Q. Signs of constrictive pericarditis?

1) Jugular venous pressure (JVP) is elevated in all patients of CP which reflects the elevated diastolic pressure of the right atrium. In CP, the JVP can engorge during inspiration, known as Kussmaul's sign; there can be prominent ‘Y' descent representing early rapid filling of  the right ventricle, Friedrich's sign.

2) One third of CP patients have irregularly irregular pulse due to atrial fibrillation. In patients with effusive CP there can be pulsus paradoxus.

3) Praecordial examination may reveal cardiomegaly by percussion. The first heart sound may be muffled. A pericardial knock, which is due to early cessation of ventricular filling due to pericardial restriction is audible. This is a high pitched sound audible in diastolic phase earlier than the timing of S3. Murmurs are not common even though atrioventricular valve regurgitations due to alteration of ventricular geometry have been described.

4) Hepatomegaly and ascites are almost always present. Splenomegaly is detected in chronic cases.