Telemetry Preceptorship Course

Pericarditis Pericarditis & &

Cardiac Cardiac TamponadeTamponade

Natalie Bermudez, RN, BSN, MS Clinical Educator for Telemetry

What is Pericarditis?What is Pericarditis?

• Inflammation of the pericardial sac

FactsFacts• More common in men

• Occurs between the ages of 20 to 50 years

EtiologyEtiology• Most common cause is viral illness• AMI• Bacterial infection

– Stab wounds, pneumonia, endocarditis, sepsis, surgical contamination

• Medications• Pericardial Neoplasm (very rare)• Uremia and/or renal failure• Idiopathic

– Relatively common in developing countries– Turns out to be viral in nature

Associated Viral CausesAssociated Viral Causes

• Coxsackie A & B• Echovirus• Hepatitis B• HIV• Influenza• Mononucleosis• Mumps• Varicella

Pericarditis & AMIPericarditis & AMI• If occurs within 2 – 7 days following an

AMI– Considered a pericardial inflammatory response

to the underlying AMI

• Dressler Syndrome– Autoimmune response to myocardial necrosis

involving both the pleura and the pericardium– May occur 2 weeks to several months after the

event

Pericarditis & MedicationsPericarditis & Medications

• Medications that produce pericarditis symptoms in patients with SLE– Pronestyl (procainamide)– Apresoline (hydralazine)– INH (ioniazid)

Clinical PresentationClinical Presentation• May mimic AMI

– Chest pain & ST-segment elevation

• Chest pain w/ pericarditis– Pleuritic in nature; worsens with inspiration– Relief obtained by sitting upright and leaning

forward

• Fever may be present or antecedent• Dyspnea, SOB, cough• Chills• Weakness

Differentiating Chest PainDifferentiating Chest Pain

Pericarditis• Pain is often sharp,

piercing• Located between the

neck and shoulder• Dyspnea unrelated to

exertion• Pericardial friction rub

Acute MI• Pain is described as

pressure• Dyspnea related to

exertion• Pain is in the chest and

may sometimes radiate

Diagnostic TestsDiagnostic Tests12-Lead EKG• Most definitive test in acute pericarditis• ST-segment elevation in most leads except

V1 and AVR• No reciprocal changes or inverted T’s• PR segment depressed• Electrical alternans

– QRS varies from beat to beat

• Atrial dysrhythmias common

Diagnostic TestsDiagnostic TestsChest X-Ray

• Cardiac silhouette enlarged– If more than 250 ml is present

Diagnostic TestsDiagnostic TestsEchocardiogram

• Evaluates hemodynamic changes associated with cardiac tamponade

Transesophageal Echocardiogram (TEE)

• Helpful in evaluating the size of an effusion and compromised ventricular filling

Diagnostic TestsDiagnostic TestsLabs• Erhythrocyte Sedimentation Rate (ESR) &

Complete Blood Count (CBC)– Non-specific elevation

• Cardiac Profile (CK-MB, troponins)– Rule out AMI

• PPD, HIV-AIDS screening• Rheumatoid factors (RF), Antinuclear

Antibodies (ANA)• CT scan – locate neoplastic lesions

Clinical ManagementClinical ManagementUncomplicated Idiopathic Pericarditis

• NSAIDs

• Indomethacin & Colchicine– Allergy to NSAIDs or aspirin

• Narcotic analgesia

• Corticosteroids

Clinical ManagementClinical ManagementPost-MI Pericarditis

• Avoid use of corticosteroids and anti-inflammatory agents– May cause rupture

of the infarcted area

Clinical ManagementClinical ManagementPericarditis (recurrent pain or connective

tissue disorders)

• Corticosteroids are most effective

Medication-Related Pericarditis

• Stop the medication

ComplicationsComplications

• Pericardial Effusion

• Cardiac Tamponade

• Constrictive Pericarditis

Pericardial EffusionPericardial Effusion• Accumulation of

excessive fluid in the pericardial space

• May happen slowly over time and the pericardial sac accommodates

• Rapid fluid accumulation results in Cardiac Tamponade