Pericarditis Flashcards
Explain the clinical manifestations that can occur with pericarditis.
- What kind of pain and where?
- Pain is generally worse with?
- Relieved by?
- Pain may radiate to?
Progressive, frequently severe, sharp chest pain!!!!
The pain is generally worse with deep inspiration and when lying flat.
It is relieved by sitting up and leaning forward.
The pain may radiate to the neck, arms, or left shoulder, making it difficult to differentiate from angina
One distinction that the pain is from Pericarditis?
Why does dysapnea happen with acute pericarditis?
Dysapnea may be aggravated by?
One distinction is that the pain from pericarditis
can be referred to the trapezius muscle (shoulder, upper back).
Happend due to the patient’s need to breathe in rapid, shallow breaths to avoid chest pain.
Dyspnea may be aggravated by fever and anxiety.
What is the hallmark finding in Acute Pericarditis?
What does the rub sound like?
How to best hear it?
Pericardial friction rub!!
Scratching, grating, high-pitched sound resulting from friction between pericardium and epicardium
Stethoscope placed at the lower left sternal border and patient leaning forward
How do you tell the difference between Pericardial Friction rub and pleural friction rub?
Ask the patient to hold their breath, if you still hear the rub then it is cardiac
What is a pericardial effusion and why does it occur with pericarditis?
Build-up of fluid in the pericardium
When the pericardium is inflamed, it can cause fluid to accumulate around the heart
Why does Pericarditis cause cough, dysapnea, and tachypnea?
Why does it cause hiccups?
Why does it cause hoarsness?
Pulmonary tissue compression
Phrenic nerve compression can cause hiccups
Compression of the laryngeal nerve can cause hoarsness
- Cardiac tamponade happens as a result of?
- What affects severity of manifestations?
- Patient with cardiac tamponade may report and are often?
Pericardial effusion increasing in volume 20-50ml
Speed of accumalation affects severity of manifestations
Chest pain and are often confused, anxious, and restless
- Cardiac tamponade: what increases and what decreases?
- There is also?
- Becks Triad?
As the compression of the heart increases, cardiac output decreases.
There is also hypotension, jugular neck vein distention, and muffled heart sounds (Beck’s Triad)
Narrowed pulse pressure
Weak, peripheral pulses
Tachypnea and tachycardia
What is exaggerated during cardiac tamponade?
In a patient with a slow onset of a cardiac tamponade what may be the only symptom?
Pulsus paradoxus: a decrease in systolic BP during inspiration
Dyspnea!!!
Explain the significance of the different diagnostic tests associated with pericarditis.
Echo?
EKG?
Chest x-ray?
CT and MRI?
Echocardiogram - Detects inflammation and fluid buildup as well as indications for heart failure and helps to confirm the diagnosis
EKG: ST segment elevation, reflects the abnormal repolarization (resting after heart contraction) that develops after pericardial inflammation
Chest X-ray: Cardiomegaly may be seen in a patient who has a large pericardial effusion
CT scan and MRI - visualization of the pericardium and the pericardial space
Pericarditis Lab changes
WBC?
ESR?
CRP?
Troponin?
ELEVATED
Troponin may be elavated, indicates heart muscle damage.
What is Beck’s triad?
Narrowed pulse pressure
Weak, peripheral pulses
Tachypnea and tachycardia
What is pulsus paradoxus?
A decrease in systolic BP during inspiration
What meds are given for pain and inflammation?
4
NSAIDs
Salicylates [aspirin]
Ibuprofen (Motrin)
Naproxen (Aleve)
Why are corticosteroids given for pericarditis?
generally reserved for patients with? 3
They are antinflammatory
Pericarditis secondary to lupus
Patients already taking corticosteroids for
rheumatologic or other autoimmune conditions
Patients who do not respond to NSAIDs
Explain 3 reasons why a pericardiocentesis would be performed.
It is to remove fluid from the pericardial sac
Pericardial effusion with acute cardiac tamponade
Purulent pericarditis
Suspected cancer
What are complications that could occur with a pericardiocentesis?
There are two that I have emphasized in class that are not in the notes.
Dysrhythmias
Cardiac tamponade
Pneumothorax
Myocardial laceration
Coronary artery laceration
Lungs can be punctured and anything can happen to the heart
Explain why a pericardiectomy and a pericardial window would be performed.
To help relieve pressure on the heart.
Pericardiectomy: The entire pericardium is removed if the problem is severe and long-term (like chronic inflammation or scarring).
Pericardial Window: A small part of the pericardium is removed to let fluid drain out and prevent buildup.
