Cardiac disease

1. Seminar on Pericardial Effusion, Cardiac Tamponade
& Ischemic heart disease
Presented by Group One
Presented to: Mr Bikila k. (BSC, MSc, Ass/t Prof)
Sep, 2023
Fitche, Ethiopia
SALALE UNIVERSITY COLLEGE OF HEALTH SCIENCE
DEPARTMENT OF ADULT HEALTH NURSING
MASTERS PROGRAM
10/22/2023 Group 1 1

2. Group Members
SN Name ID
1 Amensisa Debesa ROM 176/15
2 Azazhu Abate ROM 177/15
3 Mekonnen Urgessa ROM 183/15
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3. Seminar Outline
 Introduction
 Etiology
 Pathaphysiology
 Epidemiology
 Clinical manifestations
 Diagnosis
 Medical management
 Nursing Management
 Summary
 Reference
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4. Objectives Of Presentation
 After Completion of this seminar, the students will
able to:
 Define pericardial effusion, cardiac tamponade and
Ischemic heart disease
 Discuss the causes and risk factors for pericardial
effusion, cardiac tamponade and Ischemic heart
disease
 Identify the diagnosis and management of
pericardial effusion, cardiac tamponade and
Ischemic heart disease
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5. Introduction of Anatomy and physiology
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6. Introduction of Anatomy and physiology…
The normal function of pericardium is to maintain
 An optimal Cardiac Shape
 Reducing the friction between beating heart and
adjacent structure.
 Protecting the heart from other disease which
are caused by other organs. Eg T.B , cancer etc.
 Preventing the overfilling of the heart.
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7. Introduction of Anatomy and physiology…
Pericardial fluid
 Norma amount of fluid is 15-50ml
 It secreted from serous membrane of
pericardium
 It lubricates the two layers
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8. Pericardial Effusion
• Presence of an abnormal amount of fluid and/or
an abnormal character to fluid in the pericardial
space.
• Effusion mismatch secretion and absorption.
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9. Pericardial Effusion…
Types
 Transudate: Congestive heart failure, myxedema
and nephrotic syndrome
 Exudative: TB, spread from empyema
 Hemorrhagic: Trauma, rapture of aneurysms,
malignant
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10. Classification Pericardial effusion
Based on:
 Onset: acute, sub-acute and chronic if more than
three months.
 The size: mild (<10 mm), moderate (10–20 mm) or
large (>20 mm)
 Distribution: (circumferential or loculated)
 Composition: exudative and transudative
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11. Pericardial Effusion…
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12. Etiology
 Pericarditis (infectious and idiopathic)
 Neoplastic (Lung CA-37%, Breast CA-22%,
Leukemia/lymphoma-17%)
 Uremia, Post operative, Myxedema, Severe
pulmonary Hypertension, Chest trauma
10/22/2023 Group 1 12

13. Etiology…
• Autoimmune (SLE, RA, Sarcoidosis, Ankylosing
spondylitis)
• Drugs (procainamide, Hydralazine, Isoniazid,
Minoxidil, Phenytoin, methylsergide,
Anticoagulants)
10/22/2023 Group 1 13

14. Cardiac Tamponade
• It is the potential complication of pericardial effusion
and life threatening which requires emergence
management
• It results accumulation of fluid in the pericardial
space, resulting in reduced ventricular filling and
subsequent hemodynamic compromise
• 300-600 ml of non hemorrhagic pericardial fluid can
cause tamponade.
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15. Cardiac Tamponade…
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16. Pathophysiology
• Clinical manifestations are highly dependent on
the rate of accumulation of fluid in the pericardial
sac.
• Pericardial effusion increased pericardial
pressure overcomes ventricular filling
pressure decreased stroke volume
reduced COP Cardiogenic shock and death
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17. Clinical Presentation
The clinical presentation of patients with
pericardial effusion will vary according to
 the underlying process
 rate of accumulation
 hemodynamic effect
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18. Clinical Presentation…
• Chest pain – relieved by sitting up and leaning
forward, aggravated by lying supine
• Light-headedness, syncope
• Palpitations
• Cough, dyspnea, hoarseness
• Anxiety and confusion
• hiccup
10/22/2023 Group 1 18

