Constrictive pericarditis is a rare disorder that occurs when the thin sac that surrounds and protects the heart becomes stiff and thick, limiting the heart’s ability to pump blood. Symptoms may include swelling in the ankles or legs, fatigue, and shortness of breath.

In developing countries, the most common cause of constrictive pericarditis is tuberculosis, while in developed countries, the cause is usually a viral infection, cardiac surgery, or is unknown.

Treatment typically involves a surgical procedure to remove the affected parts of the pericardium.

Read on to learn more about constrictive pericarditis. This article discusses the symptoms, leading causes, how doctors diagnose the condition, and more.

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The heart is encased in a thin, elastic sac called the pericardium. The pericardium holds the heart in position and separates it from the lungs.

During each heartbeat, the heart fills with blood and then forcefully squeezes the blood out to the rest of the body. The pericardium helps protect the heart by giving it a lubricated area to fill and squeeze, so it is not rubbing against the lungs.

Constrictive pericarditis is when this elastic sac becomes thick and fibrous. Calcium deposits are often present in the pericardium. This tight constriction causes the heart to have trouble filling with blood and squeezing forcefully.

The symptoms of constrictive pericarditis are similar to several other heart conditions.

People with constrictive pericarditis may notice swelling in their legs or abdomen and feel short of breath while sleeping or after light activity.

Often, people with constrictive pericarditis also feel full more easily and feel more tired than usual.

Constrictive pericarditis occurs due to inflammation that causes scarring and thickening of the pericardial lining. Inflammation can result from infections or other causes.

In developing countries, tuberculosis is the main cause of constrictive pericarditis.

In the United States and other developed countries, the most common cause of constrictive pericarditis is a viral infection, or the cause remains unknown.

Other possible causes include:

Doctors use a combination of medical history, physical examination, and other tests to diagnose constrictive pericarditis.

For the medical history, the doctor will ask questions about a person’s symptoms and other medical conditions.

For the physical examination, the doctor will listen to the heart and lungs and do an evaluation, looking for signs of swelling or distended veins.

Doctors will also use imaging and other studies to help them diagnose constrictive pericarditis. These may include:

  • Electrocardiogram (ECG): This test records the heart’s electrical activity and may show changes in the electrical patterns related to constrictive pericarditis.
  • Chest X-ray, MRI, or CT scan: These tests may show the calcification of the pericardium.
  • Echocardiogram: This test involves using an ultrasound to check the heart’s structures. It can also assess how well the heart is functioning.
  • Right heart catheterization: Doctors may insert a catheter into the heart to measure pressure in the different heart chambers.

After confirming the presence of constrictive pericarditis, doctors may order separate tests to determine the cause of the constrictive pericarditis.

Treatment for constrictive pericarditis depends on the severity of the condition.

People with mild constrictive pericarditis, or those who do not have many symptoms, may benefit from taking diuretic medications to reduce swelling or elevated pressures.

People with severe constrictive pericarditis may need surgery to remove the part of the pericardium causing the constriction. However, the procedure mortality rate ranges from 10–55%.

For some people, constrictive pericarditis can resolve on its own, or it may respond to medical management, such as anti-inflammatory medications.

Preventing constrictive pericarditis involves addressing the underlying causes.

This includes maintaining a healthy heart and getting regular checkups from a doctor.

It is best to practice good hygiene to prevent viral infections and seek medical attention for any symptoms of an infection.

Individuals who have connective tissue disorders, are receiving radiation treatments, or have had recent cardiac surgery should have regular heart assessments by a doctor.

The outlook for people with constrictive pericarditis varies.

Early diagnosis and correct management may improve the quality of life. However, if not treated, constrictive pericarditis may lead to complications, such as renal failure, an enlarged liver, and death.

Regular checkups and staying consistent with treatments are important for a better outcome.

People living with constrictive pericarditis will benefit from several lifestyle changes.

Reducing sodium intake may reduce swelling in the legs and abdomen and shortness of breath.

It is also important to take all medications as the doctor prescribes and keep regular checkups with the doctor.

Constrictive pericarditis is a condition in which the heart’s protective sac becomes stiff and thick, affecting how well the heart can function.

It is important to recognize the symptoms of constrictive pericarditis, such as leg swelling, shortness of breath, and fatigue, and to see a doctor promptly for diagnosis.

Because the condition has similar symptoms to several other heart conditions, the doctor may run various tests to get an accurate diagnosis.

Treatment may involve medications to reduce inflammation, reducing sodium intake, or for people with severe cases, surgery to remove part of the pericardium.

While not always preventable, adopting heart-healthy lifestyle practices and maintaining good hygiene may help reduce the risk of constrictive pericarditis.

With prompt treatment and proper care, people with constrictive pericarditis may lead fulfilling lives despite this challenging condition.