Constrictive pericarditis: Pathophysiology, epidemiology, clinical presentation, imaging, treatment and prognosis

Constrictive pericarditis (CP) is characterized by a thickened, fibrotic pericardium, limiting the heart's ability to function as 'a pump.' Causes are many but commonly it is a late effect of an inflammation of the pericardium, which may be an infective etiology, but may also follow myocardial infarction or cardiac surgery. The thickened pericardium in CP, irrespective of the etiology, impedes normal diastolic filling, which commonly involves the parietal pericardium, but the visceral pericardium may be also affected. CP, classed as acute and sub-acute whether symptomatic or asymptomatic may deposit fibrin, which, can result in a pericardial effusion, pericardial inflammation, fibrotic scarring, calcification, and restricted cardiac filling. The presentation of CP is diverse and overlaps myocardial infarction, aortic dissection, pneumonia, influenza, and many connective tissue diseases. Thus, diagnosis is elusive and challenging. A high index of clinical suspicion is required to facilitate a correct diagnosis and timely intervention. The difficulty is encountered differentiating CP from restrictive cardiomyopathy and other syndromes associated with an elevated right-sided pressure that all share similar presentation. An adequate history and careful physical examination remain the cornerstones of diagnosis. Nevertheless, advances in technology such as Doppler echocardiography, high-resolution computed tomography (CT), magnetic resonance imaging (MRI), and invasive hemodynamic measurement are now considered essential to accurate work-up. Definitive treatment of CP is predominantly by Pericardiectomy's. Symptomatic improvement following Pericardiectomy's is rapidly achieved.