Constrictive Pericarditis: Causes, Symptoms, and Treatment
Written by Sumiran Racherla, MD. Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Constrictive Pericarditis?
A cardiologist, a doctor who treats heart conditions, usually leads care for constrictive pericarditis. If other methods do not control the problem, a surgery called a pericardiectomy may be needed. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is constrictive pericarditis?
Constrictive pericarditis happens when the sac-like covering of the heart, called the pericardium, becomes thickened and scarred. This makes it hard for the heart to expand properly when it beats. As a result, the heart chambers do not fill up with enough blood. Blood backs up behind the heart, causing heart swelling and other symptoms of heart failure.
Constrictive pericarditis is a rare cause of heart failure, and the diagnosis is often missed. It may be life threatening if it is not treated.
Symptoms
These are symptoms of chronic constrictive pericarditis.
- Trouble breathing, called dyspnea, that develops slowly and gets worse
- Fatigue
- Long-term swelling, called edema, of the legs and ankles
- A swollen abdomen
- Weakness
Early symptoms can be vague, such as fatigue and being less able to exercise. Complications may include heart failure, liver and kidney problems, and scarring of the heart muscle.
Causes and who gets it
Most of the time, it happens because of things that cause inflammation around the heart. Examples are heart surgery, chest radiation, and tuberculosis. A less common cause is a buildup of fluid in the covering of the heart, called a pericardial effusion. This may occur because of infection or as a complication of surgery. The condition may also develop without a clear cause.
It is rare in children.
How doctors diagnose it
Constrictive pericarditis is very hard to diagnose. No single test can give a definite diagnosis. The signs are similar to those of other conditions, so your provider will need to check for those too.
A physical exam may show that your neck veins stick out. That can point to higher pressure around the heart. The provider may hear weak or distant heart sounds through a stethoscope, and a knocking sound may also be heard. The exam may also show liver swelling and fluid in the belly area.
These tests may be ordered: a chest MRI, a chest CT scan, a chest x-ray, an ECG, and an echocardiogram. CT and MRI scans can show how far the thickening has spread and help plan surgery.
Treatment
The goal of treatment is to improve heart function. The cause must be identified and treated. Treatment depends on the cause. It may include antibiotics or medicines for tuberculosis.
Diuretics, also called water pills, are often used in small doses to help the body remove extra fluid. Some people may need to cut down on their activity, and a low-sodium diet may also be recommended.
The treatment of choice is a surgery called pericardiectomy. It involves cutting or removing the scarring and part of the sac-like covering of the heart. More than 90 percent of patients have better symptoms after the procedure. However, the surgery has a high risk for complications. For this reason, it is most often done in people who have severe symptoms. The risk of dying from the operation ranges between 5% and 20%.
When to see a doctor
Contact your provider if you have symptoms of constrictive pericarditis. It may be life threatening if it is not treated. Call 911 or go to the emergency room if you have severe trouble breathing, chest pain or discomfort lasting for two minutes or more, or fainting or loss of consciousness.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Such a doctor can be the provider you contact if you have symptoms of constrictive pericarditis. Your provider will need to check for other conditions that look similar.
Common questions
Is constrictive pericarditis life threatening?
It may be life threatening if it is not treated. Surgery to treat it has a high risk for complications. For this reason, it is most often done in people who have severe symptoms.
Can constrictive pericarditis be prevented?
In some cases, constrictive pericarditis is not preventable. However, conditions that can lead to it should be properly treated.
What causes constrictive pericarditis?
Most of the time, it happens because of things that cause inflammation around the heart. Examples are heart surgery, chest radiation, and tuberculosis. It may also develop without a clear cause.
Is constrictive pericarditis easy to diagnose?
No, it is very hard to diagnose. Its signs and symptoms are similar to other conditions, so your provider will need to check for those conditions too.
Sources
- MedlinePlus - Pericarditis - constrictive
- National Library of Medicine (PubMed Central) - Constrictive Pericarditis: A Commonly Missed Cause of Treatable Diastolic Heart Failure
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
