{ "schemaVersion": 2, "eyebrow": "Cardiology", "title": "Constrictive Pericarditis", "summary": "Constrictive pericarditis requires confirmation of ventricular interdependence, separation from restrictive myocardial disease, and classification as inflammatory and potentially reversible versus chronic fibrotic disease requiring pericardiectomy. Multimodality imaging guides the sequence of anti-inflammatory treatment, diuresis, invasive hemodynamics, and surgical referral.", "seoDescription": "Diagnosis and management of constrictive pericarditis, including echocardiography, CMR, CT, catheterization, anti-inflammatory therapy, and pericardiectomy.", "clinicalQuestion": "How should clinicians confirm constrictive pericarditis and select medical therapy, hemodynamic testing, or pericardiectomy?", "specialty": "Cardiology", "audience": "U.S. physicians and medical trainees", "tags": [ "constrictive pericarditis", "pericardiectomy", "annulus reversus", "septal bounce", "effusive-constrictive pericarditis", "cardiac magnetic resonance", "right heart failure" ], "keyTakeaways": [ "Obtain transthoracic echocardiography first when constrictive physiology is suspected; use CMR when echocardiographic findings are inconclusive, CT for calcification and operative planning, and invasive catheterization when noninvasive testing remains equivocal. [6][15]", "Differentiate active inflammatory or transient constriction from chronic fibrotic constriction: imaging evidence of pericardial inflammation supports an initial anti-inflammatory trial, whereas persistent symptomatic constriction without inflammatory features should prompt pericardiectomy evaluation. [17][22][23]", "Diuretics can restore euvolemia but do not reverse pericardial noncompliance and should not delay definitive surgery in patients with chronic fibrotic or calcific constriction. [22][23]", "Pericardiectomy is definitive treatment for chronic constrictive pericarditis with persistent symptoms and objective constrictive physiology; reported operative mortality ranges from 0% to 18.6% across series. [7][22]", "Previous cardiac surgery, mediastinal radiation, idiopathic pericarditis, and tuberculous pericarditis are important etiologic clues; postradiation constriction has particularly unfavorable prognosis after pericardiectomy. [7][9][11]" ], "sections": [ { "id": "stabilize-and-identify-constriction", "eyebrow": "Initial triage", "heading": "Identify clinically important constriction and exclude urgent effusion-related compromise", "intro": "Treat hemodynamic instability and define the dominant pericardial syndrome before pursuing elective surgical planning.", "paragraphs": [ "In a patient with systemic venous congestion, ascites, edema, elevated jugular venous pressure, a pericardial knock, or otherwise unexplained right-sided heart failure, obtain transthoracic echocardiography (TTE) promptly to assess pericardial effusion and constrictive hemodynamics. Distended neck veins with a prominent y descent, ascites, and lower-extremity edema support the clinical phenotype; a pericardial effusion may coexist with constriction as effusive-constrictive pericarditis. [20][6]", "Do not equate pericardial thickening or calcification alone with hemodynamically significant constriction. The diagnostic target is ventricular interdependence caused by a noncompliant pericardium, integrated with symptoms, examination, and imaging. TTE is the recommended noninvasive hemodynamic test for both constrictive pericarditis and effusive-constrictive pericarditis. [6][15]", "If volume overload is present, use diuretic therapy to restore euvolemia while diagnostic testing proceeds. This is symptomatic treatment only: it does not change the natural history of constrictive physiology and should not substitute for anti-inflammatory treatment in active disease or for surgical assessment in irreversible disease. [23][22]" ], "bullets": [ "Obtain TTE first to define effusion, septal motion, respiratory ventricular interaction, and Doppler/tissue-Doppler features of constriction. [6][15]", "Consider effusive-constrictive physiology when an effusion and constrictive features coexist; TTE is the recommended initial hemodynamic assessment. [6]", "Use diuresis for congestion, but reassess the reversible inflammatory versus chronic fibrotic branch rather than continuing palliative therapy indefinitely. [22][23]" ], "subsections": [], "table": { "caption": "Clinical and imaging findings that should trigger a constrictive-pericarditis workup. [6][20]", "columns": [ "Finding", "Interpretation", "Next action" ], "rows": [ [ "Elevated JVP with prominent y descent, ascites, edema, or