Myocarditis, Pericarditis and Cardiac Tamponade Flashcards
Is an inflammatory process involving the myocardium and commonly results from a viral infection
Myocarditis
The viral causative agents of myocarditis
-Coxsackievirus A and B
-HIV
-Influenza A
Clinical Manifestations of Myocarditis
-May be asymptomatic
-Mild to moderate symptoms
-Fatigue
-Dyspnea
-Syncope
-Palpitations
-Occasional discomfort in chest and upper abdomen
-Sudden cardiac death
Medical Management of Myocarditis
-Identify and treat underlying cause
-Bed rest
-Activity restriction until heart size and function have returned to normal
-Avoid NSAIDS
Nursing Management of Myocarditis
-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
Is the inflammation of the pericardium
Pericarditis
Clinical Manifestations of Pericarditis
-Pleuritic Chest Pain
-Pericardial Friction Rub
-Fever
-Dyspnea
-Tachycardia
Usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning
Pleuritic Chest Pain
Heard most clearly at left lower sternal border
Pericardial Friction Rub
Labs and Diagnostics of Pericarditis
-Elevated ESR
-Elevated CRP
This diagnostics measures how quickly RBCs settle at the bottom of a test tube
ESR or Erythrocyte Sedimentation Rate
What are the normal results of ESR in male and females?
Males: ≤ 15 mm/hr
Females: ≤ 20 mm/hr
Is a protein made by the liver which is sent into the blood stream in response to inflammation
C- Reactive Protein
Normal result of C-Reactive Protein
<1.0 mg/dl
Medical Management of Pericarditis
-Determine and treat underlying cause
-Analgesic Therapy
-NSAIDS- first line
PERICARDITIS DRUG
Drugs for pain relief during acute phase
Aspirin and Ibuprofen
Is contraindicated as it decreases coronary blood flow
Indomethacin
For severe pericarditis or patients unresponsive to NSAIDS
Colchicine or Prednisone
A procedure in which some pericardial fluid is removed rarely is necessary
Pericardiocentesis
Nursing Management of Pericarditis
-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
Is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise
Cardiac Tamponade
Clinical Manifestation of Cardiac Tamponade
-Chest Pain
-Tachypnea, tachycardia
-Dyspnea
-Pulsus paradoxus
Becks Triad
-Distended neck veins
-Distant heart sound
-Decreased arterial blood pressure
systolic blood pressure that is markedly lower during inhalation
Pulsus paradoxus
Confirms the diagnosis and quantify the amount of pericardial fluid
Echocardiogram
May show an enlarged cardiac silhouette due to pericardial effusion
Chest X-ray
A small opening is made in the pericardium; allowing continuous drainage of fluid into the chest cavity and into the lymphatic system
Pericardiotomy
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
Avoid NSAIDs
Patients with myocarditis are sensitive to
Digitalis
Digitalis Toxicity is evidenced by a
-the new onset of dysrhythmia
-anorexia
-nausea
-vomiting
-headache
-malaise
The first line of drug in pericarditis
NSAIDs
The diagnostics for cardiac tamponade
-Echocardiogram
-CXR
