Cardiology: constrictive pericarditis versus restrictive cardiomyopathy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: constrictive pericarditis versus restrictive cardiomyopathy

Sample item

A 45-year-old farmer who had tuberculous pericarditis years ago has progressive ankle swelling and ascites. Jugular venous pressure rises on inspiration, an early diastolic sound is heard, and ejection fraction is normal. Which echocardiographic finding best favours constrictive pericarditis over restrictive cardiomyopathy?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Septal shift toward the left ventricle during inspiration, showing ventricular interdependence

In constriction the rigid pericardium isolates the heart from intrathoracic pressure changes, so inspiration increases right ventricular filling at the expense of the left and shifts the septum leftward. This exaggerated respiratory ventricular interdependence is the key discriminator. Preserved ejection fraction, a plethoric IVC and raised venous pressure occur in both conditions, whereas marked atrial enlargement with thick walls suggests an infiltrative restrictive process such as amyloid.

Option by option

  • A. Dilated inferior vena cava without inspiratory collapse

    A dilated non-collapsing IVC reflects raised right atrial pressure, which is present in both disorders.

  • B. Septal shift toward the left ventricle during inspiration, showing ventricular interdependence (correct)

    Respiratory septal shift with ventricular interdependence is characteristic of constriction and is absent in restriction.

  • C. Marked biatrial enlargement with thickened ventricular walls

    Biatrial enlargement with thick walls points to restrictive (infiltrative) cardiomyopathy, not constriction.

  • D. Preserved ejection fraction with impaired diastolic filling

    Both conditions show preserved systolic function with diastolic filling impairment, so this does not separate them.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Septal shift toward the left ventricle during inspiration, showing ventricular interdependence. In constriction the rigid pericardium isolates the heart from intrathoracic pressure changes, so inspiration increases right ventricular filling at the expense of the left and shifts the septum leftward.

Why is "Dilated inferior vena cava without inspiratory collapse" not the answer?

A dilated non-collapsing IVC reflects raised right atrial pressure, which is present in both disorders.

Why is "Marked biatrial enlargement with thickened ventricular walls" not the answer?

Biatrial enlargement with thick walls points to restrictive (infiltrative) cardiomyopathy, not constriction.

Why is "Preserved ejection fraction with impaired diastolic filling" not the answer?

Both conditions show preserved systolic function with diastolic filling impairment, so this does not separate them.

What concept does this question test?

It tests Cardiology: constrictive pericarditis versus restrictive cardiomyopathy in General Medicine. This exaggerated respiratory ventricular interdependence is the key discriminator. Preserved ejection fraction, a plethoric IVC and raised venous pressure occur in both conditions, whereas marked atrial enlargement with thick walls suggests an infiltrative restrictive process such as amyloid.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: constrictive pericarditis versus restrictive cardiomyopathy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.