Constrictive pericarditis: a structures review of the medical literature Diagnosis, multimodal imaging and contemporary Management

Constrictive pericarditis (CP) is an uncommon but potentially curable cause of heart failure with preserved ejection fraction, in which a fibrotic, inelastic, and often calcified pericardium restricts diastolic filling of the ventricles. The disease remains a diagnostic challenge because its clinical picture overlaps with restrictive cardiomyopathy, severe tricuspid regurgitation, and non-cardiac causes of systemic venous congestion. This review synthesizes the contemporary medical literature on CP, covering its epidemiology and evolving etiologic spectrum, the two cardinal pathophysiologic mechanisms (dissociation of intrathoracic and intracardiac pressures and exaggerated ventricular interdependence), the validated echocardiographic diagnostic criteria, the complementary roles of cardiac magnetic resonance imaging, cardiac computed tomography, and invasive hemodynamics, and current management strategies. Particular emphasis is placed on the identification of transient (inflammatory) constriction, which may resolve with anti-inflammatory therapy, and on the outcomes and risk stratification of radical pericardiectomy, the definitive treatment for chronic disease.