Acute pericarditis is inflammation of the pericardium which can be caused by viruses, bacteria, fungi, or other conditions. It presents with central chest pain worsened by inspiration or lying flat and may have a pericardial friction rub. Tests like ECG, bloodwork, and echocardiogram can help in diagnosis. Treatment involves analgesia and treating the underlying cause. A pericardial effusion is fluid accumulation in the pericardium and can lead to cardiac tamponade, requiring drainage. Constrictive pericarditis occurs when the heart is encased in rigid pericardium, requiring surgical excision. Nursing focuses on relieving pain, monitoring for complications,

2. Acute pericarditis
 This is inflammation of the pericardium. It may be
idiopathic or secondary to:
 Viruses (Coxsackie, flu, Epstein–Barr, mumps,
varicella, HIV)
 Bacteria (pneumonia, rheumatic fever, TB, staphs,
streps.
 Fungi
 Myocardial infarction.

3. cont
 Drugs: procainamide, hydralazine, penicillin,
isoniazid.
 Others: uraemia, rheumatoid arthritis, SLE, trauma,
surgery, malignancy (and anti-neoplastic agents),
radiotherapy.

4. Clinical features:
 Central chest pain worse on inspiration or lying flat ±
relief by sitting forward. A pericardial friction rub may
be heard.
 Look for evidence of a pericardial effusion or cardiac
tamponade . Fever may occur.

5. Tests
ECG classically shows concave (saddle-shaped) ST
segment elevation, but may be normal or non-specific
(10%).
Blood tests: FBC, ESR, U&E, cardiac enzymes (NB:
troponin may be raised), viral serology, blood cultures,
and, if indicated, autoantibodies , fungal precipitins,
thyroid function tests.
Cardiomegaly on CXR may indicate a pericardial
effusion. Echo (if suspected pericardial effusion).

6. Treatment
 Analgesia, eg ibuprofen 400mg/8h PO with food.
 Treat the cause.

7. Pericardial Effusion
 Accumulation of fluid in the pericardial sac.
 Causes:
 Any cause of pericarditis

8. Clinical features
 Dyspnoea ,
 raised JVP ,
 bronchial breathing at left base (Ewart’s sign: large
effusion compressing left lower lobe).
 Look for signs of cardiac tamponade .

9. Diagnosis
 CXR shows an enlarged heart.
 ECG shows low-voltage QRS complexes and
alternating QRS morphologies (electrical alternans) .
 Echocardiography shows an echo-free zone
surrounding the heart

10. Management:
 Treat the cause .
 Pericardiocentesis may be diagnostic (suspected
bacterial pericarditis) or therapeutic (cardiac
tamponade)
 .Send pericardial fluid for culture, ZN stain/TB
culture, and cytology

11. Cardiac tamponade
 Accumulation of pericardial fluid raises intra-
pericardial pressure, hence poor ventricular filling and
fall in cardiac output.
Causes:
 Any pericarditis
 aortic dissection
 Warfarin
 trans-septal puncture at cardiac catheterization
 post cardiac biopsy.

12. Signs
Pulse↑
BP↓
pulsus paradoxus
JVP↑
Kussmaul’s sign
muffled S 1 & S 2.

13. Diagnosis
 Beck’s triad: falling BP; rising JVP; small, quiet heart.
 CXR: big globular heart (if >250mL fluid).
 ECG: low voltage QRS ± electrical alternans.
 Echo .

14. Management
 Seek expert help. The pericardial effusion needs urgent
drainage . Send fluid for culture, ZN stain/TB culture
and cytology.

15. Constrictive pericarditis
 The heart is encased in a rigid pericardium.
 Causes:
Often unknown , elsewhere TB, or after any pericarditis.

16. Clinical features
 These are mainly of right heart failure with ↑JVP
 Kussmaul’s sign (JVP rising paradoxically with
inspiration)
 soft, diffuse apex beat
 quiet heart sounds
 diastolic pericardial knock
 hepatosplenomegaly, ascites, and oedema.

17. Tests
 CXR: small heart ± pericardial calcification (if none,
CT/MRI helps distinguish from other
cardiomyopathies) .
 Echo
 cardiac catheterization

18. Management
 Surgical excision.

19. Nursing Assessment
1. Evaluate complaint of chest pain.
a. Ask the patient if pain is aggravated by
breathing,turning in bed, twisting body, coughing, or
swallowing.
b. Elevate head of bed; position pillow on over-the-bed
table so the patient can lean on it.
c. Assess if above intervention relieves the patient’s
chest pain (associated pleuritic pain of pericarditis is
usually relieved by sitting up and/or leaning forward).

20. 2. Auscultate heart sounds.
a. Listen for friction rub by asking patient to hold breath
briefly.
b. Listen to the heart with patient in different positions.
c. Assess for pulsus paradoxus.
3. Evaluate history for precipitating factors.

21. Nursing diagnoses
1. Acute Pain related to pericardial inflammation
(pericarditis).
2. Decreased cardiac output related to impaired valvular
function and ventricular expansion
3. Impaired gas exchange
4. Activity intolerance related to reduced oxygen delivery
5. Impaired physical mobility
6. Risk for infection

22. Nursing Interventions
Reducing Discomfort
1. Give prescribed drug for pain and symptomatic relief.
2. Relieve anxiety of patient and family by explaining the
difference between pain of pericarditis and pain of MI
3. Encourage patient to remain on bed rest when chest
pain,fever, and friction rub occur.
5. Assist patient to position of comfort.

23. Maintaining Cardiac Output
1. Assess heart rate, rhythm, BP, respirations at least
hourly in the acute phase , hemodynamically unstable.
2. Assess for signs of cardiac tamponade (increased heart
rate, decreased BP, presence of paradoxical pulse, distended
jugular veins, restlessness, muffled heart sounds).
3.Prepare for emergency pericardiocentesis or surgery
4. Assess for signs of heart failure .
5. Monitor closely for the development of dysrhythmias.

24. To improved physical mobility and tolerate
activity
―bed rest is important .
―Assess cardiovascular status frequently, and watch for
signs and symptoms of left-sided heart failure
―Check for changes in cardiac rhythm or conduction.
―Administer oxygen and evaluate arterial blood gas
levels, as needed, to ensure adequate oxygenation.
―Assist the patient with self care activity if necessary. .

25. To prevent infection
―Used infection control in CCU unite .
―Obtain a patient history of allergies before giving an
antibiotic.
― Administer the prescribed antibiotic on time to
maintain a consistent drug level in the blood.
―Observe the venipuncture site for signs of infiltration
or inflammation .
―Used a septic technique for all invasive procedure

26. Patient Education
1. Teach patient the etiology of pericarditis.
2. Instruct patient about signs and symptoms of
pericarditis and the need for long-term medication
therapy to help relieve symptoms.
3. Review all medications with the patient purpose,
adverse effects, dosage, and special precautions.

27. End