Pericarditis Flashcards
What is the pericardial space?
- Space between visceral and parietal layers of the pericardium
- contains fluid
- 10-25mL of serous fluid
- provides lubrication to prevent friction during contractions
Pericarditis manifestations?
- progressive, frequently severe, sharp chest pain
- pain is worse with deep inspiration when lying flat
- relieved when sitting up and leaning forward
- dyspnea: patient has rapid shallow breaths to avoid pain
- pain can radiate to neck, arms, or left shoulder
- pain is refered to trapezius muscle (shoulder/upper back)
- pericardial friction rub
- due to roughened surfaces (not enough serous fluid)
How can a pericardial friction rub be heard?
- best heard lower left sternal border with patient leaning forward
- if sound is heard while patient is holding breath, it’s cardiac
- often intermittent and short-lived (may need multiple attempts)
sounds like scratching, grating, high pitched sound
What is pericardial effusion?
When there is more fluid in the pericardial space than there should be.
What can pericardial effusion cause?
- pulmonary tissue compression
- cough, dyspnea, tachypnea
- phrenic nerve compression
- hiccups
- laryngeal nerve compression
- hoarseness
- muffled and distant heart sounds
More fluid in sac puts pressure on chambers and outwardly (ex: lungs)
What is the physiologic rationale of a person with pericarditis and the person has hiccups?
How are other body systems affected by pericardial effusion?
- More and more fluid in that pericardial sac
- Think about what’s happening in the chambers in the heart
- The chambers are getting smaller
- Decreased capacity in the chambers, decreased CO, decreased blood flow and O2 to tissues, now rest of body is going to dysfunction
What is cardiac tamponade?
- Cardiac tamponade happens as a result of pericardial effusion
- A really bad pericardial effusion (even MORE fluid)
What are the clinical manifestations of cardiac tamponade?
- chest pain
- confused, anxious, restless
- due to lack of O2 to the brain
- decreased CO (<5L/min)
- Beck’s Triad: hypotension, jugular neck distention, muffled heart sounds
- narrowed pulse pressure (lower than normal)
- weak peripheral pulses
- decreased CO leads to decreased blood flow
- tachypnea
- avoid pain when breathing in
- tachycardia
- body’s attempt to raise CO
- pulsus paradoxus - decreased SBP during inspiration
What can be used to diagnose pericarditis?
- echocardiogram
- EKG
- Chest X-Ray
- CT scan and MRI
- Laboratory Tests
How is an echocardiogram used on a patient with pericarditis?
- detects inflammation and fluid build up
- shows indications of heart failure
helps confirm diagnosis
What would an EKG show on a patient with pericarditis?
- ST segment elevation
- abnormal repolarization (secondary to pericardial inflammation)
- PR segment depression
- T wave inversion
painless, uses electricity already in the body
What would an X-Ray show on a patient with pericarditis?
cardiomegaly
How does CT Scan and MRI work on a patient with pericarditis?
visualizes the pericardium and pericardial space
What would be the lab results on a patient who has pericarditis?
- WBC - leukocytosis
- ESR - elevated
- during inflammation, cells drop faster
- CRP - elevated
- rise with inflammation
- Troponin levels - elevated
- indicate heart muscle damage
What meds are used to control pain and inflammation?
- NSAIDs
- Salicylates (Aspirin)
- Ibprofen (Motrin)
- Naproxen (Aleve)
Why can corticosteroids be given for pericarditis?
- they are anti-inflammatory
- not first choice due to long-term side effects
When are corticosteroids given for pericarditis?
- pericarditis secondary to systemic lupus erythematosus
- patient is already taking corticosteroids
- NSAIDs were ineffective
Why would a pericardiocentesis be performed?
- pericardial effusion with cardiac tamponade
- purulent pericarditis (pus in pericardial space)
- suspected cancer
What is the purpose of pericardiocentesis?
remove excess liquid from pericardial sac
What are complications that could occur with a pericardiocentesis?
- lungs can be punctured
- anything can happen to the integrity or function of the heart
Explain why a pericardiectomy and a pericardial window would be performed.
- recurrent tamponade or effusion
- constrictive pericarditis (thickened and scarred pericardium)
- adhesions from chronic pericarditis
portion (window) or all (pericardiectomy) of pericardium is removed
