Constrictive pericarditis Management Empiric antibacterial therapy Q Does the patient have suspected or confirmed purulent pericarditis? Yes Initiate intravenous antibiotic therapy in patients with purulent pericarditis. No Empiric anti-tuberculous therapy Q Does the patient live in an area that is endemic for tuberculosis? Q Does the patient have an exudative pericardial effusion? Yes to all Initiate empiric antituberculosis therapy in patients with exudative pericardial effusion living in endemic areas, after excluding other causes. B No to any Avoid antituberculosis treatment prior to diagnostic confirmation in patients living in non- endemic areas. D Empiric anti-inflammatory therapy Q Does the patient have evidence of pericardial inflammation? Yes Consider empiric anti-inflammatory therapy in patients with transient or new diagnosis of constrictive pericarditis in whom there is concomitant evidence of pericardial inflammation, such as an elevated CRP or pericardial enhancement on cardiac CT or cardiac MRI. C No Patients with purulent pericarditis Q Do diagnostic investigations confirmed purulent pericarditis? Yes Initiate intravenous antibiotic therapy in patients with purulent pericarditis. B Perform effective pericardial drainage. B Consider intrapericardial thrombolysis. C No Patients with tuberculous pericarditis Q Does the patient have confirmed tuberculous pericarditis? Yes Administer standard antituberculosis drugs for 6 months for the prevention of tuberculous pericardial constriction. B Consider adjunctive steroids in patients with tuberculous pericarditis, unless the patient is HIV-positive. C Consider intrapericardial urokinase to reduce the risk of constriction. C Perform pericardiectomy if the patient's condition is not improving or is deteriorating after 4-8 weeks of antituberculosis therapy. B Patients with radiation-induced constrictive pericarditis Q Does the patient have radiation-induced constrictive pericarditis? Yes No Consider performing pericardiectomy in patients with radiation-induced constrictive pericarditis, acknowledging that outcomes may be worse than when performed for constrictive pericarditis of other causes. C No Indications for pericardiectomy Q Does the patient remain with chronic, permanent constriction? Yes Refer patients with chronic, permanent constriction for pericardiectomy when clinically appropriate. B No Continue management and follow-up as clinically appropriate.