PERICARDITIS

Acute Pericarditis

• Inflammation of the sac

surrounding the heart
• Area becomes rough &
scarred
 Etiology

1. Bacteria, viruses, fungal organisms

2. Dressler’s syndrome [Post-MI]
3. Post-pericardiotomy syndrome [PPS]
4. Acute exacerbation of systemic connective
tissue
5. Previous trauma or cardiac surgery
6. Radiation
 Assessment/Noticing:
Manifestations/Presentation
• Substernal precordial pain: radiating
to L neck, shoulder or neck
• Grating, oppressive pain: made worse
by breathing [on inspiration], coughing
& swallowing [Dysphagia]
• Pain worse: supine position: relieved:
Sitting up & leaning forward
• Pericardial friction rub: L lower
sternal border
 Assessment/Noticing: Presentation:
Diagnostics
• WBC: Elevated
• Fever [infectious cause]
• Blood cultures
• EKG: ST elevation [all leads]; Afib
• Echo: pericardial effusion
• S/S cardiac tamponade
 Proposed Diagnostic Criteria
• Presence of 2 of the following:
• Pericardial chest pain
• Pericardial rub presence
• New ST elevation or PR-segment depression
• New or worsening pericardial effusion
 Chronic Constrictive Pericarditis
• Results from inflammation
causing fibrous thickening of
pericardium
• Causes
• Radiation, TB, Trauma, renal
failure [uremia] or metastatic
cancer
• Pericardium: rigid, thick
preventing filling of ventricles
leading to cardiac failure
• Presentation
• R-side HF incl. dyspnea,
exertional fatigue, orthopnea
• Elevated systemic venous
pressures w/JVD
• Hepatic engorgement [ascites]
• Dependent edema
Diagnostics
• Echo/CT: pericardial thickening
 Interventions
• Promote comfort
• Encouraging rest
• Nonsteroidal anti-inflammatory drugs [NSAIDS]
• Corticosteroid Rx: if NSAIDS ineffective & no
infection exists
• Positioning: Upright; leaning slightly forward
• No relief within 24-48 hours: notify provider
• Colchicine 0.5 mg PO twice/day x3 months
 Interventions
• Treat specific cause of pericarditis
• Bacterial: AB & pericardial drainage
• Chronic
• Radiation or chemo: malignant disease
• Hemodialysis: uremia from renal disease
• Pericardiectomy [Chronic]: definitive treatment
• Monitor for pericardial effusion
• Risk for Cardiac tamponade
Pleural Effusion
 Cardiac Tamponade

• Emergency; Notify if suspected

• Accumulation of fluid, blood [20-50
mL] or exudates between the two
layers of the pericardium
• Results in compression of cardiac
muscle
• Most serious complication of
pericarditis
• Causes
• MI, RV biopsy, trauma to ches, cardiac
bypass surgery
 Assessment/Presentation/Manifestations
• ___________Cardiac output
• Central venous pressures: ____________
• Blood Pressure: ______________
• Heart sounds: Muffled or distant
• Narrow pulse pressure: difference b/w SBP & DBP
• JVD; clear BS on auscultation
• Paradoxical pulse [pulsus paradoxus: SBP 10 mm
Hg or more higher on expiration than inspiration
• Decreased HR, dyspnea, fatigue
 Pericardiocentesis

• Removes fluid, blood and relieve pressure

from around the heart
• Procedure under echocardiography,
fluoroscopic and hemodynamic
monitoring:
• 16-18 g needle into pericardial space
• Pericardial drain temporarily placed
• Monitor pulmonary artery wedge and R
atrial pressures
• Send pericardial fluid to lab for c/s,
cytology
 Nursing Safety Priority: Action Alert
• Post procedure
• Close monitoring for recurrence of tamponade
• Be prepared to provide adequate fluid volume
to increase CO ad prepare for emergency
sternotomy if tamponade recurs
 Pericardial Window

• Surgical removal of portion of

pericardium and create a
'window' to continuously drain
the excess fluid into pleural
space