Constrictive Pericarditis

What is constrictive pericarditis?

Constrictive pericarditis is a condition where the pericardium, the thin membrane that holds your heart in place, becomes stiffer and thicker than normal. That interferes with your heart’s pumping ability and can lead to severe problems like heart failure. It's usually a chronic (long-term) problem, but it is treatable in most cases, especially with early diagnosis.

What happens with this condition?

The pericardium is a fluid-filled membrane with two layers that surrounds your heart. Part of the pericardium’s job is to hold your heart in place. There’s also a layer of fluid inside the pericardium between it and your heart. That fluid helps cushion your heart and protect it from injury.

Under normal circumstances, the pericardium is flexible and stretchy. That means your heart doesn’t have any trouble expanding to fill up with blood between heartbeats. The pericardium is stiffer and thicker than normal when you have constrictive pericarditis. That keeps your heart from expanding as it should.

When your heart can’t expand enough to fill up with blood, it struggles to pump enough to meet your body’s needs. To compensate, the filling pressures increase, which leads to heart failure.

What is the difference between constrictive pericarditis and restrictive pericarditis?

These are the same condition, but "restrictive pericarditis" is no longer in common use.

Who does it affect?

Constrictive pericarditis is most likely to happen to people who have a history of heart surgery, radiation therapy around their heart, or idiopathic/viral pericarditis (idiopathic means “unknown”). In developing countries, tuberculosis is the most common cause. It’s two to three times more likely to happen to men than women. It’s also extremely rare in children.

How common is this condition?

Constrictive pericarditis is a rare condition overall. It happens to about 9% of people with acute pericarditis, and acute pericarditis accounts for about 5% of all chest pain-related emergency room visits.

What are the symptoms?

The symptoms of constrictive pericarditis include:

• Shortness of breath (dyspnea).
• Chest pain.
• Fatigue.
• Dizziness.
• Swelling (especially in the abdomen and lower legs) from fluid buildup.
• Loss of muscle mass.
• Loss of appetite and feeling full even when eating very little.

Types of constrictive pericarditis

Constrictive pericarditis has a few different subtypes:

• Acute. This type happens when scarring of the pericardium happens quickly, usually over a matter of days.
• Subacute. This type is like acute constrictive pericarditis, but the symptoms aren’t as severe.
• Effusive-constrictive pericarditis. This subtype causes pericardial effusion, a buildup of fluid inside the pericardium that can put too much pressure on your heart. That causes cardiac tamponade, where your heart can’t beat because fluid buildup takes up more and more space. Eventually, your heart stops because of the pressure from fluid around it. Effusive constriction happens when elevated filling pressures in the heart remain even after draining the extra fluid.
• Transient constrictive pericarditis. This type usually involves acute pericarditis that turns into inflammatory constrictive pericarditis. This is treatable with anti-inflammatory medications.
• Occult constrictive pericarditis. In medicine, the term “occult” means hidden. This type of constrictive pericarditis carries that name because it's hard to detect. Finding and diagnosing this condition usually happens by accident when running other tests.

What causes the condition?

Constrictive pericarditis means that your pericardium is stiffer or thicker than normal, often because of scar tissue from previous medical conditions. This stiffening of the pericardium can happen for several reasons, including.

• Infections. In developing countries, these are usually because of bacterial infections, especially tuberculosis (constrictive pericarditis happens in 20% to 30% of tuberculosis-related cases of pericarditis). In developed countries, viral infections are more likely to cause this condition.
• Heart and circulatory problems. This includes heart attacks or other conditions that affect the major blood vessels closest to your heart.
• Trauma. Injuries to the chest (either blunt impacts or penetration injuries like knife or bullet wounds) can cause inflammation that leads to scar tissue formation.
• Immune system conditions or inflammatory disorders. Examples of these conditions include lupus, rheumatoid arthritis or Sjögren’s syndrome.
• Medical causes. Pericardial thickening or scarring can happen after heart surgery, radiation therapy for cancer or as a side effect of some medications.
• Cancer. This includes either cancer of the pericardium itself or cancer from somewhere else in your body.
• Other. Constrictive pericarditis can happen for unknown reasons. Healthcare providers often assume these cases happen because of a viral infection or group unknown and viral causes together for statistical reasons.

Is it contagious?

No. While constrictive pericarditis can happen because of infections (some of which are potentially contagious), this condition isn’t contagious on its own.

How is it diagnosed?

A doctor can diagnose this condition based on a combination of your symptoms, your medical history, a physical examination and diagnostic tests. This condition is sometimes difficult to diagnose, especially when the symptoms aren’t severe or when you have other conditions with similar or related symptoms.

What tests may happen as healthcare providers try to diagnose this condition?

If a healthcare provider suspects you have constrictive pericarditis, the following tests are possible.

• Testing for tuberculosis.
• Blood tests to confirm or rule out immune system conditions.
• Echocardiogram.
• Electrocardiogram.
• Chest X-ray.
• Heart computerized tomography (CT) scan.
• Heart magnetic resonance imaging (MRI).
• Left and right heart catheterization.

How is it treated, and is there a cure?

This condition is usually treatable, and curing it is often possible.

