Effusive-Constrictive Pericarditis

An effusion can produce the familiar picture of tamponade—dyspnea, tachycardia, raised venous pressure, hypotension, and pulsus paradoxus—yet drainage does not always restore normal filling. Effusive-constrictive pericarditis (ECP) is recognized when the fluid-related compression is relieved but the visceral pericardium continues to limit diastolic expansion. The practical clue is a post-drainage right-atrial pressure that has not achieved the expected fall; interpret the finding after excluding severe tricuspid regurgitation and primary right-ventricular failure. The sequence determines priority. Tamponade physiology makes pericardiocentesis urgent; after the effusion is adequately decompressed, pressure data, jugular venous findings, and echocardiography show whether constriction has been unmasked. In a stable patient, active inflammation can be a reversible phase rather than an automatic surgical endpoint, so CRP and MRI findings help determine whether medical treatment should come first. Persistent, chronic constriction despite appropriate therapy requires referral to an experienced pericardial surgery centre. For a Canadian NP, begin with idiopathic or post-viral disease, which is common in Canada and the United States, then let the history direct testing for cardiac injury, radiation, malignancy, purulent infection, or tuberculosis. TB should be...