Telemetry Preceptorship Course Pericarditis &  Cardiac Tamponade Natalie Bermudez, RN, BSN, MS  Clinical Educator for Tele...
What is Pericarditis? <ul><li>Inflammation of the pericardial sac </li></ul>
Facts <ul><li>More common in men  </li></ul><ul><li>Occurs between the ages of 20 to 50 years </li></ul>
Etiology <ul><li>Most common cause is viral illness </li></ul><ul><li>AMI </li></ul><ul><li>Bacterial infection </li></ul>...
Associated Viral Causes <ul><li>Coxsackie A & B </li></ul><ul><li>Echovirus </li></ul><ul><li>Hepatitis B </li></ul><ul><l...
Pericarditis & AMI <ul><li>If occurs within 2 – 7 days following an AMI </li></ul><ul><ul><li>Considered a pericardial inf...
Pericarditis & Medications <ul><li>Medications that produce pericarditis symptoms in patients with SLE </li></ul><ul><ul><...
Clinical Presentation <ul><li>May mimic AMI </li></ul><ul><ul><li>Chest pain & ST-segment elevation </li></ul></ul><ul><li...
Differentiating Chest Pain <ul><li>Pericarditis </li></ul><ul><li>Pain is often sharp, piercing </li></ul><ul><li>Located ...
Diagnostic Tests <ul><li>12-Lead EKG </li></ul><ul><li>Most definitive test in acute pericarditis </li></ul><ul><li>ST-seg...
Diagnostic Tests <ul><li>Chest X-Ray </li></ul><ul><li>Cardiac silhouette enlarged </li></ul><ul><ul><li>If more than 250 ...
Diagnostic Tests <ul><li>Echocardiogram </li></ul><ul><li>Evaluates hemodynamic changes associated with cardiac tamponade ...
Diagnostic Tests <ul><li>Labs </li></ul><ul><li>Erhythrocyte Sedimentation Rate (ESR) & Complete Blood Count (CBC) </li></...
Clinical Management <ul><li>Uncomplicated Idiopathic Pericarditis </li></ul><ul><li>NSAIDs </li></ul><ul><li>Indomethacin ...
Clinical Management <ul><li>Post-MI Pericarditis </li></ul><ul><li>Avoid use of corticosteroids and anti-inflammatory agen...
Clinical Management <ul><li>Pericarditis (recurrent pain or connective tissue disorders) </li></ul><ul><li>Corticosteroids...
Complications <ul><li>Pericardial Effusion </li></ul><ul><li>Cardiac Tamponade </li></ul><ul><li>Constrictive Pericarditis...
Pericardial Effusion <ul><li>Accumulation of excessive fluid in the pericardial space </li></ul><ul><li>May happen slowly ...
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Pericarditis, Pericardial Effusion, & Cardiac Tamponade - BMH/Tele

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Pericarditis, Pericardial Effusion, & Cardiac Tamponade - BMH/Tele

