A 47-year-old man has progressive right-sided heart failure with elevated JVP, hepatomegaly, and ascites. Kussmaul sign is present. Which finding on imaging or investigation best distinguishes constrictive pericarditis from restrictive cardiomyopathy as the cause?

• A Pericardial thickness greater than 4 mm with septal bounce on cardiac MRI ✓
• B Preserved systolic function on echocardiography
• C Elevated NT-proBNP level
• D Prominent y descent in the jugular venous pulse

Explanation

Both conditions produce Kussmaul sign, prominent y descents, preserved EF, and near-equalization of diastolic pressures, so hemodynamic signs cannot separate them. Thickened calcified pericardium on CT/MRI with interventricular septal bounce indicates constriction, where the problem is extrinsic compression. Elevated natriuretic peptides favor restriction, since the diseased myocardium itself secretes more BNP, making option C the key distractor that actually points away from the correct answer.

Reference: Braunwald's Heart Disease, 12th ed.

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Written and medically reviewed by the StethoPrep medical team.