Acute Pericarditis

Question 1

What is Acute Pericarditis

Answer 1

inflammation of pericardial sac (pericardium)

Question 2

What is the pericardial sac

Answer 2

a double-walled sac containing the heart and the roots of the great vessels.

Question 3

Two layers of the pericardial sac

Answer 3

Fibrous pericardium: strong inelastic connective tissue outer layer
Serous pericardium: serous membrane, encloses the pericardial cavity and contains 10-15mls of serous fluid which protects the heart

Question 4

Etiologies (3)

Answer 4

1. infectious: bacterial, viral, fungal
2. non-infectious: acute, MI, radiation, neoplasm
3. hypersensitive (drug reaction) or autoimmune

Question 5

Acute pericarditis

Answer 5

Pericarditis in acute MI
within 48-72 hours

Question 6

Dressler’s Syndrome

Answer 6

an immune response after damage to heart tissue or the pericardium and sac surrounding the heart
- after 4-6 weeks

Question 7

Clinical Manifestations: most common

Answer 7

progressive, severe chest pain -> sharp, pleuritic in nature
- worse with deep inspiration and on supine position, relieved in an upright position

Question 8

Other clinical manifestations

Answer 8

dypsnea - rapid shallow breaths, to avoid chest pain

Question 9

Hallmark of acute pericarditis

Answer 9

pericardial friction rub
- scratching grating sound. sounds like walking on snow. Believed to arise from the roughened pericardial and epicardial surfaces rubbing against each other. best heard with stethoscope in the left sternal border of the chest with the patient leaning forward

Question 10

Complications of AP

Answer 10

Pericardial effusion (accumulation of excess fluid in the pericardium)
Cardiac tamponade (fluid accumulates in the pericardial sac and causes increase in pericardial pressure and compresses the heart

Question 11

S&S of cardiac tamponade

Answer 11

heart sounds are muffled and pt will report chest pain, confusion, restlessness, tachypnea, and tachycardia as pressure increases

Question 12

Diagnosis

Answer 12

ECG, labs - leukocytosis, elevated CRP and ESR (erythrocyte sedimentation rate)

Question 13

Collaborative Care & Nursing Management (6)

Answer 13

Treat underlying problem (abx for bacterial pericarditis)
Pain and inflammation (NSAIDs or high-dose ASA)
Colchicine (used for gout, will reduce inflammation in the heart)
Pericardiocentesis (if drainage necessary)
Bedrest & pain relief
HOB elevated to 45