A 42-year-old female with a history of tuberculosis treated with anti-tubercular therapy (ATT) presented with progressive abdominal distension for 7 years and shortness of breath for 2 years. Clinical evaluation, including echocardiography, revealed signs of constrictive pericarditis (Septal bounce). The patient underwent successful pericardiectomy, with marked improvement in cardiac function and resolution of ascites postoperatively. Histopathology confirmed fibrosed pericardial tissue, and microbiological studies were negative for active tuberculosis. This case highlights the importance of considering constrictive pericarditis along with ascites and deranged liver function as a long-term complication in patients with a history of tuberculosis.