pericardial knock [20]", "Compatible with systemic venous congestion from constrictive physiology but not diagnostic alone [20][15]", "Obtain comprehensive TTE for noninvasive hemodynamic assessment. [6]" ], [ "Septal bounce with annulus reversus on echocardiography [20]", "Supports constrictive physiology; annulus reversus reflects relatively reduced lateral versus medial annular motion from pericardial constraint. [20]", "Integrate with respiratory Doppler findings and clinical syndrome; obtain CMR if confirmation or inflammatory characterization is needed. [6]" ], [ "Pericardial effusion plus constrictive features [6]", "Suggests effusive-constrictive pericarditis. [6]", "Use TTE-based hemodynamic assessment and define whether active inflammation is present. [6]" ], [ "Pericardial calcification or marked thickening [6][20]", "Supplementary evidence of chronic pericardial disease, not standalone proof of constriction. [6][15]", "Obtain cardiac CT for calcification assessment and preoperative planning when pericardiectomy is being considered. [6]" ] ] } }, { "id": "confirm-physiology-and-exclude-restriction", "eyebrow": "Diagnostic confirmation", "heading": "Use an imaging-to-catheterization pathway to confirm constrictive physiology", "intro": "Escalate testing when the clinical syndrome and initial echocardiogram do not provide a coherent answer.", "paragraphs": [ "Use TTE as the first-line imaging modality because it evaluates constrictive hemodynamics noninvasively. Findings that support constriction include interventricular septal bounce and tissue-Doppler annulus reversus, in which lateral annular movement is lower than medial annular movement because the abnormal pericardium constrains lateral mitral annular motion. [15][20]", "Order CMR when TTE is nondiagnostic or discordant with the clinical phenotype. CMR is reasonable for supportive evidence of constrictive pericarditis and is recommended to identify active pericardial inflammation as the cause of constriction. That distinction changes management because inflammatory constriction may be reversible with medical therapy, whereas fibrosis and calcification favor surgery. [6][17][22]", "Use cardiac CT as an adjunct, not a physiologic replacement for echocardiography. CT can identify pericardial calcification and is reasonable for preoperative mapping before pericardiectomy. CT is especially useful when chronic calcific disease is suspected or when operative anatomy must be defined. [6]", "Proceed to invasive cardiac catheterization when TTE, CMR, and clinical data remain nondiagnostic or equivocal and the result will determine whether to pursue pericardiectomy. Invasive catheterization is recommended in this setting because differentiating constrictive pericarditis from restrictive cardiomyopathy is essential: constriction is often surgically treatable, whereas restrictive myocardial disease is not corrected by pericardiectomy. [6][2][15]" ], "bullets": [ "Do not diagnose constriction from morphology alone; integrate clinical congestion, TTE hemodynamics, and cross-sectional imaging. [15][16]", "Use CMR specifically to identify active inflammation when deciding whether a medical trial is justified. [6][17]", "Use catheterization selectively after equivocal noninvasive studies, particularly before committing a patient to high-risk surgery. [6][7]" ], "subsections": [ { "heading": "Constrictive pericarditis versus restrictive cardiomyopathy", "paragraphs": [ "The pivotal distinction is whether impaired filling is driven predominantly by external pericardial restraint or intrinsic myocardial restriction. Constrictive pericarditis is potentially curable with pericardiectomy, whereas restrictive cardiomyopathy generally requires disease-specific myocardial management and, in selected advanced cases, transplantation. Avoid surgical referral based solely on right-heart-failure symptoms or pericardial thickening without objective constrictive physiology. [2][15][16]" ], "bullets": [ "Favor a pericardial process when TTE demonstrates septal bounce and annulus reversus in the appropriate clinical setting. [20]", "Use CMR and, if necessary, invasive hemodynamics when the noninvasive distinction from myocardial restriction remains uncertain. [6][15]" ] } ], "table": { "caption": "Test selection when constrictive pericarditis is suspected. [6][15][16]", "columns": [ "Test", "Primary role", "Result that changes management" ], "rows": [ [ "TTE [6][15]", "First-line noninvasive assessment of constrictive and effusive-constrictive hemodynamics [6]", "Constrictive features establish the working diagnosis and direct inflammatory characterization