The document discusses pericarditis, which is inflammation of the pericardium, the sac-like membrane surrounding the heart. It can be acute, lasting less than 6 weeks, or chronic, lasting over 6 months. Causes include viral or bacterial infections, autoimmune conditions, myocardial infarction, tumors, and physical trauma. Symptoms include chest pain, dyspnea, fever, and a pericardial friction rub. Diagnosis involves ECG, imaging tests, and biopsy. Treatment focuses on managing underlying causes with antibiotics, corticosteroids, NSAIDs, or pericardiocentesis. Chronic constrictive pericarditis involves scarring and thickening that decreases cardiac output.

1. PERICARDITIS
Presented By:
Mr. Nandish.S
Asso. Professor
Mandya Institute of Nursing Sciences

3. DEFINITION :
 It is a condition caused by inflammation of the pericardial sac, which
may occur on acute or chronic basis.
 It is the inflammation of the pericardium, a sac like structure with two
thin layers of tissue that surround the heart.
 It is the swelling and irritation of pericardium, a thin sac like
membrane that surround your heart.

4. INCIDENCE :
- It is seen in 5 to 30 % cases after pericardectomy.
- 1 to 3% cases develop after acute Myocardial Infarction.
- There are 40 patients with pericarditis for every 1,00,000 population.

6. CLASSIFICATION :
Based on the duration and symptoms :
1. Acute Pericarditis (< 6 weeks)
2. Subacute Pericarditis ( 6 weeks to 6 months)
3. Chronic Pericarditis (> 6 months)
4. Recurrent Pericarditis

7. CLASSIFICATION :
Based on the Causes :
Constrictive Pericarditis
Viral Pericarditis
Tuberculous Pericarditis
Purulent / Suppurative Pericarditis
Radiation Pericarditis
Traumatic Pericarditis
Serous Pericarditis
Fibrous Pericarditis
Hemorrhagic Pericarditis
Adhesive Mediastino Pericarditis

8. ACUTE PERICARDITIS :
• It is an inflammation of the pericardial sac which occur within 6
weeks or on an acute basis.

9. Etiology :
1) Infection :
Viral – Coxsackievirus A & B, Echovirus, Adenovirus, Epstein – Barr
Virus, Varicella Zoster, HIV, Mumps, Hepatitis B
Bacterial – Pneumococci, Staphylococci, Streptococci, N.Gonorrhoeae,
Legionella Pneumophila, M.Tuberculosis.
Fungal – Histoplasma, Candida species
Other infections like Toxoplasmosis, Lyme disease.

10. 2) Non infectious factors :
• Uremia
• Acute Myocardial Infection
• Neoplasms : Lung cancer, Breast cancer, Leukemia, Hodgkin’s
Disease
• Trauma : thoracic surgery, pacemaker insertion, cardiac diagnostic
procedures
• Radiation
• Dissecting Aortic Aneurysm
• Myxedema

11. 3) Hypersensitive or Autoimmune :
- Delayed post myocardial Injury
- Postpericardiotomy syndrome
- Rheumatic Fever
- Drug reactions (procainamide, Hydralazine)
- Systemic Lupus Erythematosus, Scleroderma, Ankylosing Spondylitis

12. PATHOPHYSIOLOGY :
Due to Etiological factors
An influx of Neutrophils
Increased Pericardial vascularity
Fibrin deposition on the Visceral Pericardium
Clinical features

13. CLINICAL FEATURES :
 Chest pain (intense, sharpest retrosternally) – pain will increase by
lying on supine, deep breathing, coughing, swallowing)
 Dyspnoea
 Pericardial friction rub – it is scratching, grating, high pitched sound
arise due to friction between pericardial & Epicardial surfaces.
 Ewart’s or Pins sign : an area of dullness with bronchial breath
sounds & increased tactile fremitus below left scapular angle.
 Fever with chills, night sweats.
 Malaise and Myalgia
 Palpitation

14. DIAGNOSTIC STUDIES :
o History collection & Physical Examination
o ECG
o BUN
o Tuberculin Test / Mantoux Test
o Chest X – Ray
o Echocardiogram
o Pericardial Biopsy
o CT Scan
o Cardiac Nuclear Scan

15. MANAGEMENT :
- It is directed towards identification and treatment of underlying causes.
- Antibiotics
- Corticosteroids (prednisone)
- NSAID’s (Indomethacin)
- Adequate bed rest
- Pericardocentesis is usually performed when systolic BP is reduced
30mm of Hg. A 16 – 18 gauze needle is inserted into the pericardial
space to remove fluid for analysis and to relieve cardiac pressure.

17. NURSING MANAGEMENT :
Pain, acute, chest related to transmission & perception of impulses.
Decreased cardiac output related to reduced systolic blood pressure.
Anxiety related to disease condition outcome.
Activity intolerance related to poor heart functioning.
Ineffective therapeutic regimen management related to unawareness
regarding treatment and follow up care.

18. CHRONIC CONSTRICTIVE PERICARDITIS :
• It results from scarring with consequent loss of elasticity of the
pericardial sac.
• It caused due to frequent acute pericarditis.
Common etiological factors are :
 Neoplasia
 Radiation
 Previous surgery
 Idiopathic factors.

20. PATHOPHYSIOLOGY :
Due to etiological factors
Fibrin deposition with clinically undetected pericardial effusion
Resorption of effusion
Chronic fibrous scarring
Calcium deposition causes more thickening of pericardium
Impairing the ability of atria & ventricle to stretch during diastole

21. CLINICAL MANIFESTATIONS :
Many of the symptoms are due to decreased cardiac output.
 Dyspnoea on exertion
 Pedal edema & ascites
 Fatigue
 Anorexia
 Weight loss
 Hepatomegaly
 JVD(Jugular vein distension)
 Kussmaul’s sign
 Pericardial Knock (early diastolic sound) heard at apex of heart.

22. MANAGEMENT :
 Medical management and other protocol remain same as for acute
pericarditis.
 If the condition is not improving, then treatment of choice is
“pericardiectomy”.
 It involves complete resection of pericardium through median
sternotomy with cardio pulmonary bypass.
 Postoperative prognosis depends on patient’s ability to improve.

23. NURSING MANAGEMENT :
It remains same as for acute pericarditis.
In postoperative cases nursing interventions will be changed according to
patient’s condition .
- Impaired skin Integrity related to surgical incision
- Fatigue related to post operative restrictions.