THE CONTEXT
Systemic venous congestion is the hallmark of constrictive pericarditis, even when echocardiography shows apparently normal heart size and function.
Characteristic clinical findings
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Venous congestion: Symptoms and signs of systemic venous congestion predominate, often with dramatic ascites and hepatomegaly.
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Rhythm: Atrial fibrillation is common.
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Kussmaul sign: A paradoxical rise in jugular venous pressure during inspiration may be observed.
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Breathlessness: This is not a prominent symptom because the lungs are seldom congested.
When to suspect the diagnosis
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Diagnostic clue: Consider constrictive pericarditis in any patient with unexplained right heart failure and apparently normal heart size and function on echocardiography; the condition can be overlooked.