Constrictive Pericarditis

Constrictive pericarditis is a potentially treatable cause of diastolic heart failure that arises because a diseased, inelastic pericardium restricts ventricular diastolic expansion. Affected patients present with heart failure with predominant right-sided symptoms and signs. The key to diagnosis is identification of the unique hemodynamic properties associated with constriction: dissociation of intrathoracic and intracardiac pressures and enhanced ventricular interaction. Comprehensive echocardiography with Doppler imaging is useful, but invasive hemodynamic assessment and cross-sectional imaging may be required for confirmation. Cardiac MRI provides an opportunity to evaluate for pericardial inflammation. Most cases of chronic constriction are progressive and life limiting, and require surgical pericardiectomy.