Constrictive Pericarditis: Understanding Its Clinical Features

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. Understanding the clinical manifestations of this condition is essential for timely diagnosis and effective management.

Common Clinical Features of Constrictive Pericarditis

1. Association with Tuberculosis

One of the most common underlying causes of constrictive pericarditis is a prior infection, particularly tuberculosis. Patients with a history of pulmonary tuberculosis may develop tuberculous pericarditis, which can progress to constrictive disease over time. Notably, some individuals may have had asymptomatic or subclinical involvement of the pericardium without overt signs of heart failure during the acute phase of infection.

2. Gradual Onset and Progression

This condition typically develops insidiously. The pericardium undergoes progressive thickening, fibrosis, and contraction, eventually forming a rigid, shell-like structure around the heart. As a result, the heart's normal filling during diastole is impaired, leading to elevated venous pressures and reduced cardiac output. Symptoms often evolve slowly over months or even years, making early detection challenging.

3. Symptoms of Reduced Cardiac Function

As the disease progresses, patients often experience a decline in physical performance. Common complaints include fatigue, reduced exercise tolerance, and generalized weakness. During physical exertion, individuals may develop dyspnea (shortness of breath), chest discomfort, and palpitations due to the heart's inability to meet the body's increased demands.

4. Systemic and Multi-organ Involvement

In addition to cardiac symptoms, constrictive pericarditis can lead to a variety of systemic manifestations. Gastrointestinal disturbances such as bloating, nausea, and poor appetite are frequent due to hepatic congestion and impaired venous return. Physical examination often reveals signs of fluid retention, including jugular venous distension, hepatomegaly, and splenomegaly. Hypotension and tachycardia may also be present. In advanced cases, peripheral edema — particularly in the lower extremities and lumbar region — is a hallmark of severe disease.

Conclusion

Recognizing the diverse and often subtle clinical features of constrictive pericarditis is crucial for clinicians. Early diagnosis and appropriate intervention can significantly improve patient outcomes. Given its varied presentation, a high index of suspicion is necessary, especially in patients with a history of pericardial infection or inflammation.