Pericarditis (Exam 1) Flashcards
Pericarditis
Inflammation of the heart covering
What do you hear with pericarditis?
Pericardial friction rub
Pericardium
Fibrous outside of the heart
What are the layers of the pericardium? What is in between them?
Parietal (outer) and Visceral (inner)
Pericardial sack between them
Who gets pericarditis?
Most often idiopathic - with a variety of suspected infective organisms
Post-myocardial infarction
Acute exacerbations of systemic connective tissue disease
(RA - lupus)
Pericarditis Clinical Manifestations: Pain
-Substernal - Precordial radiates to left side of neck / shoulder / back
-Typically grating and oppressive
-Worse by breathing (inspiration), coughing, swallowing. Laying supine
Pericarditis Pain is relieved by
Sitting up and leaning forward (helping minimize stretch)
Pericarditis Pain is aggravated by
Breathing (inspiration), coughing, swallowing
Laying supine
Pericarditis vs MI: Pain Onest
Pericarditis = Most often sudden substernal or left precordial
MI = Gradual - Crescendo. Same or confined to zones of radiation
Pericarditis vs MI: Pain Quality
Peri = Sharp - Stabbing: Background ache or dull and oppressive
MI = Heavy - Pressure - Burning
Pericarditis vs MI: Pain Duration
Peri = Persistent: may wax and wane
MI = Intermittent <30 min each recurrence. Longer for unstable angina
Pericarditis vs MI: Pain Body movements and posture
Peri = Increased pain with body movements. Worse on recumbency, improved on sitting, learning forward
MI = No effect
Pericarditis vs MI: Pain Nitro
Pericarditis = No effect
MI = Relief (usually)
What is the hallmark finding of pericarditis?
Pericardial Friction Rub
Where / How is pericardial friction rub best heard?
Place stethoscope at lower LSB
Patient lean forward; hold breath prn
Two complications of pericarditis
- Pericardial Effusion
- Cardiac Tamponade
Pericardial Effusion
Complication of Pericarditis
(collection of fluid surrounding heart)
-Build up of fluid in pericardium
Someone with pericardial effusion may have
Cough
Tachypnea
Dyspnea
Distant / Muffled Heart Sound
What the big deal with a pericardial effusion?
Heart begins to get squished and can not contract and squeeze
Decrease CO
Cardiac Tamponade
-Develops as pericardial effusion increases in volume
Someone with Cardiac Tamponade may have
Dyspnea
Chest Pain
Restless and anxious
Decrease CO
JVD (RSHF)
Muffled heart sounds
Narrowed pulse pressure
Pulsus paradoxus
Classic Signs of Cardiac Tamponade
Narrow pulse pressure
Pulsus Paradoxus (most classic)
Narrow Pulse Pressure
Systolic minus diastolic
This number will narrow
Pulsus Paradoxus
Systolic BP 10 mm Hg (or more) higher on expiration than on inspiration.
Or may be defined as Systolic 10 mm Hg (or more) lower on inspiration than expiration
How to perform Pulsus paradoxus
Inflate BP cuff beyond palpable blood pressure
Deflate cuff gradually and note when sounds are first audible on expiration only
Then identify when sounds audible on both inspiration and expiration
If that number is greater than 10 mm Hg - indicates tamponade
Pericarditis: Diagnostic Test
EKG changes (90%) of time
Echocardiogram
Labs
Pericarditis EKG changes
Diffuse / widespread ST elevation (all leads)
AMI = 2
Why is echocardiogram done with pericarditis?
To determine if complication of either effusion or tamponade
Pericarditis vs MI: EKG
Pericarditis
-Diffuse widespread ST elevation
MI
2 or more contiguous leads
Labs associated with pericarditis
Increase WBC
Increase ESR (chronic inflammation)
Increase CRP (acute inflammation)
Collaborative Care: Pericarditis
Bedrest w HOB 45%
Antibiotics if bacterial pericarditis
NSAIDS (treat itis)
-naproxen
-high dose ibuprofen
-colchicine for recurrent pericarditis
Prednisone taper (only if NSAIDS do not work)
Pericardiocentesis
Pericardiocentesis removal of 5-10 ml may increase SV by
25-50%
Hallmark treatment of pericarditis
NSAIDS
naproxen
high dose ibuprofen
colchicine
