Constrictive Pericarditis

Written by Kimberly Holland | Published on July 23, 2012
Medically Reviewed by Brenda B. Spriggs, MD, MPH, FACP

What Is Constrictive Pericarditis?

Constrictive pericarditis is chronic (long-term) inflammation of the pericardium. The pericardium is the sac-like membrane that surrounds the heart. Inflammation to this part of the heart causes scarring, thickening, and muscle tightening (contracture). Over time, the pericardium loses its elasticity and becomes rigid.

The condition is rare in adults, and even less common in children.

It can, however, become a serious health issue. If left untreated, a rigid pericardium can lead to symptoms of heart failure, and may even be life threatening. Luckily, there are effective treatments for the condition.

What Causes Constrictive Pericarditis?

When the covering of your heart is chronically inflamed, it becomes rigid. As a result, your heart cannot stretch as much as it should when it beats. This in turn can prevent your hear chambers from filling up with the right amount of blood. This is what leads to the symptoms of heart failure.

Constrictive pericarditis most commonly results from conditions that cause inflammation around the heart. These include

  • heart surgery
  • radiation therapy to the chest
  • tuberculosis

Some of the less common causes are

  • viral infection
  • bacterial infection
  • mesothelioma (an uncommon type of cancer caused by asbestos exposure

In some cases, your doctor may not be able to uncover the source inflammation. Luckily, you will have plenty of treatment options even if the cause of the condition is never found.

Who Is at Risk?

The following increase your risk for developing this condition:


Untreated pericarditis can become chronic.

Autoimmune Disorders

Systemic lupus, rheumatoid arthritis, and other immune diseases have been shown to increase your risk for constrictive pericarditis.

Trauma or Injury to the Heart

Having had a heart attack or having undergone heart surgery can both increase your risk.


Pericarditis is a side effect of some medications.

Gender and Age

It is most common in men between the ages of 20 and 50.

What Are the Symptoms of Constrictive Pericarditis?

Symptoms include:

  • chest pain
  • breathing difficulty that develops slowly and becomes worse
  • fatigue
  • swollen abdomen
  • chronic, severe swelling in the legs and ankles
  • weakness

How is it Diagnosed?

This condition is difficult to diagnose. It may be confused with other heart conditions such as:

  • restrictive cardiomyopathy (where the heart chambers cannot fill with blood because of stiffness in the heart)
  • cardiac tamponade (where fluid between the heart muscle and the pericardium compresses the heart)

Ultimately, a diagnosis is often made by ruling out these other conditions.

Your doctor will ask about your symptoms and conduct an exam. The following signs are common:

  • Kussmaul’s sign: increased blood pressure causes the neck veins to stick out
  • weak or distant heart sounds
  • liver swelling
  • fluid in the belly area

Your doctor may order one or more of the following tests:

Imaging Tests

Chest MRIs, CT scans, and X-rays produce detailed images of the heart and the pericardium. A CT scan and MRI can detect thickening in the pericardium and blood clots.

Cardiac Catheterization

In this procedure, a thin tube is inserted into your heart through your groin or arm. The tube collects blood samples, removes tissue for biopsy, and takes measurements from inside your heart.

Electrocardiogram (ECG)

An ECG measures your heart’s electrical impulses. Irregularities may suggest this or another heart condition.


This imaging test makes a picture of your heart using sound waves. It can detect fluid or thickening in the pericardium.

Treatment Options

Treatment focuses on improving your heart’s function.

In early stages of pericarditis, the following may be recommended:

  • diuretics (water pills) to remove excess fluids
  • analgesics (pain killers) to control pain
  • decreased activity
  • less sodium (salt) in your diet

If it is clear that you have constrictive pericarditis, and if your symptoms have become severe, your doctor may suggest a pericardiectomy. In this surgery, parts of the scarred sac are cut away from around the heart. This is a complicated surgery that does have some risk, but is the best option.

What is the Long-Term Outlook?

If untreated, this condition can be life threatening. You may develop symptoms of heart failure. However, with treatment, many patients can lead healthy lives.

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