This patient has evidence of constrictive pericarditis and should be treated with an anti-inflammatory medication, such as a high-dose NSAID or prednisone. Supportive findings are symptoms and signs of right heart failure and congestion, with hemodynamic evidence of constriction on echocardiography. In some patients with constrictive pericarditis, the constriction can be transient and either spontaneously resolve or respond to medical therapy. This subtype of constrictive pericarditis more frequently has idiopathic, viral, or postsurgical causes. Although a minority of patients will have this transient constrictive pericarditis, a trial of medical therapy with an anti-inflammatory medication is reasonable. If medical therapy is successful, then surgical pericardiectomy can be avoided. Anti-inflammatory medication regimens for potentially transient constrictive pericarditis are similar to those for acute pericarditis, with relatively high doses of NSAIDs used (for example, ibuprofen, 800 mg three times daily; indomethacin, 50 mg three times daily; aspirin, 650 mg three times daily), with a slow taper over 2 to 3 weeks.

Cardiac catheterization for hemodynamic assessment of possible constriction is only indicated when diagnostic information cannot be obtained with echocardiography, which is not the case in this patient.

Pericardiectomy is inappropriate before a 2- to 3-month trial of anti-inflammatory medication in this patient. Although pericardiectomy is the definitive treatment for relief of heart failure in patients with constrictive pericarditis, it is a complex, invasive procedure that should not be used in patients with transient constriction.

Transesophageal echocardiography is only indicated when data from other noninvasive imaging studies (such as transthoracic echocardiography) are inconclusive.