BSC NURSING
MEDICAL SURGICAL NURSING -I
UNIT V – DISORDERS OF THE
CARDIO VASCULAR SYSTEM
PERICARDITIS
Objectives
Define pericarditis
Classify the types of pericarditis
Describe the etiology, risk factors, clinical
manifestations, diagnostic criteria of pericarditis
Explain the pathophysiology of pericarditis
Enumerate the complications of pericarditis
Describe the management of pericarditis
Introduction
• Pericardium is a thin fibroelastic sac composed of two
layers that seperates the heart from the surrounding
mediastinal structures.
• The functions of the pericardium is maintenance of cardiac
position within the chest and as a barrier to infection and
inflammation.
Definition
It is an acute inflammation of the pericardium
results in visceral and parietal layers of the pericardium
characterised by chest pain, pericardial friction rub,
changes in ECG, rarely pericardial effusion.
Etiology
C-Collagen vascular disease
A-Aortic aneurysm
R-Radiation
D- Drugs such as hydralazine
I- Infections
Etiology
A-Acute renal failure
C- Cardiac infarction
R- Rheumatic fever
I-Injury
N-Neoplasms
D-Dresslers syndrome
ETIOLOGY:
Acute idiopathic disease
Infections
Connective tissue disease
Collagen disease
Acute rheumatic fever
Post open heart surgery
Bleeding into the pericardium
Post MI
• MISCELLANEOUS:
Drugs & vaccinations
Neoplasms
Radiation therapy
Chronic renal failure
Uremia
Sarcoidosis
Amyloidosis
Myxoedema
Types of pericarditis
Idiopathic pericarditis
Viral pericarditis- coxsackie virus B
Purulent pericarditis- pneumonia
Tuberculous pericarditis- pulmonary TB
Uremic and Dialysis associated pericarditis
Pericarditis following MI
Dressler’s syndrome
Malignancy
Traumatic pericarditis- sharp blunt post ablation procedures
TYPES BASED ON THE DURATION OF MI
INCIDENCE: Following cardiac surgery 10% to 40%
• ACUTE PERICARDITIS • LATE PERICARDITIS
• Occur with in the initial • Which appears 4 to 6
48 to 72 hours after MI weeks after MI.
ACUTE PERICARDITIS
DEFINITION:
Inflammation of the pericardial sac enveloping
the heart, which occurs on an acute basis.
Pathophysiology
Etiological factors
↓
Influx of neutrophils and other chemical mediators
↓
Change the permeability of pericardial vascularity
↓
Pericardial inflammation and edema
↓
Restriction of heart motion and pain with breathing
CLINICAL MANIFESTATION:
Chest pain: sharp & pleuritic in nature
Worse in deep inspiration, may radiate to neck, arms
& shoulders near trapezius muscle.
Rapid & shallow breaths
• Fever, sweating & chills, Malaise & Myalgias
• Dysrhythmias, Restlessness
• HALLMARK FINDING- PERICARDIAL FRICTION
RUB Rub is scratching, grating, high pitched sound
believed to arise from friction between the
roughened pericardial & epicardial surface.
CONSTRICTIVE PERICARDITIS
DEFINITION:
It is characterized by a thickening and fibrosed
pericardium which impairs ventricular filling by
impeding diastolic relaxation and results in elevated
heart pressures
- GOLDSTEIN, 2004.
