Brief Answer:
I would explain as follows:

Detailed Answer:

Hello!

Welcome and thank you for asking on HCM!

Regarding your concern, I would like to explain that when dealing with constrictive pericarditis, it is important to consider some important clues for an optimal medical management:

(1) Heart failure functional class should be evaluated to better decide the right treatment strategy.

You should discuss with your attending cardiologist for a careful review of your functional status.

As you ride 50 kms/day, seems that you have a favorable physical status. In such case surgery should be deferred.

coming to this point medication option should be preferred. Small loop diuretic doses, steroids,,etc should be tried.

(2) An etiological factor of your constrictive pericarditis should be sought, as a proper underlying treatment may resolve the aggravated clinical symptomatology of constriction. For example steroids have a spectacular result in rheumatoid arthritis, antituberculars when tuberculosis is the cause, etc.

(3) It is important to explore the exact extend of pericardial calcification, myocardial fibrosis and th presence of a mixed prolonged constrictive-restrictive physiology.

To correctly address these topics, imagine tests like cardiac ultrasound, cardiac CT & MRI and even video-assisted thoracoscopy could be utilized.

If such is the case, even surgical pericardiectomy would not yield beneficial results; but otherwise, it could pose to considerable peri-operative risks.

But, if the above unfavorable predictors are not present surgical pericardiectomy would be the procedure of choice to definitely improve your clinical status as much as possible.

You need to discuss with your attending cardiologist on the above mentioned topics.

If you have available medical tests, please upload them for a direct review.

Hope to have been helpful to you!

I will be at your disposal whenever you need!

Greetings!

Dr.Iliri

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