Pericarditis

Disorders of the Pericardium

Acute Pericarditis Pericardial Effusion Cardiac Tamponade
Constrictive Pericarditis

Acute Pericarditis
Is a syndrome that is caused by inflammation of the parietal and visceral pericardium.

Pericardial Effusion
Acute pericarditis with effusion results when fluid accumulates within the pericardial sac.

Cardiac Tamponade
Cardiac tamponade is the compression of the heart as a result of fluid within the pericardial sac.

Constrictive Pericarditis
In constrictive pericarditis, scar tissue develops between visceral and parietal layers of the serous pericardium.

Clinical Manifestations
Chest pain Friction rub WBC Mild fever ECG changes

DIAGNOSTICS
Auscultation Chest Radiology ECG

TREATMENT
Treatment depends on the cause. ANALGESICS and NSAIDs CORTICOSTEROID ANTIBIOTIC PERICARDIOCENTESIS SURGICAL TREATMENT

Nursing Management
Positioning Psychological support Minimize complications Monitor for heart failure

Nursing Diagnosis
Acute pain related to inflammation of the pericardium. Goal: The patients major goal may include relief of pain and absence of complications

Nursing Intervention
Relief of pain by having the patients rest
Instruct patient to restrict activity until the pain subsides

Cardiac Tamponade
Cardiac tamponade also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium (the sac in which the heart is enclosed).

Cardiac tamponade occurs when the pericardial space fills up with fluid faster than the pericardial sac can stretch. If the amount of fluid increases slowly the pericardial sac can expand to contain a liter or more of fluid prior to tamponade occurring. If the fluid occurs rapidly (as may occur after trauma or myocardial rupture) as little as 100 ml can cause tamponade.

Pathophysiology

The outer pericardium is made of fibrous tissue which does not easily stretch, and so once fluid begins to enter the pericardial space, pressure starts to increase.

If fluid continues to accumulate, then with each successive diastolic period, less and less blood enters the ventricles, as the increasing pressure presses on the heart and forces the septum to bend into the left ventricle, leading to decreased stroke volume. This causes obstructive shock to develop, and if left untreated then cardiac arrest may occur (in which case the presenting rhythm is likely to be pulseless electrical activity)

Clinical Manifestations
Falling systolic BP Rising venous pressure Distant heart sounds

Diagnostics
Echocardiography, which is the diagnostic test of choice. Chest X-ray are usually sufficient to diagnose pericardial effusion.

Treatment
Administration of oxygen Thoracotomy Pericardiocentesis