Myocarditis, Pericarditis and Cardiac Tamponade

Question 1

Is an inflammatory process involving the myocardium and commonly results from a viral infection

Answer 1

Myocarditis

Question 2

The viral causative agents of myocarditis

Answer 2

-Coxsackievirus A and B
-HIV
-Influenza A

Question 3

Clinical Manifestations of Myocarditis

Answer 3

-May be asymptomatic
-Mild to moderate symptoms
-Fatigue
-Dyspnea
-Syncope
-Palpitations
-Occasional discomfort in chest and upper abdomen
-Sudden cardiac death

Question 4

Medical Management of Myocarditis

Answer 4

-Identify and treat underlying cause
-Bed rest
-Activity restriction until heart size and function have returned to normal
-Avoid NSAIDS

Question 5

Nursing Management of Myocarditis

Answer 5

-Monitor for resolution of fever, tachycardia an other clinical manifestations
-Closely monitor for lethal dysrhythmias
-Apply anti-embolic stockings, as ordered
-Provide active and passive ROM exercises
-Administer anticoagulants, if indicated and as ordered

Question 6

Is the inflammation of the pericardium

Answer 6

Pericarditis

Question 7

Clinical Manifestations of Pericarditis

Answer 7

-Pleuritic Chest Pain
-Pericardial Friction Rub
-Fever
-Dyspnea
-Tachycardia

Question 8

Usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning

Answer 8

Pleuritic Chest Pain

Question 9

Heard most clearly at left lower sternal border

Answer 9

Pericardial Friction Rub

Question 10

Labs and Diagnostics of Pericarditis

Answer 10

-Elevated ESR
-Elevated CRP

Question 11

This diagnostics measures how quickly RBCs settle at the bottom of a test tube

Answer 11

ESR or Erythrocyte Sedimentation Rate

Question 12

What are the normal results of ESR in male and females?

Answer 12

Males: ≤ 15 mm/hr
Females: ≤ 20 mm/hr

Question 13

Is a protein made by the liver which is sent into the blood stream in response to inflammation

Answer 13

C- Reactive Protein

Question 14

Normal result of C-Reactive Protein

Answer 14

<1.0 mg/dl

Question 15

Medical Management of Pericarditis

Answer 15

-Determine and treat underlying cause
-Analgesic Therapy
-NSAIDS- first line

Question 16

PERICARDITIS DRUG

Drugs for pain relief during acute phase

Answer 16

Aspirin and Ibuprofen

Question 17

Is contraindicated as it decreases coronary blood flow

Answer 17

Indomethacin

Question 18

For severe pericarditis or patients unresponsive to NSAIDS

Answer 18

Colchicine or Prednisone

Question 19

A procedure in which some pericardial fluid is removed rarely is necessary

Answer 19

Pericardiocentesis

Question 20

Nursing Management of Pericarditis

Answer 20

-Facilitate rest periods
-Instruct patient to restrict activity until pain is subside
-ADL or activities of daily living may be resumed gradually once chest pain and friction rub abates
-Monitor for GI side effects if taking NSAIDs or colchicine

Question 21

Is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise

Answer 21

Cardiac Tamponade

Question 22

Clinical Manifestation of Cardiac Tamponade

Answer 22

-Chest Pain
-Tachypnea, tachycardia
-Dyspnea
-Pulsus paradoxus

Becks Triad
-Distended neck veins
-Distant heart sound
-Decreased arterial blood pressure

Question 23

systolic blood pressure that is markedly lower during inhalation

Answer 23

Pulsus paradoxus

Question 24

Confirms the diagnosis and quantify the amount of pericardial fluid

Answer 24

Echocardiogram

Question 25

May show an enlarged cardiac silhouette due to pericardial effusion

Answer 25

Chest X-ray

Question 26

A small opening is made in the pericardium; allowing continuous drainage of fluid into the chest cavity and into the lymphatic system

Answer 26

Pericardiotomy

Question 27

In myocarditis, this must be avoided due to its ineffective in relieving the inflammatory process and has been linked to worsening inflammation of the myocardium

Answer 27

Avoid NSAIDs

Question 28

Patients with myocarditis are sensitive to

Answer 28

Digitalis

Question 29

Digitalis Toxicity is evidenced by a

Answer 29

-the new onset of dysrhythmia
-anorexia
-nausea
-vomiting
-headache
-malaise

Question 30

The first line of drug in pericarditis

Answer 30

NSAIDs

Question 31

The diagnostics for cardiac tamponade

Answer 31

-Echocardiogram
-CXR