Constrictive Pericarditis: Understanding Its Clinical Characteristics

Constrictive pericarditis is a chronic condition that develops when the pericardium — the sac-like membrane surrounding the heart — becomes thickened and rigid. This abnormality restricts the heart's ability to expand properly during filling, leading to a cascade of systemic symptoms and cardiovascular complications. Below are the key clinical features associated with this condition.

Common Associations and Underlying Causes

One of the most notable associations of constrictive pericarditis is its link to tuberculosis. Patients with a history of TB, particularly pulmonary tuberculosis, may develop tuberculous pericarditis. In some cases, this may occur without overt signs of heart failure, making early detection challenging. Other potential causes include viral infections, post-cardiac surgery complications, radiation therapy, or autoimmune disorders, though tuberculosis remains a leading global cause.

Progressive and Insidious Onset

The development of constrictive pericarditis is typically slow and progressive. Over time, the pericardium undergoes fibrosis and thickening, eventually forming a rigid, shell-like structure around the heart. This process impairs both ventricular filling and cardiac output. As the condition advances, patients may experience gradually worsening symptoms due to the heart's reduced efficiency in pumping blood.

Impact on Cardiac Function

As the heart struggles to fill with blood, patients often report a significant decline in physical stamina. Symptoms such as fatigue, weakness, and reduced exercise tolerance are common. During physical activity, individuals may experience dyspnea (shortness of breath), chest tightness, and palpitations — all signs of compromised cardiac function. These manifestations are a direct result of elevated filling pressures and decreased cardiac output.

Systemic Manifestations and Physical Findings

Due to impaired venous return, constrictive pericarditis often leads to systemic congestion. Gastrointestinal symptoms such as bloating, early satiety, and indigestion are frequently reported, largely due to hepatic congestion and intestinal edema. On physical examination, clinicians may observe jugular venous distension, hepatomegaly, splenomegaly, and peripheral edema — particularly in the lower extremities and lumbar region. Hypotension and tachycardia are also commonly noted, reflecting the heart's inability to maintain adequate circulation.

Diagnostic and Clinical Implications

Recognizing these clinical features is essential for timely diagnosis and management. Physicians should maintain a high index of suspicion, especially in patients with a history of tuberculosis or prior cardiac interventions. Early identification can lead to improved outcomes through appropriate therapeutic strategies, including medical management or surgical pericardiectomy in severe cases.