What is constrictive pericarditis?

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

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

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

The symptoms of constrictive pericarditis include:

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

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

The cause of constrictive pericarditis isn’t always known. However, possible causes may include:

Some of the less common causes are:

  • viral infection
  • bacterial infection
  • mesothelioma, which is an uncommon type of cancer caused by asbestos exposure

In some cases, your doctor may not be able to find the cause of the inflammation. There are plenty of treatment options even if the cause of the condition is never determined.

The following factors increase your risk of developing this condition:


Untreated pericarditis can become chronic.

Autoimmune disorders

Systemic lupus, rheumatoid arthritis, and other autoimmune 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

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

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

  • restrictive cardiomyopathy, which occurs when the heart chambers can’t fill with blood because of stiffness in the heart
  • cardiac tamponade, which occurs when fluid between the heart muscle and the pericardium compresses the heart

A diagnosis of constrictive pericarditis is often made by ruling out these other conditions.

Your doctor will ask about your symptoms and perform a physical exam. The following signs are common:

  • neck veins that stick out due to increased blood pressure, which is called Kussmaul’s sign
  • 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 cardiac catheterization, your doctor inserts a thin tube into your heart through your groin or arm. Through this tube, they can collect blood samples, remove tissue for biopsy, and take measurements from inside your heart.


An electrocardiogram measures your heart’s electrical impulses. Irregularities may suggest you have constrictive pericarditis or another heart condition.


An echocardiogram makes a picture of your heart using sound waves. It can detect fluid or thickening in the pericardium.

Treatment focuses on improving your heart’s function.

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

  • taking water pills to remove excess fluids, which are called diuretics
  • taking pain medication (analgesics) to control pain
  • decreasing your activity level
  • decreasing the amount of salt in your diet
  • taking over-the-counter anti-inflammatories, such as ibuprofen (Advil)
  • taking colchicine (Colcrys)
  • taking corticosteroids

If it’s clear that you have constrictive pericarditis and 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 it’s often the best option.

If it’s left untreated, this condition can be life-threatening, possibly leading to the development of symptoms of heart failure. However, many people with constrictive pericarditis can lead healthy lives if they get treatment for their condition.