**Question:** All are true in chronic constrictive pericarditis except-

A. Cardiac dilation
B. Pulmonary hypertension
C. Preserved ejection fraction
D. Absence of tamponade

**Core Concept:**

Chronic constrictive pericarditis is a condition characterized by the progressive inflammation and scarring of the pericardium, leading to the formation of adhesions and the narrowing of the heart's chambers and the spaces between them. This results in impaired filling and emptying of the heart, leading to symptoms like dyspnea, fatigue, and orthopnea.

**Why the Correct Answer is Right:**

In chronic constrictive pericarditis, the constriction of the pericardium restricts the ability of the heart to fill and empty effectively. The condition typically presents with symptoms such as dyspnea, fatigue, and orthopnea due to the impaired cardiac function.

A. Cardiac dilation: The constriction of the pericardium in chronic constrictive pericarditis results in reduced cardiac chambers' size, not dilation.

B. Pulmonary hypertension: While chronic constrictive pericarditis can lead to pulmonary hypertension, it is not a defining feature.

C. Preserved ejection fraction: The constriction of the pericardium in chronic constrictive pericarditis results in impaired cardiac function rather than preserved ejection fraction.

D. Absence of tamponade: Chronic constrictive pericarditis often presents with tamponade, a condition where the pericardial fluid accumulates, leading to acute symptoms like jugular venous distension, decreased breath sounds, and a diastolic heart murmur.

**Why Each Wrong Option is Incorrect:**

A. Cardiac dilation: The constriction of the pericardium in chronic constrictive pericarditis results in reduced cardiac chambers' size, not dilation.

B. Pulmonary hypertension: While chronic constrictive pericarditis can lead to pulmonary hypertension, it is not a defining feature.

C. Preserved ejection fraction: The constriction of the pericardium in chronic constrictive pericarditis results in impaired cardiac function rather than preserved ejection fraction.

D. Absence of tamponade: Chronic constrictive pericarditis often presents with tamponade, a condition where the pericardial fluid accumulates, leading to acute symptoms like jugular venous distension, decreased breath sounds, and a diastolic heart murmur.

**Clinical Pearls:**

Chronic constrictive pericarditis should be suspected in patients presenting with symptoms like dyspnea, fatigue, orthopnea, and elevated jugular venous pressure. These symptoms are associated with the impaired cardiac function due to the constriction of the pericardium. The condition can lead to tamponade, which may present with acute symptoms like jugular venous distension, decreased breath sounds, and a diastolic heart murmur.

**Why you should remember this:**

Understanding the key features of chronic constrictive per