or surgical evaluation. [6][20]" ], [ "CMR [6]", "Supportive diagnosis when TTE is inconclusive; identifies active pericardial inflammation [6]", "Inflammatory findings support an anti-inflammatory treatment trial before surgery. [17][22]" ], [ "Cardiac CT [6]", "Detects calcification and supports preoperative planning [6]", "Calcification supports chronic pericardial disease and informs operative assessment. [6][22]" ], [ "Invasive cardiac catheterization [6]", "Resolves nondiagnostic or equivocal noninvasive evaluation [6]", "Confirmation of constrictive physiology can justify referral for definitive pericardiectomy when symptoms persist. [6][22]" ] ] } }, { "id": "define-cause-and-reversibility", "eyebrow": "Etiologic branch point", "heading": "Classify inflammatory, transient, and chronic fibrotic constriction before choosing surgery", "intro": "The most consequential management decision is whether the constrictive physiology is likely reversible.", "paragraphs": [ "Obtain a focused history for prior cardiac surgery, mediastinal radiation, previous pericarditis, tuberculosis exposure or disease, connective-tissue disease, trauma, myocardial infarction, and drug exposure. Frequently reported causes include mediastinal radiation, chronic idiopathic pericarditis, prior cardiac surgery, and tuberculous pericarditis; prior surgery, irradiation, infarction, and idiopathic disease have also been prominent causes in surgical series. [9][11][7]", "Classify patients with CMR or other evidence of active pericardial inflammation as inflammatory or potentially transient constriction. Current guidance supports empirical anti-inflammatory therapy for constrictive pericarditis, with serial symptom assessment, inflammatory markers, and repeat imaging to determine whether constrictive physiology resolves. [17][22][23]", "Classify patients with persistent symptoms, objective constrictive physiology, absent inflammatory features, and fibrotic or calcific pericardial disease as chronic constriction. In this phenotype, diuretics may improve congestion but definitive reversal of pericardial noncompliance is unlikely with medical therapy alone; refer early to a multidisciplinary pericardial and cardiac-surgery team for pericardiectomy assessment. [22][23]", "When tuberculosis is a plausible cause, pursue etiologic confirmation when tissue becomes available. Pericardial tissue obtained at pericardiectomy should undergo acid-fast bacilli staining and assessment for granulomatous inflammation. Cause-directed therapy remains necessary even when surgery relieves mechanical constriction. [20][1]" ], "bullets": [ "Inflammatory phenotype: use anti-inflammatory therapy first and reassess for physiologic resolution. [17][22][23]", "Chronic noninflammatory phenotype: do not prolong ineffective medical therapy; obtain surgical evaluation if symptoms and constrictive physiology persist. [22][23]", "Postradiation disease warrants early expert review because it has the worst prognosis among major constrictive etiologies after pericardiectomy. [7]" ], "subsections": [], "table": { "caption": "Management branches based on reversibility and etiology. [17][20][22][23]", "columns": [ "Phenotype", "Supporting features", "Management direction" ], "rows": [ [ "Inflammatory or transient constriction [17][22]", "Active pericardial inflammation on CMR or other imaging; potentially reversible constrictive physiology [6][22]", "Start anti-inflammatory therapy, manage congestion with diuresis as needed, and reassess symptoms, CRP, and echocardiography. [17][22]" ], [ "Chronic fibrotic or calcific constriction [22][23]", "Persistent objective constrictive physiology without active inflammatory features; fibrosis or calcification predominates [22]", "Refer for pericardiectomy evaluation; diuretics are palliative and should not defer definitive treatment. [22][23]" ], [ "Tuberculous constriction [20]", "Compatible epidemiology or pathology; AFB staining or granulomatous inflammation in pericardial tissue when obtained [20]", "Treat the underlying infection and involve cardiac surgery when advanced constrictive physiology requires definitive mechanical relief. [20][1]" ], [ "Postradiation constriction [7][9]", "History of mediastinal radiation with constrictive physiology [9]", "Refer to an experienced center; discuss the less favorable surgical prognosis during risk assessment. [7]" ] ] } }, { "id": "medical-treatment-and-reassessment", "eyebrow": "Potentially reversible disease", "heading": "Use anti-inflammatory therapy as a time-limited test of reversibility", "intro": "Medical treatment is appropriate when active pericardial