PATHOPHYSIOLOGY:
Begins in acute pericarditis with pericardial effusion
↓
Effusion slowly progresses to the subacute phase of
reabsorption followed by chronic inflammation
FIBROSIS SCARRING
THICKENING OF THE PERICARDIUM
↓
Closure of pericardial space
Fusion of the layers
↓
Rigidity & Inelasticty which reduces the filling of heart chambers
Decreased cardiac output HEART FAILURE
Clinical manifestations
Severe sharp retrosternal chest pain often radiates to neck, shoulder,
back
High pitched friction rub
Cardiac tamponade
Dry cough
Ankle, feet and leg swelling (occasionally)
Anxiety
Muffled or heart sounds
Fatigue if severe-rales, breath sounds
Fever
Diagnostic evaluation
History collection
Physical examination muffled heart sounds
Chest x ray –Cardiomegaly
ECG- ST depression
ECHO- Regional wall motion abnormalities
CT,MRI- Thickness and effusion of pericardial space
COMPLICATION:
PERICARDIAL EFFUSION
CARDIAC TAMPONADE
HEART FAILURE
HEMOPERCARDIUM
Complications
Pericardial effusion – Fluid
collection in the
pericardial space more
than 50 ml
Complications
• Cardiac tamponade:
Compression of the heart
caused by fluid collecting
in the sac surrounding the
heart.
Medical management
• Combination of colchicine and NSAID’s
such as Ibubrufen 600 mg + Indomethacin 50 mg 8 hrly
• High dose salicylates (Aspirin) can be given
• Corticosteroids
• Antibiotics: penicillin, penicillin G &
• anti tuberculosis chemo therapy
• Antifungal
Non Surgical: Percutaneous Intervention
Pericardiocentesis is a procedure
done to remove fluid from
pericardium using a needle and
small catheter to drain excess fluid
by percutaneous approach guided
by ECG & echocardiogram to
remove fluid for analysis and to
relieve cardiac pressure.
Surgical management
Peri cardiectomy- It is the
surgical removal of part or
most of the pericardium
through a median sternotomy
with use of cardiopulmonary
bypass.
Total/ Complete to relieve
constrictive pericarditis
Partial (pericardial window)
resection of the pericardium
Nursing management
Rest: to reduce inflammatory process & pain
Adequate fluid & electrolyte input
Reducing fever
Assess the vital signs, CVP & ECG
Amount quality & location of pain
Close observation & monitoring of respiratory
function
Avoid alcoholic beverages Misoprostal can be given
to protect the gastric mucosa
Anxiety reducing measures
Nursing management
The nurse monitors the patients temperature
Heart sounds assessed (A new or worsening
murmur may indicate dehiscence of a prosthetic valve,
rupture of an abscess or injury to valve leaflet)
The nurse monitors for signs and symptoms of
complications
Nursing management (contd)
After discharge the nurse supervises and monitors IV
Antibiotics therapy delivered in the home setting and
educates the patient and family about prevention and
health promotion
The nurse provides the patient and family with emotional
support and facilitates coping strategies during the
prolonged course of the infection and antibiotic
treatment.
Nursing process
ASSESSEMENT
Subjective and objective data from patient
Assess for pericardial friction rub
Assess for pain
Assess for ECG changes
General assessment for typical signs and symptoms.
Nursing diagnosis
1.Acute chest pain related to fluid built up in the
pericardial space
Assess the level of pain
Provide comfort and rest
Administer antipyretics according to physicians order
such as aspirin or non steroidal anti inflammatory drugs
Reduce physical activity to decrease cardiac workload
2. Decreased cardiac output related to fluid
overload in pericardium as manifested by
pericardial friction rub tachycardia
Auscultate heart sound, rate and rhythm
Monitor hemodynamic status of the patient.
Assess capillary refill, skin colour and temperature.
Assess for jugular venous distention.
Provide oxygen therapy to increase oxygen to promote comfort
by relieving hypoxemia.
Administer diuretics according to order.
Assess for blood pressure
3. Activity intolerance related to generalized
weakness and alteration in oxygen transport
secondary to pericardial effusion
Monitor vital signs during activity to evaluate cardiac
response
Monitor for signs of activity intolerance
Reduce activity if systolic blood pressure goes down
Plan rest periods between activities to reduce cardiac
workload.
PERICARDITIS
References
Suzanne C , Brenda G. Textbook of Medical Surgical
Nursing,2003;9
Black J M, Hawks J H . Medical surgical Nursing,2005;7
Woods S L .Cardiac nursing,1995;3;847-850
www.medicalcriteria.com
www.wikipedia.com
www.emedicine.medscape.com
