Pericarditis
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Constrictive Pericarditis

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Published on October 4, 2024
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Constrictive pericarditis is an uncommon form of heart failure in which the pericardium — the sac of tissue surrounding the heart — becomes stiff and prevents the heart from filling and pumping blood normally. Symptoms can include fatigue, shortness of breath, chest discomfort, and swelling in the abdomen, feet, ankles, and legs. With proper treatment, constrictive pericarditis can be cured.


What Is Constrictive Pericarditis?

Constrictive pericarditis is a chronic inflammatory condition where the pericardium — the sac surrounding the heart — becomes thickened and scarred, making it hard for the heart to expand properly when it beats. The heart chambers fill up with blood, causing blood to back up behind the heart, leading to swelling and heart failure.

Heart failure, if not treated promptly, can be life-threatening — which is why it’s important to see your healthcare provider if you start to experience the symptoms listed below.

Signs and Symptoms of Constrictive Pericarditis

Constrictive pericarditis symptoms include:

  • Shortness of breath
  • Chest pain
  • Fatigue
  • Dizziness
  • Lack of appetite
  • Weakness and loss of muscle mass
  • A swollen abdomen
  • Swelling of the legs and ankles (edema)
Doctors may also be able to hear a “pericardial knock,” a high-pitched sound in between heartbeats, when they listen to your heart with a stethoscope. This happens when scar tissue makes the pericardium stiff so the heart can’t beat properly and pump enough blood to the rest of your body.

Causes and Risk Factors for Constrictive Pericarditis

Several conditions tied to heart inflammation can lead to constrictive pericarditis. If you have one of the following, be aware that you may be at higher risk for pericarditis particularly if you develop these symptoms:

How Is Constrictive Pericarditis Diagnosed?

“Constrictive pericarditis is diagnosed through a combination of clinical evaluation and imaging,” says Adedapo Iluyomade, MD, a cardiologist at Miami Cardiac and Vascular Institute, part of Baptist Health South Florida. The condition can be tricky to diagnose if you have other conditions with related symptoms, or if your symptoms aren’t severe.

A doctor will first ask about your symptoms and listen to your heart. To rule out other related conditions, they will perform imaging tests to see how your pericardium looks. These can include:

Treatment and Medication Options for Constrictive Pericarditis

The best way to manage constrictive pericarditis is to follow a doctor’s treatment plan. “We usually will start with additional rounds of colchicine and nonsteroidal anti-inflammatory drugs,” says Jennifer Wong, MD, a cardiologist and the medical director of non-invasive cardiology at Memorial Care Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California. If these don’t help enough, doctors will try treatments like steroids. If a person doesn’t respond to medications, they may be a candidate for surgery.

Medication Options

Medication options include:

You’ll also receive treatment for any underlying causes. For example, if a bacterial infection is the cause, you’ll receive antibiotics; if you have rheumatoid arthritis, you may be prescribed DMARDs (disease-modifying antirheumatic drugs), as well as NSAIDs and steroids.

Surgery

“A lot of times if people have symptoms that are severe and unrelenting, they are really looking at heart surgery,” says Cheng-Han Chen, MD, a cardiologist and the medical director of the Structural Heart Program at Memorial Care Saddleback Medical Center in Laguna Hills, California. Pericardiectomy is a surgical procedure that removes all or part of the pericardium, allowing the heart to move freely so it can pump blood efficently.

 It takes between six to eight weeks to recover from the procedure, depending on how serious your condition was before the surgery.

Conditions Related to Constrictive Pericarditis

Constrictive pericarditis can be difficult to distinguish from other heart problems that cause similar symptoms.

Restrictive cardiomyopathy: Cardiomyopathy involves the heart muscle itself becoming stiff, as opposed to the pericardium. “While both conditions result in impaired ventricular filling in the heart, the underlying problems are different,” says Dr. Iluyomade. Imaging tests can help doctors determine which of these conditions is affecting you.

Pericardial effusion: “Pericardial effusion is when you have fluid buildup in between the pericardium and the heart,” says Chen. When too much fluid builds up, it puts pressure on the heart and it can’t pump normally. This can also be distinguished through testing.

Other heart diseases: Constrictive pericarditis can coexist with heart failure symptoms or make them worse. And people who have multiple cases of acute pericarditis can be at risk for chronic pericarditis, if it isn’t treated effectively.

The Takeaway

Constrictive pericarditis occurs when the sac around the heart becomes inflamed and stiff, making it difficult for the heart to expand fully. This can cause worsening heart function and can even lead to heart failure. The condition can be tricky to diagnose if you have other conditions with related symptoms. Treatment often starts with medications and careful monitoring, but in severe cases, surgery may be recommended. 

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Chung Yoon, MD

Medical Reviewer
Chung Yoon, MD, is a noninvasive cardiologist with a passion for diagnosis, prevention, intervention, and treatment of a wide range of heart and cardiovascular disorders. He enjoys clinical decision-making and providing patient care in both hospital and outpatient settings. He excels at analytical and decision-making skills and building connection and trust with patients and their families.
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Erica Patino

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Erica Patino is a freelance writer and editor, content strategist, and usability specialist who has worked for a variety of online health outlets, including Healthline, Sharecare, and Twill Care. She was previously a senior editor at Everyday Health. She is also the founder and editor-in-chief of Hear 2 Tell, a website that covers advances in hearing loss treatment. Patino lives in Portland, Oregon, with her husband and twin sons.
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