Synopsis
Distinguish potentially curable pericardial constriction from restrictive myocardium, identify transient inflammation and refer fixed disease for timely pericardiectomy.
- Constrictive pericarditis is impaired diastolic filling from a non-compliant pericardium and is a potentially curable cause of predominantly right-sided HF.
- Clues are raised JVP, prominent y descent, Kussmaul sign, pericardial knock, ascites and oedema with relatively clear lungs.
- Echo looks for ventricular interdependence: septal bounce, respiratory mitral/tricuspid inflow variation and expiratory hepatic-vein diastolic reversal.
Key red flags
Hypotension, hyponatraemia, renal dysfunction, jaundice/cardiac cirrhosis, severe hypoalbuminaemia or cachexia signals high operative risk and urgent referral.
Investigation priorities
Demonstrate interdependence and distinguish constriction from restriction.
Management branches
Unexplained right HF/HFpEF with pericardial risk or JVP signs.
- Obtain expert Doppler echo and review prior surgery, radiation, pericarditis, TB and malignancy; assess liver/renal/nutritional status.
- Use CT for thickness/calcification and CMR for inflammation, interdependence and myocardial differential.
Key medicines
FurosemideCommon oral starting dose 20-40 mg once daily, titrated cautiously to congestion.
Ibuprofen600 mg orally three times daily for active inflammatory constriction, then taper after clinical and CRP remission; maximum 2400 mg/day.