**8. Physical examination**

Symptoms vary depending on the stage of the disease.



#### **Table 2.**

*The principal haemodynamic abnormalities and typical clinical presentations associated with constrictive pericarditis.*

*Pulsus Paradoxus:* Pulsus paradoxus described by Kusmaul in 1872; It is a decrease in systolic arterial pressure by more than 10 mmHg as a result of the pooling of the blood expelled from the right ventricle in the lung bed in the inspiration [10]. In summary; It is the exaggerated form of a normal physiological event [50, 51]. Venous return limitation caused by pericardial restriction causes a decrease in systolic arterial pressure of more than 10 mm Hg in inspiration [51–53]. This event is the dynamic between the pericardium and the heart. Explains the clinical findings that occur because the relationship affects the intracardiac volume/pressure relationship at every stage of the cardiac cycle.

### **9. Palpation reveals pulsatile liver, ascites, peripheral edema**

#### **9.1 Evaluatıon**

Constrictive pericarditis is not immediately diagnosed with standard tests. The reasons why diagnosis is difficult is because it shows symptoms similar to heart failure or lung/liver disease. Constrictive pericarditis should be considered in the presence of unexplained heart failure, pleural effusion, jugular venous distension, liver disease, edema. In addition to these findings, if there is a history of cardiac surgery, chest radiotherapy/pericarditis, the diagnosis of constrictive pericarditis is correct. Constrictive pericarditis is most often confused with restrictive cardiomyopathy, which has similar findings.

Diagnostic methods initially include ECG, Chest radiograph, laboratory findings and echocardiogram.

*Electrocardiography:* The ECG is nonspecific. Low-voltage QRS, nonspecific changes in the ST segment, widening/inversion of the T wave are seen in approximately 25% of patients. The P wave may be narrow and bifid. Atrial fibrillation was detected in approximately 30% of them [32, 37, 38, 54].
