Constrictive pericarditis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor in Chief: M.Umer Tariq [2]; Hafiz M. Ahmed, M.D.[3]
Overview
Medical therapy for constrictive pericarditis depends on whether constriction is inflammatory and potentially reversible or chronic and noninflammatory. Inflammatory constrictive pericarditis, sometimes termed transient constrictive pericarditis, may improve spontaneously or with anti-inflammatory therapy. Chronic constrictive pericarditis caused by established pericardial fibrosis or calcification usually requires surgical pericardiectomy when clinically significant, while medical therapy is mainly used for symptom control or treatment of the underlying cause.
Medical Therapy
Inflammatory constrictive pericarditis
- Anti-inflammatory therapy is recommended as first-line treatment when constrictive pericarditis is associated with active pericardial inflammation.
- Evidence of inflammation may be suggested by clinical findings, elevated inflammatory markers, or imaging findings such as pericardial edema or late gadolinium enhancement on cardiac magnetic resonance imaging.
- Anti-inflammatory therapy may allow resolution of transient constrictive physiology or may reduce inflammation before pericardiectomy if surgery remains necessary.
- Inflammatory constrictive pericarditis may be treated medically for approximately 3 to 6 months before deciding whether pericardiectomy is required, depending on clinical course and response to therapy.
Tuberculous constrictive pericarditis
- In regions where tuberculosis is endemic, tuberculosis is an important cause of constrictive pericarditis.
- Antituberculous therapy may resolve constrictive pathophysiology in patients with tuberculous constrictive pericarditis.
- Corticosteroids may improve clinical response in selected patients with tuberculous constrictive pericarditis.
Chronic constrictive pericarditis
- In chronic constrictive pericarditis with heart failure symptoms, diuretics may be used to relieve volume overload.
- Diuretic therapy improves congestion but does not alter the natural history of chronic constrictive pericarditis.
- Guideline-directed heart failure therapy may be considered, although evidence is limited.
- Noninflammatory constrictive pericarditis and inflammatory constrictive pericarditis that fails anti-inflammatory therapy generally require radical surgical pericardiectomy.[1]
References
- ↑ Wang TKM, Klein AL, Cremer PC, Imazio M, Kohnstamm S, Luis SA, Mardigyan V, Mukherjee M, Ordovas K, Vakamudi S, Wohlford GF. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Diagnosis and Management of Pericarditis: A Report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. 2025;86(25):2691-2719. https://doi.org/10.1016/j.jacc.2025.05.023.