In most cases, curing this condition involves two main principles:

• Relieving pressure on the heart happens because the pericardium can’t stretch.
• Treating underlying causes or related symptoms.

What medications or treatments are used?

Most of the time, this condition involves the following:

• Surgery. Pericardiectomy, which removes all of the pericardium, usually offers the best chance to treat this condition successfully. You don't need your pericardium to survive, and many people return to their normal lives without any difficulty or long-term effects.
• Medication. Depending on the underlying cause and symptoms, different medications can help treat this condition's symptoms directly or try to cure it by stopping whatever is causing it to happen. In some cases, medications are enough to treat this condition, avoiding the need for surgery, or they can help manage symptoms for people who can’t have surgery.

What medications are used?

The most common medications for the treatment of this condition include:

• Diuretics. These medications help your kidneys remove extra fluid from your body.
• NSAIDs. Non-steroidal anti-inflammatory drugs, or NSAIDs, help reduce inflammation and relieve pain. Examples of these include ibuprofen or naproxen.
• Steroids. The anti-inflammatory effects of these medications can help treat this condition.
• Cause-specific medications. Examples of these include antibiotics for bacterial infections like tuberculosis.

Complications/side effects of the treatment

The potential complications vary based on the treatment and medication in question. The underlying cause or type of constrictive pericarditis are also factors in complications. Your healthcare provider is the best person to tell you about the potential side effects or complications, especially when it comes to medications. That’s because your provider can tailor the information to your specific situation and circumstances. They can also tell you what to watch for, how to manage these potential problems and what you can do to try and avoid them entirely.

Potential complications from surgery include:

• Heart failure.
• Irregular heart rhythms (arrhythmias).
• Infections and sepsis.
• Death.

How to take care of myself or manage my symptoms?

Because testing and imaging are necessary to diagnose constrictive pericarditis, it isn’t something you should treat or manage yourself. This is especially important because some of the symptoms of this condition also happen with life-threatening conditions like cardiac tamponade or heart attack. Because of that, you should first talk to a healthcare provider and get guidance from them on what you can do for this condition.

How soon after treatment will I feel better?

Depending on the cause of this condition and the treatments you receive, it may take days or weeks for you to feel better. If you have surgery, the time it takes for you to feel better also needs to take into account how long you’ll need to recover from the surgery itself. Most people will feel better within three months, but some people may need several months to make a full recovery.

How can I prevent this or reduce my risk?

Constrictive pericarditis happens unpredictably, so it’s not possible to prevent it. The only thing you can do to reduce your risk of developing this condition is to avoid situations that might lead to developing it. One example is getting bacterial infections treated quickly rather than delaying care. Another is for medical personnel to limit radiation damage to your pericardium if you receive radiation therapy.

What can I expect if I have this condition, and is it curable?

The outlook for this condition depends on the cause, the severity of your case, the treatments involved and any other health conditions you might have. Your healthcare provider is the best person to tell you what to expect from this condition and your likely outlook.

Because this condition often happens alongside or because of severe or deadly conditions, the outlook is often negative. This is especially true when it happens because of radiation therapy or when you also have:

• Advanced kidney disease or kidney failure.
• Heart failure.
• Liver disease.
• Pulmonary hypertension.

Because of the risks, the best outcomes usually happen with early diagnosis and treatment. Good outcomes are also more likely with the transient type of this condition. Even so, about 5% to 10% of those who undergo surgery don’t survive (hospitals that specialize in heart care tend to have better outcomes).

However, most people recover and do well. Nearly 80% of the people who have surgery for this condition live at least five years, and nearly 60% live at least 10 years.

How long does this condition last, and when can I resume my usual routine and activities?

How long this condition lasts depends on the type, cause and treatments you receive. In some cases, this condition goes away on its own or with medication only. That usually takes a few weeks to a few months. The more severe the case or cause, the longer it usually takes for you to recover.

How do I take care of myself?

If you have this condition, it's important to follow their guidance on caring for yourself. This includes the following:

• Take your medication as prescribed. Medications for this condition should be taken as prescribed, not just until you feel better.
• Follow diet instructions. Many people will need to limit their salt intake. The sodium in salt can cause your body to retain too much fluid, which can make this condition worse.
• Limit physical activity if necessary. This can help reduce the strain on your heart and prevent or limit damage to your heart muscle.

When should I see my healthcare provider, and when should I seek care?

Most people will need to see their provider regularly as they recover from this condition. If your condition improves, your provider will likely recommend reducing how frequently you see them.

You should call your healthcare provider or schedule an appointment if you notice that your symptoms are returning or have symptoms that start to change and affect your usual activities and routine.

When should I go to ER?

Many of the symptoms of this condition also happen with life-threatening medical emergencies. Because of that, you should get medical care immediately if you have any of the following symptoms:

• Shortness of breath (dyspnea).
• Chest pain.
• Dizziness or feeling lightheaded.
• Fainting or passing out.

A note from Cleveland Clinic

Constrictive pericarditis is an uncommon condition that happens unpredictably. It also shares symptoms with many other conditions, so sometimes it can be tough to diagnose. Fortunately, advances in medical knowledge and technology mean it’s easier to diagnose this condition with certain imaging tests. The treatments for this condition have also made great strides. That means that this condition is treatable in most cases, and in some cases, a cure is possible.