6.8.2 Constrictive pericarditis
Constrictive pericarditis may develop following resolution of effusive pericarditis as a result of an inflammatory response to the accumulation of fluid, or may occur without a known previous effusive episode. Frequently the epicardium is also involved, resulting in a limitation of diastolic filling. Constrictive pericarditis can be more difficult to recognise on clinical grounds than a pericardial effusion because there may be no abnormal auscultatory findings. However, clinical signs are very similar to those in effusive pericarditis. If constrictive pericarditis is suspected, echocardiography is very useful to confirm the diagnosis. A thick, echogenic pericardium is seen and in some cases tamponade is present despite there being a relatively small volume of effusion. Diastolic filling and wall motion may halt abruptly when the elastic limit of the pericardium is reached. Steroid treatment may be worthwhile, but the prognosis is grave.
Clinical features of pericardial disease are summarised in Table 6.7.