Constrictive pericarditis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Huda A. Karman, M.D.

Physical findings of patients with constrictive pericarditis may include general, cardiovascular and other organ systemic findings. General findings could be indistinct or could include muscle wasting, cachexia, or jaundice. Cardiovascular Findings include sinus tachycardia, distant or muffled heart sounds, pericardial knock, cardiac murmur, pulsus paradoxicum (paradoxus), kussmaul sign (elevation of systemic venous pressures with inspiration). Other systemic findings include hepatomegaly, spider angiomata, palmar erythema, peripheral edema.

Physical findings of patients with constrictive pericarditis may include general, cardiovascular and other organ systemic findings ^[1]

The physical examination may show that your neck veins protrude, suggesting increased blood pressure in the area. This condition is called Kussmaul’s sign. During the physical examination the doctor may note weak or distant heart sounds when listening with a stethoscope.

• Indistinct physical findings (early findings)
• Muscle wasting, cachexia, or jaundice (advanced findings)
• Pericardial constriction could be present with symptoms such as: pleural effusion, hepatomegaly, jugular venous distention, or ascites.

• Sinus tachycardia
• Distant or muffled heart sounds
• Pericardial knock
• Cardiac murmur
• Pulsus paradoxicum (paradoxus)
• Kussmaul sign (elevation of systemic venous pressures with inspiration)

Kussmaul sign can also be a symptom for patients with right ventricular failure, restrictive cardiomyopathy, right ventricular infarction, and tricuspid stenosis.

• Hepatomegaly in about 70% of patients
• Spider angiomata
• Palmar erythema
• Peripheral edema (less prevalent in younger patients)

The physical exam may also reveal liver swelling and fluid in the belly area.

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