19. Clinical Presentation
 Beck triad –3 Ds
 Decreased pulse pressure (hypotension)
 Decreased/Muffled heart sounds
 Distended neck veins (Raised JVP)
 Pulsus paradoxus
 a decrease in systolic blood pressure of more
than 10mm Hg with inspiration, signaling falling
cardiac output during inspiration
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20. Clinical Presentation…
 Pericardial friction rub, Tachycardia, Tachypnea
 Weakened peripheral pulses, cyanosis and
edema
 Ewart Sign- dullness to percussion beneath the
angle of left scapula from compression of left
lung by pericardial effusion
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21. Complications
 Cardiac arrhythmia
 Pneumothorax
 Pleural effusion
 Myocardial injury
 Peritoneal injury
 Liver/stomach injury
 Internal mammary artery injury
 Diaphragmatic injury
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22. Investigations
 Baseline–CBC, Electrolytes, cardiac enzymes,
ESR, CRP
 Pericardial fluid Analysis (R/E, C/S, Adenosine
deaminase and Carcinoembryonic Antigen)
 Echocardiography: Examine size , shape and
motion of heart
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23. Investigations…
• Pericardiocentesis (diagnostic and therapeutic)
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24. Investigations…
 Thyroid profile, Rheumatoid Factor,
Immunoglobulin complexes, Antinuclear Ab test
 CT scan and MRI
 Chest Radiography – enlarged cardiac
silhouette (water bottle heart) and pericardial fat
stripe
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25. Investigations…
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26. Investigations…
ECG
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27. Investigations…
Low-voltage QRS complexes seen in large effusions and
tamponade
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28. Differentional Diagnosis
• Epicardial Fat
• Pericardial Cyst
• Pleural Effusion
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29. Medical Management
• Oxygen supplementation
• Fluid resuscitation
• Bed rest with leg elevation
• Pericardiocentesis ( if pt is unstable)
• Pharmacotherapy: Aspirin/NSAIDs, Colchicine,
Steroids, Antibiotics
• Percutaneous balloon pericardiotomy
• Surgical creation of pericardial window
10/22/2023 Group 1 29

30. Medical Management…
 Management of recurrent cardiac temponade or
pericardial effusion
 Pericardial sclerosis: Tetracycline,
doxycycline, cisplatin, 5-Fluorouracil
 Pericardio-peritoneal shunt
 pericardiectomy
10/22/2023 Group 1 30

31. Nursing Management
 Continuously monitor ECG
 Auscultation of breath sounds and heart sounds.
 Monitor strictly vital signs, especially respiratory
rate.
 Give the semi-Fowler position
 Teach clients a deep breath.
 Give medication as indicated
10/22/2023 Group 1 31

