| Severe chronic systemic venous congestion associated with low cardiac output, including jugular venous distension, hypotension with a low pulse pressure, abdominal distension, oedema, and muscle wasting |
| Can be normal, or reveal low QRS voltage, generalised T wave inversion/flattening, LA abnormalities, atrial fibrillation, atrioventricular block, intraventricular conduction defects, or rarely pseudoinfarction pattern |
| Pericardial calcifications, pleural effusions |
| Pericardial thickening and calcifications* as well as the indirect signs of constriction:–RA and LA enlargement with normal appearance of the ventricles, and normal systolic function –Early pathological outward and inward movement of the interventricular septum (“dip-plateau phenomenon”) –Flattering waves at the LV posterior wall –LV diameter is not increasing after the early rapid filling phase –VCI and the hepatic veins are dilated with restricted respiratory fluctuations†
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| Restricted filling of both ventricles with respiratory variation >25% over the AV valves‡¶ |
| Measurement of the pericardial thickness |
| Measurements of the pericardial fibrosis and thickening |
Cardiac catheterisation: | “Dip and plateau” or “square route” sign in the pressure curve of the right and/or left ventricle |
| Equalisation of pressures in the range of 5 mmHg or less§ |
| The reduction of RV and LV size and increase of RA and LA size |
| During diastole a rapid early filling with stop of further enlargement (“dip-plateau”) |
| In all patients over 35 years and in patients with a history of mediastinal irradiation, regardless of the age. |