PERICARDITIS

PERICARDITIS

Pericarditis refers to an inflammation of the pericardium, the membranous sac enveloping the heart. It may be a primary illness, or it may develop in the course of a variety of medical and surgical disorders. Pericarditis may occur after pericardectomy (opening of the pericardium) after cardiac surgery. Pericarditis may be acute or chronic. It may be classified by the layers of the pericardium becoming attached to each other (adhesive) or by what accumulates in the pericardial sac: serum (serous), pus (purulent), calcium deposits (calcific), clotting proteins (fibrinous), or blood (sanguineous).

CAUSES

The following are some of the causes underlying or associated with pericarditis:

v Idiopathic or nonspecific causes

v Infection: usually viral (e.g. Coxsackie, influenza); rarely bacterial (e.g., streptococci, staphylococci, meningococci, gonococci); and mycotic (fungal)

v Disorders of connective tissue: systemic lupus erythematosus, rheumatic fever, rheumatoid arthritis, polyarteritis

v Hypersensitivity states: immune reactions, medication reactions, serum sickness

v Disorders of adjacent structures: myocardial infarction, dissecting aneurysm, pleural and pulmonary disease (pneumonia)

v Neoplastic disease: caused by metastasis from lung cancer or breast cancer, leukemia, and primary (mesothelioma) neoplasms

v Radiation therapy

v Trauma: chest injury, cardiac surgery, cardiac catheterization, pacemaker implantation

v Renal failure and uremia

v Tuberculosis

PATHOPHYSIOLOGY

Pericarditis can lead to an accumulation of fluid in the pericardial sac (pericardial effusion) and increased pressure on the heart, leading to cardiac tamponade. Frequent or prolonged episodes of pericarditis may also lead to thickening and decreased elasticity that restricts the heart’s ability to fill properly with blood (constrictive pericarditis). The pericardium may become calcified, further restricting ventricular expansion during ventricular filling (diastole). With less filling, the ventricles pump out less blood, leading to decreased cardiac output and signs and symptoms of heart failure. Restricted diastolic filling may result in increased systemic venous pressure, causing peripheral edema and hepatic failure.

CLINICAL MANIFESTATIONS

v Chest pain

v Pain beneath the clavicle, in the neck, or in the left scapula region that worsen with deep inspiration and when lying down or turning.

v Dyspnea

v Other signs and symptoms of heart failure may occur as the result of pericardial compression due to constrictive pericarditis or cardiac tamponade.

COMPLICATIONS

v Pericardial effusion

v Cardiac tamponade

DIAGNOSTIC FINDINGS

v Echocardiogram: may detect inflammation and fluid build-up, as well as indications of heart failure, and help to confirm the diagnosis.

v ECG

MEDICAL MANAGEMENT

The objectives of management are to determine the cause, administer therapy, and be alert for cardiac tamponade.

v Analgesics and NSAIDs such as aspirin or ibuprofen

v Corticosteroids (e.g. prednisone)

v Colchicine may also be used as an alternative medication.

v Pericardiocentesis, a procedure in which some of the pericardial fluid is removed

v Pericardiectomy: surgical removal of the tough encasing pericardium may be necessary to release both ventricles from the constrictive and restrictive inflammation.

NURSING MANAGEMENT

v Monitor for possibilities of cardiac tamponade.

v Health education and reassurance that the pain is not a heart attack. To minimize complications

v Educates and assists the patient with activity restrictions until the pain subside

v Encourage gradual increases of activity.

v Monitor the patient for heart failure.

NURSING PROCESS:

THE PATIENT WITH PERICARDITIS

Assessment

v History taking

v Assess by observing and evaluating the patient in various positions.

v Auscultate for pericardial friction rub However, it may be elusive and difficult to detect.

Diagnosis

Based on the assessment data, the major nursing diagnosis of the patient may include:

v Acute pain related to inflammation of the pericardium

Planning and Goals

The patient’s major goals may include:

v Relief of pain

v Absence of complications.

Nursing Interventions

v Encourage adequate rest.

v Place the patient in a comfortable position.

v Instruct the patient to restrict activity until the pain subsides.

v Administer prescribed analgesic

v Monitor for signs of complications

v Reassure patient and significant others

Evaluation

Expected patient outcomes may include:

1.     Is free of pain

a.   Performs activities of daily living without pain, fatigue, or shortness of breath

b.  Temperature returns to normal range

c.   Exhibits no pericardial friction rub

2.     Absence of complications

a.   Sustains blood pressure in normal range

b.  Has heart sounds that are strong and can be auscultated

c.   Shows absence of neck vein distention

REFERENCES

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