This document discusses cardiac tamponade and pericardial diseases. Cardiac tamponade occurs when fluid accumulates in the pericardial space, increasing pressure and compressing the heart. Common causes include malignancy, idiopathic pericarditis, renal failure, cardiac surgery/trauma, tuberculosis, and hemopericardium. Accumulated fluid under high pressure compresses the cardiac chambers and impairs filling, leading to increased venous pressures and decreased cardiac output. Clinical features include hypotension, elevated jugular venous pressure, muffled heart sounds, and pulsus paradoxus. Management involves relieving symptoms, improving heart function, and saving the patient's life through interventions like diuretics, dig

1. PERICARIAL DISEASES
PART -2

2. CARDIAC TAMPONADE
• Accumulation of fluid in the pericardial
space causing increase in pressure with
subsequent cardiac compression.
Most common causes :
– Malignancy
– Idiopathic pericarditis
– Renal failure
– cardiac Surgery and trauma.
– TB & Hemopericardium

3. • Accumulated fluid under high pressure:
compresses cardiac chambers & impairs
diastolic filling of both ventricles.
• SV venous pressures.
• Cardiac output, systemic
• Hypotension/shock JVP Reflex
» Tachycardia, hepatomegaly ascites peripheral
oedema.
CONT..

4. PATHOPHYSIOLOGY
• Modest amounts of rapidly accumulating fluid can
have major effects on cardiac function.
• An effusion reduces the volume of the cardiac
chambers that cardiac output begins to decline –
Mainly by impeding right-sided heart filling.
• chronic changes in the pericardial pressure effect
on the left side of the heart due to secondary filling.

5. PATHOPHYSIOLOGY…

6. CLINICAL FEATURES
• Symptoms acute : confusion / agitation
• Signs - hypotension - elevated JVP -
muffled heart sounds.
• Pulsus paradoxus : When severe, it may be
detected by palpating weakness or
disappearance of the arterial pulse during
inspiration

7. PULSES PARADOXUS
Paradoxic pulse, in an abnormally large
decrease in stroke volume. The normal fall in
pressure is less than 10 mmHg. When the
drop is more than 10mmHg, it is referred to as
pulses paradoxus.

8. BECK’S TRIAD
• Distant heart sounds
• Distended jugular veins
• Decreased arterial
pressure

9. MANAGEMENT
• Save the patient’s life
• Improve the heart function
• Relieve the symptoms

10. MANAGEMENT
• Diuretics & salt restriction
• Digoxin for sinus tachycardia to slow the
ventricular rate.
• Beta blockers & calcium channel blockers
Surgical management
• Pericardiectomy

11. PERICARDIOCENTESIS

12. MEDICAL MANAGEMENT
• Oxygenation
• Inotropic drugs ( Dobutamine)
• Mechanical ventilation
• Maintain volemic status (normovolemia)

13. NURSING ASSESMENT
• Physical assessment to obtain the base
line data.
• Vital signs.
• Assess patient in various positions in order
to detect pain whether it is influenced by
respiratory movements, coughing and
swallowing.

14. NURSING ….
• Assess Heart and Lung Sounds
May hear a pericardial friction rub,
muffled heart sounds, or extra sounds because of
the pressure being placed on the hear
• Assess and Address Oral Hygiene
There is a significant connection between
oral health and pericarditis. Bacteria can travel to
the heart easily from the oral cavity. Patients
should brush their teeth twice daily to prevent
complications.

15. NURSING INTERVENTIONS
• Pain management – elevate head end to
45 deg.
• Anti inflammatory drugs as prescribed.
• Monitor complications

16. NURSING DIAGNOSIS
• Ineffective breathing pattern related to chest pain.
• Altered thermoregulation , hyperthermia, related to infection
and inflammation as evidenced by temp.
• Pain related to inflammation of the pericardium.
• Risk for cardiogenic shock related to decreased cardiac
output.
• Ineffective tissue perfusion related to decrease blood flow.
• Anxiety related to therapeutic interventions and uncertainty
of prognosis.

17. NURSING MANAGEMENT
• Explain every procedure to the patient in order to
get consent, cooperation and array anxiety.
• Position patient in semi fowlers to relieve pain
and allow expansion of chest for effective
breathing.
• Explain the pathophysiology to the patient.
• Encourage gradual increase activity.
• Monitor vital signs closely to detect infections.

18. NURSING MANAGEMENT
• Educate patient on signs and symptoms of
infection.
• Educate patient to inform the need
prophylactic antibiotics.
• No dental procedures for at least 6 months.

19. COMPLICATIONS
• Pericarditis progresses to heart failure.
• Pericardial effusion fluid collection in
pericardial space.
• Cardiac tamponade - it develops when
pericardial effusion increases.

20. Thank you