This video demonstrates the heart sounds associated with constrictive pericarditis. It has an early diastolic component which can be mistaken for a physiological 3rd heart sound. It has a similar mechanism but tends to be of a higher pitch, occurs earlier in diastole, and is louder due to the constricted myocardium or pericardium.

It is unlikely due to the emergency nature of constrictive pericarditis, that you will have it as a PACES case.  However it is useful to be able to distinguish it from a physiological 3rd heart sound, and to be able to explain the difference.

The greater the constriction the earlier in diastole of the extra heart sound.

Clinical features of constrictive pericarditis include:

  • Prominent x and y descents in the JVP
  • Positive Kussmaul’s sign
  • Pericardial knock
  • Quiet heart sounds
  • Extra-cardiac signs: non-pulsatile hepatomegaly, ascites and peripheral oedema

Constrictive pericarditis is caused by tuberculosis, viral infections and rarely malignancy.   Symptoms may also be caused by resultant pericardial effusion.

The life-threatening complication of a pericardial effusion is cardiac tamponade.

Definitive management requires a pericardectomy to relieve the constriction, as well as treating the underlying cause.