inflammation may still be driving the constrictive physiology.", "paragraphs": [ "For inflammatory or transient constrictive pericarditis, initiate anti-inflammatory therapy before surgery when there is evidence of active inflammation and no immediate indication for definitive operative treatment. Contemporary management describes colchicine with or without an NSAID when not contraindicated, and corticosteroids with consideration of IL-1 inhibition in selected cases; treatment is guided by symptoms, CRP, and imaging evidence of pericardial inflammation. [22][23]", "Do not infer a specific drug dose or duration from constrictive physiology alone. The cited management approach describes a 3- to 6-month period of anti-inflammatory therapy to evaluate resolution of inflammation and constrictive physiology, with serial CRP monitoring and repeat echocardiography at 8 to 12 weeks. [22][23]", "Escalate toward surgery when congestion and objective constrictive physiology fail to improve despite an appropriate anti-inflammatory course, or when imaging indicates predominantly chronic noninflammatory fibrosis or calcification. Further prolonged medical treatment in that setting risks deferring the only definitive therapy. [22][23]" ], "bullets": [ "Monitor clinical volume status and use diuretics as needed to achieve euvolemia during a medical trial. [22][23]", "Follow CRP serially until normalization and repeat echocardiography at 8 to 12 weeks during treatment for inflammatory constriction. [22]", "Use CMR to document inflammation when uncertainty about reversibility would otherwise delay surgical referral. [6][22]" ], "subsections": [ { "heading": "When not to persist with medical therapy", "paragraphs": [ "Persistent constrictive physiology after anti-inflammatory treatment is an escalation trigger, not an indication for indefinite diuretic and anti-inflammatory management. Early surgical referral is recommended when constriction does not improve after appropriate medical therapy, particularly when fibrosis or calcification predominates. [22][23]" ], "bullets": [] } ], "table": { "caption": "Reassessment during treatment of inflammatory constrictive pericarditis. [22][23]", "columns": [ "Monitoring element", "Timing", "Actionable interpretation" ], "rows": [ [ "Symptoms and congestion [22][23]", "Serially during medical therapy [22]", "Improvement supports continued medical management; persistent symptomatic constriction prompts surgical consideration. [22][23]" ], [ "C-reactive protein [22]", "Serial measurements until normalization [22]", "Persistent inflammatory activity supports reassessment of anti-inflammatory control and imaging phenotype. [22][23]" ], [ "TTE [22]", "Reassess at 8-12 weeks [22]", "Resolution or improvement supports transient constriction; persistent objective constriction should trigger early surgical referral. [22]" ], [ "CMR [6][22]", "When inflammation or reversibility remains uncertain [6]", "Active inflammation supports medical therapy; absent inflammatory features favor definitive surgical evaluation. [6][22]" ] ] } }, { "id": "pericardiectomy", "eyebrow": "Definitive treatment", "heading": "Refer symptomatic chronic constriction for pericardiectomy before advanced functional decline", "intro": "Pericardiectomy is definitive for persistent chronic constrictive physiology when operative risk is acceptable.", "paragraphs": [ "Refer for pericardiectomy when chronic constrictive pericarditis causes persistent symptoms with objective constrictive physiology, especially when there is no evidence of reversible pericardial inflammation or when anti-inflammatory treatment has failed. Pericardiectomy is the definitive reversal of pericardial noncompliance; diuretics alone are palliative in this setting. [22][23][20]", "Preoperative assessment should include TTE-based hemodynamics, CMR when inflammatory activity or myocardial involvement needs clarification, and cardiac CT for calcification and surgical planning. Lower right atrial pressure with diuresis as tolerated and control active pericardial inflammation before surgery when possible, because inflammatory activity can increase operative complications such as bleeding and injury to coronary structures. [6][22]", "Discuss meaningful operative risk explicitly. Across reported pericardiectomy series, operative mortality ranges from 0% to 18.6%; older surgical literature reports operative risk of 5% to 10%, with long-term outcomes varying substantially by etiology and comorbidity. Postradiation constriction carries particularly unfavorable prognosis. [7][24]", "Pericardiectomy is commonly performed through median sternotomy, which