  1. 1. Telemetry Preceptorship Course Pericarditis & Cardiac Tamponade Natalie Bermudez, RN, BSN, MS Clinical Educator for Telemetry
  2. 2. What is Pericarditis? <ul><li>Inflammation of the pericardial sac </li></ul>
  3. 3. Facts <ul><li>More common in men </li></ul><ul><li>Occurs between the ages of 20 to 50 years </li></ul>
  4. 4. Etiology <ul><li>Most common cause is viral illness </li></ul><ul><li>AMI </li></ul><ul><li>Bacterial infection </li></ul><ul><ul><li>Stab wounds, pneumonia, endocarditis, sepsis, surgical contamination </li></ul></ul><ul><li>Medications </li></ul><ul><li>Pericardial Neoplasm (very rare) </li></ul><ul><li>Uremia and/or renal failure </li></ul><ul><li>Idiopathic </li></ul><ul><ul><li>Relatively common in developing countries </li></ul></ul><ul><ul><li>Turns out to be viral in nature </li></ul></ul>
  5. 5. Associated Viral Causes <ul><li>Coxsackie A & B </li></ul><ul><li>Echovirus </li></ul><ul><li>Hepatitis B </li></ul><ul><li>HIV </li></ul><ul><li>Influenza </li></ul><ul><li>Mononucleosis </li></ul><ul><li>Mumps </li></ul><ul><li>Varicella </li></ul>
  6. 6. Pericarditis & AMI <ul><li>If occurs within 2 – 7 days following an AMI </li></ul><ul><ul><li>Considered a pericardial inflammatory response to the underlying AMI </li></ul></ul><ul><li>Dressler Syndrome </li></ul><ul><ul><li>Autoimmune response to myocardial necrosis involving both the pleura and the pericardium </li></ul></ul><ul><ul><li>May occur 2 weeks to several months after the event </li></ul></ul>
  7. 7. Pericarditis & Medications <ul><li>Medications that produce pericarditis symptoms in patients with SLE </li></ul><ul><ul><li>Pronestyl (procainamide) </li></ul></ul><ul><ul><li>Apresoline (hydralazine) </li></ul></ul><ul><ul><li>INH (ioniazid) </li></ul></ul>
  8. 8. Clinical Presentation <ul><li>May mimic AMI </li></ul><ul><ul><li>Chest pain & ST-segment elevation </li></ul></ul><ul><li>Chest pain w/ pericarditis </li></ul><ul><ul><li>Pleuritic in nature; worsens with inspiration </li></ul></ul><ul><ul><li>Relief obtained by sitting upright and leaning forward </li></ul></ul><ul><li>Fever may be present or antecedent </li></ul><ul><li>Dyspnea, SOB, cough </li></ul><ul><li>Chills </li></ul><ul><li>Weakness </li></ul>
  9. 9. Differentiating Chest Pain <ul><li>Pericarditis </li></ul><ul><li>Pain is often sharp, piercing </li></ul><ul><li>Located between the neck and shoulder </li></ul><ul><li>Dyspnea unrelated to exertion </li></ul><ul><li>Pericardial friction rub </li></ul><ul><li>Acute MI </li></ul><ul><li>Pain is described as pressure </li></ul><ul><li>Dyspnea related to exertion </li></ul><ul><li>Pain is in the chest and may sometimes radiate </li></ul>
  10. 10. Diagnostic Tests <ul><li>12-Lead EKG </li></ul><ul><li>Most definitive test in acute pericarditis </li></ul><ul><li>ST-segment elevation in most leads except V 1 and AVR </li></ul><ul><li>No reciprocal changes or inverted T’s </li></ul><ul><li>PR segment depressed </li></ul><ul><li>Electrical alternans </li></ul><ul><ul><li>QRS varies from beat to beat </li></ul></ul><ul><li>Atrial dysrhythmias common </li></ul>
  11. 11. Diagnostic Tests <ul><li>Chest X-Ray </li></ul><ul><li>Cardiac silhouette enlarged </li></ul><ul><ul><li>If more than 250 ml is present </li></ul></ul>
  12. 12. Diagnostic Tests <ul><li>Echocardiogram </li></ul><ul><li>Evaluates hemodynamic changes associated with cardiac tamponade </li></ul><ul><li>Transesophageal Echocardiogram (TEE) </li></ul><ul><li>Helpful in evaluating the size of an effusion and compromised ventricular filling </li></ul>
  13. 13. Diagnostic Tests <ul><li>Labs </li></ul><ul><li>Erhythrocyte Sedimentation Rate (ESR) & Complete Blood Count (CBC) </li></ul><ul><ul><li>Non-specific elevation </li></ul></ul><ul><li>Cardiac Profile (CK-MB, troponins) </li></ul><ul><ul><li>Rule out AMI </li></ul></ul><ul><li>PPD, HIV-AIDS screening </li></ul><ul><li>Rheumatoid factors (RF), Antinuclear Antibodies (ANA) </li></ul><ul><li>CT scan – locate neoplastic lesions </li></ul>
  14. 14. Clinical Management <ul><li>Uncomplicated Idiopathic Pericarditis </li></ul><ul><li>NSAIDs </li></ul><ul><li>Indomethacin & Colchicine </li></ul><ul><ul><li>Allergy to NSAIDs or aspirin </li></ul></ul><ul><li>Narcotic analgesia </li></ul><ul><li>Corticosteroids </li></ul>
  15. 15. Clinical Management <ul><li>Post-MI Pericarditis </li></ul><ul><li>Avoid use of corticosteroids and anti-inflammatory agents </li></ul><ul><ul><li>May cause rupture of the infarcted area </li></ul></ul>
  16. 16. Clinical Management <ul><li>Pericarditis (recurrent pain or connective tissue disorders) </li></ul><ul><li>Corticosteroids are most effective </li></ul><ul><li>Medication-Related Pericarditis </li></ul><ul><li>Stop the medication </li></ul>
  17. 17. Complications <ul><li>Pericardial Effusion </li></ul><ul><li>Cardiac Tamponade </li></ul><ul><li>Constrictive Pericarditis </li></ul>
  18. 18. Pericardial Effusion <ul><li>Accumulation of excessive fluid in the pericardial space </li></ul><ul><li>May happen slowly over time and the pericardial sac accommodates </li></ul><ul><li>Rapid fluid accumulation results in Cardiac Tamponade </li></ul>

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