PERICARDITIS

DEFINITION

Pericarditis is an
inflammation of the
pericardium (the
fibrous sac
surrounding the
heart).
The Pericardium

• The pericardium is a thin, two-layered, fluid-

filled sac that covers the outer surface of the
heart. It provides lubrication for the heart,
shields the heart from infection and
malignancy, and contains the heart in the chest
wall. It also keeps the heart from over-
expanding when blood volume increases,
which keeps the heart functioning efficiently
CAUSES
1.Idiopathic: No identifiable cause found after
routine testing.
2. Infectious causes--
• Viral causes include coxsackievirus,
herpesvirus, mumps virus, and HIV
• Pneumococcus or tuberculous pericarditis are
the most common bacterial forms.
• Fungal pericarditis is usually due to
Histoplasmosis, Aspergillus, Candida,
 Cont..
3. Non-infectious causes--
• Autoimmune disease: systemic lupus erythematosus,
rheumatoid arthritis.
• Myocardial infarction
• Trauma to the heart
• Cancer
• Side effect of some medications, e.g. isoniazid,
cyclosporine, hydralazine, warfarin, and heparin
• Radiation induced
• Aortic dissection (tear in the wall of the aorta)
• Postpericardiotomy syndrome—such as after CABG
surgery
PATHOPHYSIOLOGY
 Due to etiological factors

Pericardial cells are injured and releases a

combination of fluid, fibrin and cells in an
inflammatory response

Change the permeability of pericardial vascularity

Pericardial inflammation and edema

Restriction in heart motion and pain with breathing

SIGN AND SYMPTOMS
• Substernal or left precordial pleuritic chest pain
with radiation to the trapezius ridge (the bottom
portion of scapula on the back)
• The pain is usually relieved by sitting up or
bending forward, and worsened by lying down
• Other symptoms of pericarditis may include-
• Dry cough,
• Fever,
• Fatigue, and
• Anxiety.
Contd...
• Dysphagia
• Cyanosis
• Distended neck veins
• Low-grade fever
• Abdominal or leg swelling for long term
pericarditis
DIAGNOSTIC EVALUATION
1. History collection
2. Physical examination
3.Laboratory tests:-
• Increased urea (BUN), or increased blood
creatinine in cases of uremic pericarditis
• Complete blood cell count (CBC)
• Erythrocyte sedimentation rate (ESR)
• Cardiac enzyme levels
• C-Reactive protein level
Contd...
4.Electrocardiography or ECG:- the ECG typically
shows ST-segment elevation in all leads.
5.Chest X-ray:- to detect fluid accumulation
around the heart.
COMPLICATIONS
• Pericardial effusion (is an abnormal
accumulation of fluid in the pericardial cavity)
• Cardiac tamponade (This is a sudden build-up
of fluid in between the layers of the
pericardium).
• Fatal hemorrhage
• Myocardial ischemia
• Stroke
MANAGEMENT
 MEDICAL MANAGEMENT

1. Most patients with idiopathic pericarditis can be

managed conservatively with a non-steroidal anti-
inflammatory drug (NSAID) such as ibuprofen or aspirin.
2.Patients who do not respond to an NSAID may need a
short course of a corticosteroid, such as prednisone.
3.Medication Cholchicine may be a useful alternative in
patients who cannot take NSAIDs and corticosteroids or
have major side effects with these agents.
Cont....
4.Antibiotics to treat tuberculosis or other
bacterial causes.
5.Pericardiocentesis(drainage of pericardial fluid
by inserting a needle or catheter in pericardial
space) to treat pericardial effusion/tamponade
SURGICAL MANAGEMENT
1.Pericardiotomy-
Surgical opening or puncture of the
pericardium to remove fluid, blood clots and
foreign bodies in the pericardium.
Contd...
2.Pericardiectomy-
It is the surgical removal of part or most of
the pericardium.This operation is most
commonly done to relieve constrictive
pericarditis, or to remove a pericardium that is
calcified and fibrous.
NURSING DIAGNOSIS
• Ineffective breathing pattern r/t pericardial
inflammation
• Ineffective tissue perfusion r/t decrease blood
flow
• Hyperthermia r/t infection and inflammation
• Activity intolerance r/t fatigue