permits access to the right-sided cardiac structures, great vessels, and caval-right atrial junctions and can facilitate removal of diseased pericardium from phrenic nerve to phrenic nerve. Surgical approach should be individualized in experienced centers; left anterior thoracotomy may be preferred for infected-purulent pericarditis to reduce concern for sternal infection. [24]" ], "bullets": [ "Surgical indication: persistent symptomatic chronic constrictive physiology with nonreversible features or failure of an appropriate anti-inflammatory trial. [22][23]", "Preoperative tests: TTE for hemodynamics, CMR for inflammation, and CT for calcification and operative planning. [6]", "Risk discussion: outcomes are etiology-dependent; postradiation disease is an adverse prognostic subgroup. [7]" ], "subsections": [], "table": { "caption": "Practical transition from medical management to pericardiectomy. [22][23][24]", "columns": [ "Clinical situation", "Immediate management", "Definitive next step" ], "rows": [ [ "Active inflammatory constriction with potentially reversible physiology [22][23]", "Anti-inflammatory therapy; diurese to euvolemia; monitor CRP and repeat TTE. [22]", "Reassess over the treatment course before surgery unless clinical deterioration mandates earlier escalation. [22][23]" ], [ "Persistent constriction after appropriate medical therapy [22]", "Confirm persistent physiology and reassess inflammatory activity with imaging. [22][6]", "Early referral for pericardiectomy evaluation. [22]" ], [ "Chronic calcific or fibrotic constriction without inflammatory features [22][23]", "Use diuretics for symptomatic congestion while operative evaluation proceeds. [23]", "Pericardiectomy if surgical risk is not prohibitive. [22][23]" ], [ "Possible tuberculous constriction requiring surgery [20]", "Plan pathology evaluation of resected pericardium. [20]", "Stain tissue for AFB and assess for granulomatous inflammation while treating the underlying etiology. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Pericarditis - Symptoms, diagnosis and treatment | BMJ Best Practice US", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-us/243", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com", "snippet": "Menger JS, Collini V, Groschel J, et al; ESC Scientific Document Group. 2025 ESC guidelines for the management of myocarditis and pericarditis. Eur Heart J. 2025 Oct 22;46(40):3952-4041.Full text\n\nChiabrando JG, Bonaventura A, Vecchié A, et al. Management of acute and recurrent pericarditis: JACC St", "score": 0.5815176 }, { "number": 2, "title": "DiVerential diagnosis of restrictive cardiomyopathy and ... - Heart", "detail": "heart.bmj.com", "url": "https://heart.bmj.com/content/heartjnl/86/3/343.full.pdf", "authors": "heart.bmj.com", "host": "heart.bmj.com", "snippet": "Constrictive pericarditis requires surgical treatment and is usually curable, while restrictive cardiomyopathy, short of cardiac transplantation", "score": 0.5780915 }, { "number": 3, "title": "CARDIOVASCULAR DISEASES", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/559160/archinte_93_2_008.pdf?resultClick=1", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "Pericardiectomy for chronic constrictive pericarditis is well established. Evalu¬ ating their own surgical results, Chambliss and his group 147 found 72%", "score": 0.41279107 }, { "number": 4, "title": "Avoiding Diagnostic Anchoring: The Case for Systematic Evaluation ...", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jaccas.2026.109315", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "The 2025 ACC Concise Clinical Guideline on the management of pericarditis provides a contemporary framework for the systematic evaluation of", "score": 0.6041426 }, { "number": 5, "title": "Pericardial Diseases: International Position Statement on New ...", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jcmg.2024.04.010", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Pericardial diseases have gained renewed clinical interest, leading to a renaissance in the field. There have been many recent advances in pericardial diseases in both multimodality cardiac imaging of diagnoses, such as recurrent, transient constrictive and effusive-constrictive pericarditis, and ta", "score": 0.59344494 }, { "number": 6, "title": "2025 Concise Clinical Guidance: An ACC Expert Consensus ... - JACC", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2025.05.023", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Pericardial diseases represent a heterogenous spectrum of disorders, including acute and chronic inflammation of the pericardium (pericarditis), pericardial effusion, constrictive pericarditis, and pericardial masses with malignant infiltration (Figure 1).1 Clinical management of pericarditis may be", "score": 0.5889134 }, { "number": 7, "title": "Pericardial Diseases and Best Practices for Pericardiectomy: JACC State-of-the-Art Review", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2024.05.048", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "20.