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Pericarditis

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Inflammation of the pericardium, the thin outer covering of the heart.

  • Associated with malignant neoplasms, idiopathic causes, infective organisms, as a post-MI syndrome (Dressler’s Syndrome), postpericardiotomy syndrome, systemic connective tissue disease, and chronic renal failure (due to metabolites), chest trauma
  • “Short-course” Pericarditis: <6 months; longer is considered Chronic Pericarditis.
  • Chronic Constrictive Pericarditis leads to thickening of the pericardium by fibrous tissue formation, which leads to rigidity and subsequently inadequate ventricular filling, which results in heart failure.
graph LR
A(Chronic Pericarditis)-->B(Pericardial Rigidity)
B-->C(Inadequate Ventricular Filling)
C-->D(Heart Failure)

Assessment

  1. Pain radiating to the neck, shoulder and back aggravated by inspiration, coughing and swallowing, and is worst when supine (inversely, relieved by sitting up or leaning forward)
  2. Pericardial Friction Rub: a scratchy, high-pitched sound produced by the visceral and parietal pericardium rubbing together.
  3. Signs of RSHF when pericardial rigidity develops.
  4. Thickening of the Pericardium as revealed by CXR or ECHO.
  5. Increased WBC count
  6. Atrial Fibrillation is also common

Intervention

  • NSAIDs (inhibition of prostaglandin, which causes pain) for pain management
  • Corticosteroids if caused by an autoimmune disease.
  • Antibiotics if caused by m.o.
  • Pericardial Drainage (Pericardiocentesis, Pericardiostomy), the removed fluid may also be used for cultures and other studies.
  • Radiation or Chemotherapy if caused by malignancy.
  • Hemodialysis if caused by uremic pericarditis secondary to renal failure.
  • Positioning for comfort.
  • Pericardiectomy for those with chronic constrictive pericarditis.
  • Monitor for Pericardial Effusion (>50mL)

Pericardial Effusion

The accumulation of fluid in the pericardial cavity, which may eventually result in cardiac tamponade.

Manifestations

  • Jugular Distention: increased CVP
  • Pulsus Paradoxus: hypotension with a further decrease of BP during inspiration.
  • Distant/Muffled Heart Sounds
  • Circulatory Collapse as a result of decreased cardiac output.
  • Altered Perfusion (brain: lethargy, stuporous; systematic: cool, clammy skin; kidneys: oliguria)

Intervention

  • Emergency Care: Pericardiocentesis
  • Nursing Responsibilities:
    • Preparation of items such as PPE, skin prep., sterile field, etc.
    • The patient is positioned in a semi/high-fowlers to allow gravity to help drain pericardial effusion.

Graph View