A Comprehensive Review of Effusive-Constrictive Pericarditis, Diagnosis, and Management

Effusive-constrictive pericarditis (ECP) is characterized by fluid accumulation in the pericardial space and a rigid, fibrotic pericardium that restricts heart filling. Its diverse causes include infectious agents, systemic inflammatory conditions, malignancies, and iatrogenic factors. ECP is more prevalent in areas burdened by contagious diseases, such as tuberculous pericardial effusion, and it is found in about 6.7% of patients with tuberculous pericardial effusion. The diagnosis of ECP has improved with advanced imaging techniques, yet challenges persist. Although Doppler echocardiography is sensitive, it lacks specificity, and cardiac catheterization remains the gold standard. Emerging biomarkers such as interleukin-10 may enhance diagnosis, but further validation is needed. Techniques such as cardiac magnetic resonance imaging and computed tomography are used to identify structural abnormalities, but their routine application is still developing. Management of ECP is based on its underlying cause and severity, often starting with pericardiocentesis followed by anti-inflammatory treatments. For severe cases with significant fibrosis, pericardiectomy is the definitive solution. Prognosis varies, with malignancy-related cases typically yielding poorer outcomes than infectious origins. This review explores ECP's pathophysiology, diagnostic challenges, and treatment strategies. It highlights knowledge gaps and suggests future research directions. A multidisciplinary approach is crucial for understanding and improving patient care for this complex condition.