\n\nLing L.H., Oh J.K., Schaff H.V., et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. _Circulation_. 1999;100:13: 1380-1386. \n\nPubMed\n\nGoogle Scholar\n\n [a [...] asbestosis, trauma, or drug induced (<10%).](\n [b [...] the", "score": 0.5843666 }, { "number": 8, "title": "Circulation's Editors' Picks - American Heart Association Journals", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.112.119792", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "... Constrictive Pericarditis After Anti-Inflammatory Medical Therapy: A Pilot Study. Summary. Constrictive pericarditis (CP) is a disabling disease and usually", "score": 0.5272928 }, { "number": 9, "title": "Pericardial Disease | Circulation", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/circulationaha.105.561514", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "by WC Little · 2006 · Cited by 607 — The most frequent causes are mediastinal radiation, chronic idiopathic pericarditis, after cardiac surgery, and tuberculous pericarditis.Read more", "score": 0.64639384 }, { "number": 10, "title": "Transient constrictive pericarditis following coxsackievirus A4 ...", "detail": "www.cell.com", "url": "https://www.cell.com/heliyon/fulltext/S2405-8440(23)06763-4?uuid=uuid%3A9348761c-5be9-4dd5-9d52-f79e32ef554b", "authors": "www.cell.com", "host": "www.cell.com", "snippet": "The most frequent causes of TCP in developed countries include connective tissue disorders, idiopathic/viral pericarditis, and cardiac surgery [", "score": 0.6072213 }, { "number": 11, "title": "Constrictive Pericarditis in 26 Patients With Histologically Normal ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/01.cir.0000087606.18453.fd", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "The most common causes of constriction in group 1 included previous cardiac surgery, chest irradiation, previous infarction, and idiopathic disease.", "score": 0.5749443 }, { "number": 12, "title": "Pericarditis - American Heart Association Journals", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/pdf/10.1161/01.cir.12.1.30", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "The survey supports the belief that the clinical picture of chronic constrictive pericarditis may result from tuberculosis in most cases, at times only by", "score": 0.5602773 }, { "number": 13, "title": "Holistic management of acute pericarditis: An updated clinical approach - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S2387020625003651", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Holistic management of acute pericarditis: An updated clinical approachAbordaje integral de la pericarditis aguda: un enfoque clínico actualizado. Acute pericarditis is the most frequent pericardial syndrome in clinical practice. Pericarditis refers to the inflammatory process affecting the perica", "score": 0.7120925 }, { "number": 14, "title": "Idiopathic pericarditis in 2025: Advances in diagnosis and therapeutic strategies - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1568997226000054", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Int J Cardiol\n\n### [Clinical utility of [18F]FDG-PET /CT in pericardial disease](/science/article/pii/S0306454919300969)\n\n### Curr Cardiol Rep\n\n### Constrictive pericarditis in the new millennium\n\n### J Cardiol\n\n### Interleukin 1 inhibition for constrictive pericarditis: a novel therapeutic appr", "score": 0.531672 }, { "number": 15, "title": "Review Constrictive pericarditis in the new millennium", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0914508723002253", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "## Abstract\n\nConstrictive pericarditis (CP) is a complex clinical syndrome in which an inflamed pericardium becomes fibrotic and non-compliant, ultimately reducing cardiac pump performance. Although we have known about CP for centuries, it remains a challenge to diagnose. Recent advances in cardiac ", "score": 0.49509352 }, { "number": 16, "title": "Systematic review of non-invasive cardiovascular imaging in the diagnosis of constrictive pericarditis - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0019483216302073", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Systematic review of