pericardium is the most outer layer of the heart, chest pain difficulty in breathing , pleural effusion

1. Pericarditis
Nsg.Instructor
Safoora Qureshi
CON, PIMS

2. Pericardium:
• Pericardium is the outer most
layer and is made up of two
fibrous serous sacs
Functions:
• Limits cardiac distention
• Restricts excessive movements
• Protect from injury
• Lubricate to prevent friction
• Hold the heart in place

3. Pericarditis
• Pericarditis is inflammation of the pericardium,
• Pericarditis is swelling and irritation of the thin, saclike tissue
surrounding the heart (pericardium).
• Pericarditis often causes sharp chest pain.
• The chest pain occurs when the irritated layers of the
pericardium rub against each other.

5. Etiology
Infectious Pericarditis
• Viral : coxsackievirus, adenovirus, mumps, varicella zoster, HIV,
Covid-19
• Bacterial: pneumococci, streptococci, staphylococci , tuberculosis,
Septicemia from gram- negative organisms
• Fungal . Candida
• Torch Infections: Toxoplasmosis
Noninfectious:
• Acute MI
• Neoplasms: ca lung, ca breast, leukemia, lymphomas
• Trauma: Thoracic surgery, pacemaker incretion, diagnostic
procedures
• Radiation, Dissecting aortic aneurysm
Autoimmune:
• Lupus, rheumatoid arthritis and scleroderma

6. Symptoms
Chest pain, is the most common symptom,
• Characterized by Sharp or stabbing pain,
may dull, achy or pressure-like chest pain
• Locate behind the breastbone,
or on the left side of the chest.
• Radiate to the left shoulder and neck
• Get better when sitting up or leaning forward
• Referred to trapezius muscles (shoulder, upper back)
is only the distinction between pericardial pain and angina

7. Other signs and symptoms
• Fever
• Shortness of breath
• when lying down
• Pericardial friction rub,
• is a scratching, grating, and high-pitched sound one of the
hallmark finding in acute pericarditis
• Cough
• Fatigue
• Palpitation
• Pounding or racing heartbeat)

8. Types
• Acute pericarditis:
• Begins suddenly but doesn't last longer than three weeks
• Difficult to differentiate between acute pericarditis and MI pain
• Recurrent pericarditis:
• Occurs about four to six weeks after an episode of acute pericarditis
with no symptoms in between.
• Incessant pericarditis:
• Lasts about four to six weeks but less than three months.
• The symptoms are continuous.
• Chronic constrictive pericarditis;
• usually develops slowly and lasts longer than three months.

9. Complications
• Pericardial effusion
• The fluid buildup can lead to further heart complications.
• Constrictive pericarditis).
• long-term pericarditis develop permanent thickening and scarring of the
heart lining
• The changes prevent the heart from filling and emptying properly.
• Cardiac tamponade)
• Pressure on the heart due to fluid buildup
• Prevents the heart from filling properly.
• Causing a dramatic drop in blood pressure.
• A life-threatening condition requires emergency treatment

10. Diagnosis
• History and Physical Examination
• Sharp chest pain and shortness of breathing are 2 major clues
• Heart Auscultation:
• Rubbing or creaking sound, called “pericardial rub” is the best
heard when the pt lean forward, hold breath and breathe out.
• Crackles in the lungs, which are signs of pleurisy or pericardial
effusion
• ECG: Normal/specific defused changes over aperid of hours to
days/wks. we
• PR segment depression,
• ST segment elevation and
• T wave flattening

11. Pericarditis
PR segment depression
ST segment elevation
T flattening
Normal ECG

12. • Chest X-ray
• to see the size of the heart and any fluid in lungs.
• Echocardiogram (echo) ;
• To find fluid or pericardial effusion around the heart
• Cardiac MRI;
• CT scan;
• to look for calcium in the pericardium, fluid, inflammation, tumors
around the heart
• Cardiac catheterization:
• to confirm a diagnosis of constrictive pericarditis.
• Blood tests
• ESR, CRP,
• To confirm heart attack
• To find the cause of pericarditis.
•

13. Collaborative Care
Medical treatment:
• Pain Relievers:
• Nonsteroidal anti-inflammatory (NSAIDs) use to treat pain and inflammation
such as aspirin or Ibuprofen
• Antibiotics :
• to reduce inflammation and pain
• Steroids:
• strong anti-inflammatory drug, may used in pericarditis secondary to
autoimmune conditions
• Pericardiocentesis:
• is usually performed for pericardial effusion with cardiac tamponade,
purulent pericarditis and a high suspicious of neoplasm

14. Nursing management:
• Strict bed rest
• Keep in prop-upped position
• Elevate the bed at 45 degree
• Provide an overbed table for support
• Observe for post anti-inflammatory drugs complications such as upper GI
bleed, gastric upset etc
• Advise to take these drugs with food and milk
• Instruct avoid alcohol beverages
• Take anxiety-reduce measures by explaining performed procedures and
possible cause of pain , treatment and prognosis
• Reassure the client