The pericardium becomes gradually fibrosed, thickened and inelastic. It acts as a rigid case, encasing the heart. It interferes with the diastolic relaxation of heart and hence ventricular filling. The net result is a reduction in cardiac output and elevation of systemic venous pressure.


  • TB
  • Hemopericardium and cardiac surgery.
  • Mediastinal irradiation
  • Rheumatoid arthritis
  • SLE
  • Acute pericarditis.


  • Weakness, fatigue, weight loss and anorexia.
  • Patient appears emaciated with a protuberant abdomen.
  • Pulse is of low volume and pulsus paradoxus may be present.
  • Neck veins are engorged.
  • Kussmauls signs may be positive. This is rise in height of JVP during inspiration.
  • Heart sounds may be muffled.
  • Pericardial knock may be audible.
  • Congestive hepatomegaly.
  • Ascites.


  • Chest radiography: Heart size is normal or reduced.
  • Pericardial calcification.
  • Fluoroscopy shows reduced cardiac pulsations.
  • Echocardiography can confirm pericardium thickening and calcification.
  • ECG show low voltage QRS complex and T wave changes.
  • MRI.


Pericardiectomy is the only definitive treatment.