Acute Pericarditis

Acute Pericarditis

1. Etiology

   • Infections
     • -Viral -Bacterial -Fungal
   • Metabolic
     • -Uremia -Myxedema -Acute MI -Neoplasm -Trauma -Radiation
   • Autoimmune
     • -Rheumatic fever -Drug reaction -Rheumatological diseases -Lupus -Dressler's syndrome -Delayed post myocardial pericardial injury

2. Pathophysiology & Epidemiology

   • Cardiovascular disorder caused by inflammation of the pericardial sac (pericardium)
   • -85% of cases are viral or idiopathic - Accounts for 5% of emergency department visits for chest pain

3. Diagnosis

   • Sudden onset of sharp/stabbing chest pain
   • pericardial rub on auscultation
   • ECG
     • -ST segment elevation -PR segment depression -T wave flattening and inversion
   • Chest X-ray
     • Pleural effusion
   • CT Scan/ MRI
     • Visualization of pericardium
   • Labs
     • Markers for inflammation: -CRP -ESR -WBC
     • BUN, Creatinine
   • Echocardiogram
   • Pericardiocentisis

4. High risk Patients/ Medical History

   • -Fever (>38C) -Immunosuppression -Pulsus Paradoxus -Lyme Disease -Toxoplasmosis -Anticoagulant treatment

5. Complications

   • Recurrence of acute pericarditis
   • Pericardial effusion
   • Cardiac tamponade
   • Constructive pericarditis

6. Clinical Manifestations

   • Persistent chest pain
     • Aggravated by deep inspiration & lying supine
     • Radiating pain to neck, arms, & trapezius muscle
   • Dyspnea
   • Pericardial friction rub
   • Fever
   • Fatigue
   • Abdominal & Leg edema

7. Nursing Interventions

   • Pain Relief
     • Sitting or leaning forward
       • Elevate head of bed (High Fowler)
     • Bed Rest
     • assess pain around the clock
   • Decrease pt anxiety & fear
   • Monitor for s/s of tamponade
   • Pericardiocentsis
     • Monitor catheter drainage

8. Treatment

   • Pericardiocentisis
     • if pericardial effusion & tamponade developed
   • Pericardiectomy
     • if recurrent & last resort
   • Pharmacology
     • Antibiotics
     • NSAIDS
       • Ibuprofen
     • Colchicine
       • to prevent reoccurance
     • Aspirin
     • Corticosteriods
       • Prednisone
   • Underlying disease

9. Assessment

   • V/S: BP, RR, P, Temp, O2
   • Pain Level
     • Chest Pain (PQRSTU)
   • Chest Auscultation
     • Rub
   • Observe limbs for edema
   • Physical Exam

10. Patient Education

    • Elevate head of bed
    • Healthy diet
      • Decrease Sodium
      • Take meds with food
    • No smoking
    • Elevate legs
    • Manage stress & anxiety
    • Follow ups w/ doctor

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