32. Definition
• Ischemic heart disease (IHD) are group of
closely related conditions (syndromes) caused
by an imbalance between the myocardial
oxygen demand and blood supply.
• It is the reduction of blood flow to the heart
muscle due to build-up of atherosclerotic plaque
in the arteries of the heart.
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33. Definition Cont…
• Also called Coronary artery disease (CAD),
coronary heart disease (CHD) or myocardial
ischemia
• It is the most common among cardiovascular
diseases.
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34. Anatomy and Physiology overview
• The coronary arteries provide the main blood
supply to the heart.
• They are also supply the myocardium with
oxygen to allow for the contraction of the heart
and thus causing circulation of the blood
throughout the body.
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35. Anatomy and physiology
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36. Etiology
• Coronary artery Disease
• Congenital heart defect
• Atherosclerosis and occlusion of an artery
• Vasospasm of a coronary artery
• Decreased oxygen supply (from acute blood loss,
anemia, or low blood pressure)
• Increased demand for oxygen (from a rapid heart
rate, thyrotoxicosis, or ingestion of cocaine).
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37. Epidemiology.
• Globally, about 200 million persons have IHD.
This translates to a prevalence rate of 3820
cases per 100,000 population worldwide.
• Peak incidence: 60y for males and 70y for
females, Men are more affected than women.
• The main cause of Ischemic heart disease is
coronary atherosclerosis → 90% of cases.
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38. Pathophysiology
• The underlying pathogenesis of coronary arterial
disease is atherosclerosis.
• Atherosclerosis = Hardening of the vessels
(intimal thickening) and lipid accumulation
• These processes will produce the plaque
• The plaque cause limitation of blood flow to the
heart causes ischemia (cell starvation secondary
to a lack of oxygen) of the heart's muscle cells.
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39. Cont…
Ischemia
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40. Risk factors
Modifiable
• Cigarette smoking
• Diabetes mellitus
• Hyperlipidemia
• Hypertension
• Being overweight
• Lack of exercise and a poor
diet
• Excessive alcohol
• Stress
Non modifiable
• Age
• Sex
• Family history
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41. Signs and symptoms
• Chest pain, especially after physical exertion.
• Dizziness or fainting, light headedness
• Heart palpitations, which may feel like your heart
fluttering or skipping beats.
• Shortness of breath.
• Swelling in your feet or ankles.
• Extreme fatigue and tiredness
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42. Types of IHD
IHD can cause these four conditions:
1. Angina pectoris (chest pain).
2. Acute myocardial infarction= heart attack.
3. Sudden cardiac death due to ventricular
arrhythmia.
4. Chronic ischemic heart disease (IHD) with
congestive heart failure (CHF).
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43. 1. Angina pectoris
Imbalance of oxygen supply and demand
• Decreased blood flow to myocardium. This
results in chest pain due to:
– Switch to anerobic metabolism
– Lactic acid build up
– Kinins, histamine, other substances released
– Nerve fibers are stimulated
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44. 1. Angina pectoris…
• Paroxysmal and usually recurrent attacks of
substernal of precordial chest discomfort
described as constricting, squeezing, choking,
or knifelike.
• Divided in to stable, unstable and prinzemental
angina.
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45. 2. Myocardial infarction
• Refers to the process by which areas of
myocardial cells in the heart are permanently
destroyed.
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46. 2. Myocardial infarction…
• Chest pain that occurs suddenly and continues
despite rest and medication.
• Patients may also be anxious and restless.
• They may have cool, pale, and moist skin.
• Their heart rate and respiratory rate may be
faster than normal.
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47. Angina Pectoris Vs Myocardial Infarction
Angina Pectoris
• Is not permanent heart
damage
• Chest pain can be
relieved by rest or
nitrates
• By narrowing or
insufficient perfusion
• Triggered by expression
and stress
• Last less 15 min
Myocardial Infarction
• Permanent heart
damage
• Not relieved by nitrates
unless strong opioids
• Total blockage of the
arteries
• No triggers
• Last greater than 30
min
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48. Diagnosis
• Detailed Hx and Physical examination
• Cardiac catheterization to check for blocked
arteries
• Echocardiogram to look at how your heart’s
valves and chambers are pumping blood
• Imaging studies, such as a chest X-ray, CT scan
or MRI
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49. Diagnosis…
• EKG
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50. Diagnosis
• Electrophysiology study to perform a more in-
depth evaluation of your heart’s electrical activity
• creatine kinase (CK),lactic dehydrogenase (LDH)
levels
• Myoglobin:-a heme protein that helps to transport
oxygen. Its level starts to increase within 1 to 3
hours and peaks within 12 hours after the onset of
symptoms.
10/22/2023 Group 1 50

51. Non Pharmacological Management
Lifestyle changes
• Eating a heart-healthy diet
• Getting better quality sleep
• Losing weight
• Lowering stress
• Quitting smoking
• Reducing alcohol intake
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52. Pharmacological management
• Beta-blockers
• Thrombolytic:- usually administered IV.
• Analgesics:-morphine(IV bolus) reduces pain and
anxiety
• Angiotensin-Converting Enzyme Inhibitors: for HTN
• Oxygen
• Calcium channel blockers
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53. Summary
• Coronary heart disease is the main form of
cardiovascular disease.
• Cardiac tamponade is a life threatening, slow or
rapid compression of the heart due to pericardial
accumulation of fluid, pus, blood as result of
inflammation, trauma, rupture of the heart or
aortic dissection.
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54. Reference
1. Harrison. Principles of internal medicine, 21th
ed.
2. Brunner and Saddarth(2019). Medical Surgical
Nursing 10th ed.
3. Smeltzer C. Suzane, Textbook of medical
surgical nursing, published by Lippincott,Edition
9th
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55. 10/22/2023 Group 1 55