Subacute Constrictive Pericarditis

Subacute constrictive pericarditis is a transitional form that may arise weeks to several months after an episode of acute pericarditis. Progressive fibrosis and stiffening of the pericardium restrict cardiac filling. In some patients constriction develops after pericardial inflammation subsides; in others, transient constriction resolves with medical therapy.

Causes include viral or idiopathic pericarditis, tuberculosis, post-cardiotomy syndrome, autoimmune disease, malignancy and radiation. Clinical findings reflect right-sided heart failure (elevated jugular venous pressure, hepatomegaly, ascites, leg edema) and low cardiac output.

Diagnosis is based on echocardiography, cardiac MRI (showing pericardial thickening and inflammation), CT and cardiac catheterization. Anti-inflammatory therapy (NSAIDs, colchicine, corticosteroids) is attempted first; pericardiectomy is needed if constriction persists.