non-invasive cardiovascular imaging in the diagnosis of constrictive pericarditis - ScienceDirect\n## Indian Heart Journal. Volume 69, Issue 1, January–February 2017, Pages 57-67. # Original Article Systematic review of non-invasive cardiovascular imaging in the diagnosis ", "score": 0.3499997 }, { "number": 17, "title": "2025 ESC Guidelines for the management of myocarditis and ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/eurheartj/article/46/40/3952/8234483", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Constrictive pericarditis should be treated empirically with anti-inflammatory therapy. Cases after failure of medical therapy and pericardial", "score": 0.63397753 }, { "number": 18, "title": "167 Management of pericardial tamponade - Oxford Academic", "detail": "academic.oup.com", "url": "https://academic.oup.com/book/35534/chapter/305801289", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "The most aggressive surgical method is pericardiectomy, which is usually reserved for refractory constrictive pericarditis. Various approaches may be used", "score": 0.55767727 }, { "number": 19, "title": "2015 ESC Guidelines for the diagnosis and management of ...", "detail": "www.ccjm.org", "url": "https://www.ccjm.org/lookup/external-ref?access_num=10.1093%2Feurheartj%2Fehv318&link_type=DOI", "authors": "www.ccjm.org", "host": "www.ccjm.org", "snippet": "Recurrent pericarditis is diagnosed with a documented first episode of acute pericarditis, a symptom-free interval of 4–6 weeks or longer and evidence of", "score": 0.49275014 }, { "number": 20, "title": "Treatment of Tuberculous Constrictive Pericarditis with Pericardiectomy - American College of Cardiology", "detail": "www.acc.org", "url": "https://www.acc.org/education-and-meetings/patient-case-quizzes/2020/12/09/19/43/treatment-of-tuberculous-constrictive-pericarditis-with-pericardiectomy", "authors": "www.acc.org", "host": "www.acc.org", "snippet": "Imaging characteristics of constrictive physiology includes annulus reversus, septal bounce, pericardial thickening and calcification, and pericardial effusion. Clinical signs and symptoms include distended jugular veins with prominent Y descent, pericardial knock, ascites, and lower extremity edema", "score": 0.47548413 }, { "number": 21, "title": "ESC 365 - Evolution of acute pericarditis to constrictive pericarditis with probable tuberculosis as etiology and resolution with clinical treatment.", "detail": "esc365.escardio.org", "url": "https://esc365.escardio.org/presentation/200318", "authors": "esc365.escardio.org", "host": "esc365.escardio.org", "snippet": "28 August 2026\n\nLogo\n\nthumbnail\n\nCongress Presentation\n\n##### Prognostic predictors in constrictive pericarditis, 19-year experience at a tertiary care hospital\n\n11 December 2024\n\nLogo\n\nthumbnail\n\nCongress Presentation\n\n##### Diagnosis and treatment of tuberculous pericarditis in the cardiology clin", "score": 0.47314653 }, { "number": 22, "title": "Perioperative and Surgical Management of Constrictive Pericarditis - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12985804", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Pericardiectomy is primarily indicated in patients with chronic constrictive pericarditis and persistent symptoms with objective evidence of constrictive physiology, as definitive reversal of pericardial noncompliance is unlikely with medical therapy alone.7,17 In this setting, diuretics may provide", "score": 0.8652358 }, { "number": 23, "title": "Pericardial Diseases", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12156183", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "#### Contemporary management.\n\nInitial therapy should target the underlying etiology where applicable. Where pericardial inflammation is identified, potent anti-inflammatory therapy should be initiated before consideration of surgical intervention. Pericardiectomy should be considered in symptomatic", "score": 0.79022324 }, { "number": 24, "title": "Surgical Treatment of Constrictive Pericarditis - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5408622", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "## Surgical Technique\n\nThe patient is fully monitored in order to evaluate the hemodynamic impact of the pericardiectomy intraoperatively. Pericardiectomy can be performed through either a median sternotomy or a left anterolateral thoracotomy. Median sternotomy provides good access to the right vent", "score": 0.75659186 } ], "publishedAt": "2026-09-15T22:41:39.179575+00:00", "updatedAt": "2026-09-15T22:41:39.179575+00:00", "readingMinutes": 7, "slug": "constrictive-pericarditis" }