Clinical features

Symptoms include:

• fatigue
• breathlessness is not severe and, characteristically, occurs on exertion and not at rest
• swelling of abdomen and ankles - ascites is more prominent feature than peripheral oedema

Signs include:

• small pulse:
  • pulsus paradoxus
  • atrial fibrillation
  • tachycardia
• Kussmaul's sign (a raised JVP with inspiration); dominant y descent and trough - this is more common in patients with cardiac tamponade
• cardiac impulses: barely palpable; characteristic is systolic retraction at the apex
• pericardial knock (loud-high pitched S3) following S2
• hepatomegaly
• ascites
• ankle swelling

Reference

1. Khraishah H, Kwun A, Dearani JA, Alfaddagh A. Constrictive Pericarditis: A Comprehensive Overview. Heart Views. 2025 Jul-Sep;26(3):188-197