Pericarditis Flashcards
layers of the pericardium
________ pericardium:
- visceral layer/epicardium (inner layer)
- parietal layer (outer layer)
- the space in between these two is the _________
_______ pericardium:
the outside covering of the heart (what you would see when looking at the heart)
serous pericardium:
- visceral layer/epicardium (inner layer)
- parietal layer (outer layer)
- the space in between these two is the pericardial space
fibrous pericardium:
the outside covering of the heart (what you would see when looking at the heart)
pericarditis
inflammation of the pericardium
causes of pericarditis (3)
- idiopathic
- post MI
- acutes exacerbations of systemic connective tissue diseases such as RA & SLE
clinical manifestations of pericarditis
- location of pain = __________ that radiates to ______ side of neck, shoulder, and/or back
- quality = _______ and ________ (hard to catch breath)
- aggravated by ________ (__________ usually), coughing, & swallowing
- exacerbated when ______ position and relieved when __________ or _________ position
- substernal or left precordial pain that radiates to left side of neck, shoulder, and/or back
- grating & oppressive (hard to catch breath)
- aggravated by breathing (inspiration usually), coughing, & swallowing
- exacerbated when supine, relieved by sitting up/leaning over
hallmark finding of pericarditis
pericardial friction rub
T/F
Nitroglycerin decreases pain associated with pericarditis.
False.
No effect because there is no vessel involvement with pericarditis.
Where is a pericardial friction rub best heard when listening with a stethoscope?
lower left sternal border
have patient hold their breath (eliminates breath sounds that could interfere, especially when trying to distinguish between pericardial or pleural friction rub)
patient should lean forward (brings heart closer to chest wall)
complications of pericarditis (2)
pericardial effusion
tamponade
clinical manifestations of a pericardial effusion (4)
cough
tachypnea
dyspnea
distant/muffled heart sounds
clinical manifestations of cardiac tamponade (9)
think:
breathing
pain
2 unique
sounds
dyspnea
chest pain
restless
anxious
↓ CO
marked JVD
muffled heart sounds
narrowed pulse pressure
pulsus paradoxus
___________ - build up of fluid in pericardium
______ - build up of fluid in pleural space
_________ - pericardial effusion increases in volume
pericardial effusion - build up of fluid in pericardium
pleural effusion - build up of fluid in pleural space
cardiac tamponade - pericardial effusion increases in volume
pulse pressure = ____ - ______
SBP - DBP
pulsus paradoxus is when
SBP 10 mm Hg or more higher on __________ than __________
OR
SBP 10 mm Hg or more lower on _______ than __________
SBP 10 mm Hg or more higher on expiration than inspiration
OR
SBP 10 mm Hg or more lower on inspiration than expiration
how to perform pulsus paradoxus (seasoned clinician)
- inflate cuff beyond ______ blood pressure
- deflate cuff gradually & note when sounds are first audible on ________ only
- id when sounds audible on ________ AND________
- > ____ mm Hg, indication of pulsus paradoxus
- inflate cuff beyond palpable blood pressure
- deflate cuff gradually & note when sounds are first audible on expiration only
- id when sounds audible on inspiration AND expiration
- > 10 mm Hg, indication of pulsus paradoxus
diagnostic tests of pericarditis (2)
and
(3) labs:
____ WBC, ____ ESR, ____ CRP
EKG changes (90% of time) - diffuse widespread ST elevation (not just in "2 contiguous leads" - but in many leads)
Echocardiogram
- determine if complications of either pericardial effusion or cardiac tamponade have occurred
Labs
- ↑ WBC, ↑ ESR, ↑ CRP
collaborative care of pericarditis
-bedrest?
- HOB ____ degrees; anxiety reduction
-Abx if bacterial pericarditis
-NSAIDS for inflammation =
naproxem
high dose ibuprofen
colchicine for _______ pericarditis
-prednisone taper (only if ________)
-pericardiocentesis
-bedrest with HOB 45 degrees; anxiety reduction
-Abx if bacterial pericarditis
-NSAIDS for inflammation
naproxem
high dose ibuprofen
colchicine for recurrent pericarditis
-prednisone taper (only if NSAIDS ineffective)
-pericardiocentesis
treatment for tamponade
removal of 5-10 ml
may ↑ SV by 25-50%
pericardiocentesis
removal of 5-10 ml may ↑ SV by 25-50%
EKG changes for which condition - MI vs pericarditis
- diffuse/widespread ST elevation = location is more widespread
- ST elevation in 2 contiguous leads or more = location is more specific
pericarditis
MI
________– can allow us to see pericardial effusion
Echo
concern with pericardial effusion and cardiac tamponade = heart gets ___________ , cant contract and release adequately = _____ CO
concern with pericardial effusion and cardiac tamponade = heart gets squished by fluid , cant contract and release adequately = low CO
MI pain vs pericarditis pain:
- Onset
- ____________ = sudden
- _____________ = gradual - Location
- __________ = substernal or left precordial, or certain zones of radiation
- ___________ = substernal or left precordial - Radiation
- _________ = shoulders, arms, neck, jaw, back, trapezius ridges
- _________ = shoulders, arms, neck, jaw, back, NOT trapezius ridges
- Onset
- pericarditis pain = sudden
- MI related pain (ischemia) = gradual - Location
- MI related pain (ischemia) = substernal or left precordial, or certain zones of radiation
- pericarditis pain = substernal or left precordial - Radiation
- pericarditis pain = shoulders, arms, neck, jaw, back, trapezius ridges
- MI related pain (ischemia) = shoulders, arms, neck, jaw, back, NOT trapezius ridges
MI pain vs pericarditis pain:
- Quality
- _______ = heavy pressure on chest or burning
- _______ = sharp, stabbing, aching, dull, oppressive - Inspiration
- _______ = has no effect
- ________ = makes it worse - Duration
- _________ = persistent, may wax and wane
- __________ = intermittent, <30 min events, longer for unstable angina
- Quality
- MI related pain (ischemia) = heavy pressure on chest or burning
- pericarditis pain = sharp, stabbing, aching, dull, oppressive - Inspiration
- MI related pain (ischemia) = has no effect
- pericarditis pain = makes it worse - Duration
- pericarditis pain = persistent, may wax and wane
- MI related pain (ischemia) = intermittent, <30 min events, longer for unstable angina
MI pain vs pericarditis pain:
1. Body movements
-________ = increases pain
- _______ = has no effect
2.Posture
- ________ = worse on recumbency/supine, better when sitting/leaning forward
- _________ = no effect
- Nitroglycerin (vasodilation)
- _________ = no effect
- _________ = usually provides relief
- Body movements
- pericarditis pain = increases pain
- MI related pain (ischemia) = has no effect
2.Posture
- pericarditis pain = worse on recumbency/supine, better when sitting/leaning forward
- MI related pain (ischemia) = no effect
- Nitroglycerin (vasodilation)
- pericarditis pain = no effect
- MI related pain (ischemia) = usually provides relief
pericarditis pain - PRQST
- ______: aggravated by breathing (mainly inspiration), coughing, swallowing, supine. Relieved by sitting up/leaning forward (minimizes stretch on pericardium)
- ______: Substernal, precordial – radiates to the left side of the neck/shoulder/back
- _______: Typically grating and oppressive (cant catch breath)
- P
- R
- Q
Precipitating/provactive events (What precipitated?), palliatative (what makes it better)
Quality of pain (Feel like? Ache? Squeeze? etc)
Radiation of pain (Where is the pain?)
Severity of pain (1-10 scale)
Timing (When did it begin?, how long does it last, is it constant or intermittent?)
