PERICARDITIS

FAMADOR O. GENALDO, RN, MD

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Characteristics
Pericarditis is inflammation of the
pericardium, the membranous
sac enveloping the heart
It is often a manifestation of a
more generalized disease
Pericardial effusion is an
outpouring of fluid into the
pericardial cavity seen in
pericarditis

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Constrictive pericarditis is a
condition in which a chronic
inflammatory thickening of the
pericardium compresses the
heart so it is unable to fill
normally during diastole

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Pathophysiology and
Etiology

Acute idiopathic pericarditis is the

most common and typical form

Etiology is unknown

Other causes:
Infection:

Viral: influenza
Bacterial: staphylococcal,
streptococcal
Fungal
Parasitic
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Connective tissue disorders: SLE,

periarteritis nodosa
Myocardial infarction:

Early: 24-72 hours

Late: 1 week to 2 years after MI
(Dresslers Syndrome)

Malignant diseases: thoracic

irradiation
Chest trauma, heart surgery,
including pace maker implantation
Drug induced: procainamide
(Pronestyl), phenytoin (Dilantin)

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Classifications:
a. Layers of pericardium being
attached to each other
(adhesive)
b. What accumulates in the
pericardial sac
- serous (serum)
- purulent (pus)
- calcific (calcium deposits)
- fibrinous (clotting proteins)
- sanguinous (blood)
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Clinical Manifestations

Pain in anterior chest,

aggravated by thoracic motion
May vary from mild to sharp and
severe
Located in precordial area (may be
felt beneath clavicle, neck, scapular
region)
May be relieved by leaning forward
Worsens with deep inspiration and
when lying down or turning

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Pericardial friction rub

Scratchy, granting, or creaking

sound occurring in the presence of
pericardial inflammation

Dyspnea: from compression of

the heart and surrounding
thoracic structures
Fever, sweating, chills: due to
inflammation of the pericardium
Dysrhythmias
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Diagnostic Evaluation
Echocardiogram: most sensitive
method for detecting pericardial
effusion
Chest xray: may show
cardiomegaly
ECG: to evaluate for myocardial
infarction
WBC and differential elevations
indicating infection

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Antinuclear antibody serologic

tests elevated in SLE
PPD test positive in TB
ASO titers elevated if rheumatic
fever is present
Pericardiocentesis: for
examination of pericardial fluid
for etiologic diagnosis
BUN: to evaluate for uremia

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Medical Management
Objectives of treatment are
targeted toward:
Determining the etiology of the
problem
Administering pharmacologic
therapy for specified etiology,
when known
Being alert to the possible
complication of cardiac
tamponade
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Bacterial pericarditis: Penicillin G

or other antimicrobial agents
Rheumatic fever: Penicillin G or
other antimicrobial agents
Tuberculosis: anti-tuberculosis
chemotherapy
Fungal pericarditis: Amphotericin
B and fluconazole

SLE: steroids
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Renal pericarditis: dialysis,

indomethacin (Indocin),
biochemical control of end stage
renal disease
Neoplastic disease: intrapericardial instillation of
chemotherapy, radiotherapy
Post-myocardial infarction
syndrome: bed rest, aspirin,
prednisone

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Emergency pericardiocentesis if
cardiac tamponade develops
Partial pericadiectomy
(pericardial window) or total
pericardiectomy for recurrent
constrictive pericarditis

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Complications
Cardiac tamponade
Congestive heart failure
Hemopericardium

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Nursing Management
Nursing Diagnosis
Chest Pain related to pericardial
inflammation
Decreased Cardiac Output
related to impaired ventricular
expansion

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Nursing Interventions
Reducing Discomfort
Give prescribed drug regimen for
pain and symptomatic relief

NSAIDs suppress inflammatory

symptoms of acute pericarditis
Corticosteroids for more severe
symptoms

Relieve anxiety of the client and

family by explaining the difference
between pain of pericarditis and
pain of recurrent myocardial
infarction
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Encourage the client to remain

on bed rest when chest pain,
fever, and friction rub occur
Assist client to position of
comfort

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Maintaining Cardiac Output

Assess CR, rhythm, BP, RR hourly
in the acute phase
Assess for signs of cardiac
tamponade: increased HR,
decreased BP, presence of
paradoxical pulse, distended
neck veins, restlessness, muffled
heart sounds

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Prepare for emergency

pericardiocentesis or surgery

Keep pericardiocentesis tray at bed

side

Assess for signs of CHF

Monitor closely for the
development of dysrhythmias

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Client Education and Health

Maintenance
Teach the client the etiology of
pericarditis
Instruct client about signs and
symptoms of pericarditis and the
need for long term medication
therapy to help relieve the
symptoms
Review all medications with the
client: purpose, side effects, dosage35
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Thank You

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