A classical case report of constrictive pericarditis, highlighting the role of magnetic resonance imaging and haemodynamic assessment

Background Constrictive pericarditis is a rare complication of pericarditis and is difficult to diagnose due to non-specific presentation. It mostly presents with right-sided heart failure as a consequence of a rigid pericardium that encases the heart causing impaired diastolic filling. Case summary We present the case of a patient with signs and symptoms of dyspnoea and right-sided heart failure who was initially diagnosed with heart failure with preserved ejection fraction (HFpEF) but remained symptomatic despite being euvolaemic after treatment. A septal bounce and shudder on echocardiogram prompted further investigation. Eventually, cardiac magnetic resonance (CMR) imaging and invasive biventricular pressure measurements led to the diagnosis of constrictive pericarditis. A pericardiectomy was performed after which the patient was relieved of symptoms. Discussion Constrictive pericarditis can mimic HFpEF. Due to its potentially curable character, timely recognition is of cardinal importance. In patients with symptoms of severe right-sided heart failure not resolving after diuretic therapy, a septal shudder on echocardiography should trigger further investigation, with e.g. CMR and cardiac catheterization.