Medical and Nursing Management of Pericarditis

I. Definition

• Pericarditis is inflammation of the pericardium, the fibroserous sac that surrounds the heart. It may be acute or chronic.

II. Risk Factors

• Pericarditis, particularly the acute form, may be idiopathic.
• Bacterial, fungal, or viral infections
• Neoplasms
• Connective tissue disorders
• Hypersensitivity reactions
• Injury to the pericardium (e.g. myocardial infarction, trauma, cardiac surgery)
• Drugs (e.g. hydrazaline, procainamide)
• High-dose radiation therapy to the chest
• Uremia
• Aortic aneurysm with pericardial leakage
• Myxedema with cholesterol deposits in the pericardium

III. Pathophysiology

• Acute pericarditis may be fibrinous or effusive, producing serous or hemorrhage exudates.
• Chronic constrictive pericarditis is marked by progressive pericardial thickening.

IV. Assessment/Clinical Manifestations/Signs And Symptoms

• Sharp, sudden pain over the precordium, radiating to the neck and left scapular region. Pain may be aggravated by breathing or movement and typically decreases when the client sits and lean forward.
• Dyspnea and orthopnea
• Tachycardia
• Pericardial friction rub
• Distal heart sounds
• Increased cardiac dullness on percussion
• Absent apical impulse
• In the presence of cardiac tamponade, pallor, cool, and clammy skin, hypotension, pulsus paradoxus, and jugular vein distention.
• Blood analysis reveals normal or elevated white blood cell count and erythrocyte sedimentation rate.
• Pericardiocentesis reveals positive pericardial fluid culture.
• ECG shows ST-segment elevation, T-wave inversion and diminished QRS volate with effusion.
• Echocardiography detects a free space echo between the ventricular wall and pericardium.

V. Medical Management

Objectives of management are to determine the cause, to administer therapy for the specific cause (when known), and to watch for cardiac tamponade (compression of the heart from fluid in the pericardial sac).

• Bed rest is instituted when cardiac output is impaired until fever, chest pain, and friction rub have disappeared. Then a gradual increase in activity is permitted as the patient’s condition improves.
• Narcotic analgesic agents for pain relief during the acute phase.
• Analgesic agents and nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and hasten reabsorption of fluid in rheumatic pericarditis. Colchicines may also be used as an alternative medication.
• Corticosteroids to control symptoms, hasten resolution of the inflammatory process and prevent recurring pericardial effusion.
• Penicillin for pericarditis of rheumatic fever.
• Isoniazid, ethambutol, rifampin, and streptomycin for pericarditis or tuberculosis.
• Amphotericin B for fungal pericarditis.

VI. Nursing Diagnosis

• Pain related to inflammation of the pericardium

VII. Nursing Management

• Provide pain relief
o Administer prescribed pain medication, which may include morphine to relieve pain during the acute phase; nonsteroidal anti-inflammatory drugs; and corticosteroids.
o Place the client in an upright and leaning forward position, which tends to relieve pain.
o Place the client on bed rest until fever, chest pain, and friction rub disappear.
• Monitor for signs and symptoms of cardiac tamponade, such as hypotension, muffled heart sounds and pulsus parodoxus.
• Prepare the client for possible pericardiocentesis, as ordered.

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