses the patient’s medical history, medications, and symptoms to diagnose constrictive pericarditis. The healthcare provider may recommend the following:

  1. imaging tests

X-rays, CT scans, and MRIs of the chest provide detailed images of the heart and pericardium. A CT scan or an MRI detects the pericardial thickening and blood clots.

2. Cardiac catheterization

During cardiac catheterization, a tube is inserted into the heart through the groin or arm. The healthcare professional can use this tube to collect blood samples and biopsy tissue and take measurements inside the heart.

3. Electrocardiogram

The heart’s electrical impulses are measured using an electrocardiogram. An irregularity in the heart may indicate constrictive pericarditis or another heart condition.

4. Echocardiogram

The procedure captures the image of the heart using sound waves. It can also detect the excess fluid or thickening of the pericardium.

  • Testing for tuberculosis
  • Blood tests to confirm or rule out immune system disorders

What are the treatment options available for constrictive pericarditis?

The treatment of constrictive pericarditis focuses on improving the functions of the heart. The following treatments are recommended during the early stages of the condition.

  • Diuretics – drugs to remove excess fluid
  • Analgesics – Painkillers to control pain
  • Decrease the activity level
  • Reduce the salt content in the diet
  • Taking over-the-counter anti-inflammatories

However, there are other treatment options, such as

  1. surgery – Pericardiectomy, where the entire pericardium is removed. It is usually the best option to adequately treat this disease. A human body does not need a pericardium to live and function normally. Most patients return to their normal lifestyle after surgery without any problems or long-term consequences.
  2. Medication Different treatments can help treat the symptoms of this disease directly or try to cure it by stopping whatever is causing it, depending on the underlying cause and symptoms. In certain circumstances, these drugs are enough to treat this problem without the need for surgery.

What are the complications of constrictive pericarditis treatment?

The complications vary based on the treatment, medication, cause, and type of constrictive pericarditis. It is essential to discuss this with the healthcare provider to better understand any possible complications. Some of the complications are the following:

  • heart failure
  • Arrhythmias – irregular heart rhythms
  • Infections and sepsis
  • dead


Constrictive pericarditis is a rare disease that strikes without warning. It also shares symptoms with several other diseases, making diagnosis difficult. Fortunately, medical knowledge and technological advancements have made specific imaging tests more effective in diagnosing this disease. Treatments for this disease have also advanced significantly. That means that in the vast majority of cases, this condition is treatable, and in some cases, a cure is possible.

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