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Wednesday, December 8, 2021

Pericarditis: Cause Symptoms Diagnosis Treatment Complication Nursing Interventions by Nurses Note


Pericarditis is an inflammation of the pericardium, the membranous sac enveloping the heart. It is usually a manifestation of a more generalized disease. In healthy individuals, the pericardial cavity contains about 15 to 50 mL of an ultrafiltrate of plasma. Diseases of the pericardium present clinically in four ways:

1. Acute and recurrent pericarditis.

2. Cardiac tamponade is an acute type of pericardial effusion in which the heart is compressed, either by blood or by a penetrating injury, so that its normal function is impeded.

3. Pericardial effusion is an outpouring of fluid into the pericardial cavity seen in pericarditis.

4. Constrictive pericarditis is a condition in which a chronic inflammatory thickening of the pericardium compresses the heart so it is unable to fill normally during diastole.

Pathophysiology and Etiology 

1. Acute idiopathic pericarditis is the most common and typical form; etiology unknown.

 2. Infection.

   a. Viral (influenza, coxsackievirus, HIV).

   b. Bacterial—Staphylococcus, meningococcus, Streptococcus, pneumococcus, gonococcus, Mycobacterium tuberculosis.

   c. Fungal.

   d. Parasitic.

 3. Connective tissue disorders (lupus erythematosus, periarteritis nodosa); and gastrointestinal diseases (ulcerative colitis, Crohn’s and Whipple disease).

 4. MI; early, 24 to 72 hours; or late, 1 week to 2 years after MI (Dressler’s syndrome).

 5. Malignant disease; thoracic irradiation (primary or metastatic pericardial tumors).

 6. Chest trauma, heart surgery, including pacemaker implantation.

 7. Drug-induced—procainamide, phenytoin, hydralazine, and isoniazid.

 8. Asbestosis (may induce pericardial as well as lung lesions).

 9. Metabolic disorders such as uremia; hypothyroidism may cause pericardial effusion, not necessarily pericarditis.

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Clinical Manifestations

 1. Pain in anterior chest, aggravated by thoracic motion—may vary from mild to sharp and severe; located in precordial area (maybe felt beneath clavicle, neck, scapular region); may be relieved by leaning forward.

 2. Pericardial friction rub—scratchy, grating, or creaking sound occurring in the presence of pericardial inflammation.

 3. Edema, ascites, and dyspnea—from pericardial effusion and cardiac tamponade.

 4. Fever, sweating, chills—due to inflammation of pericardium.

 5. Dysrhythmias.

Diagnostic Evaluation

 1. Echocardiogram—most sensitive method for detecting pericardial effusion.

 2. Chest x-ray—may show enlarged cardiac silhouette with clear lung fields.

 3. ECG—to evaluate for MI (acute stage of pericarditis, ST elevation is found in several or all leads).

4. WBC count and differential indicating infection.

5. Antinuclear antibody serologic tests elevated in lupus erythematosus.

6. Purified protein derivative test positive in tuberculosis.

7. ASO titers—elevated if rheumatic fever is present.

8. BUN—to evaluate for uremia.

9. Elevated erythrocyte sedimentation rate and serum C-reactive protein levels.

10. Elevated cardiac biomarkers –troponin and MB fraction of creatinine kinase.

11. Pericardiocentesis—for examination of pericardial fluid for etiologic diagnosis and relief from cardiac tamponade.

12. Cardiac MRI or CT.

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The objectives of treatment are targeted toward determining the etiology of the problem; administering pharmacologic therapy for specified etiology when known; and being alert to the possible complication of cardiac tamponade.

1. Bacterial pericarditis—penicillin or other antimicrobials.

2. Rheumatic fever—penicillin G and other antimicrobials.

3. Tuberculosis—antituberculosis chemotherapy.

4. Fungal pericarditis—amphotericin B and fluconazole.

5. Systemic lupus erythematosus—corticosteroids.

6. Renal pericarditis—dialysis, biochemical control of end-stage renal disease.

7. Neoplastic pericarditis—intrapericardial instillation of chemotherapy; radiotherapy.

8. Post-MI syndrome—bed rest, aspirin, prednisone.

9. Postpericardiotomy syndrome (after open-heart surgery)—treat symptomatically.

10. Emergency pericardiocentesis if cardiac tamponade develops.

11. Partial pericardiectomy (pericardial “window”) or total pericardiectomy for recurrent constrictive pericarditis.

12. NSAIDs are recommended for symptom relief of acute pericarditis; colchicine and steroid regimen are used as adjunct to NSAID therapy


1. Cardiac tamponade.

2. Heart failure.

3. Hemopericardium (especially patients receiving anticoagulants after MI).

Nursing Assessment

1. Assess chest pain.

   a. Ask the patient if pain is aggravated by breathing, turning in bed, twisting body, coughing, yawning, or swallowing.

   b. Assess for relief by sitting up and/or leaning forward.

   c. Be alert to the patient’s medical diagnoses when assessing pain. Post-MI patients may experience a dull, crushing pain radiating to neck, arm, and shoulders, mimicking an extension of infarction. Report change in character of chest pain or worsening pain.

2. Auscultate heart sounds.

   a. Listen for pericardial 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.

Nursing Diagnoses

1. Acute Pain related to pericardial inflammation.

2. Decreased Cardiac Output related to impaired ventricular expansion.

Nursing Interventions

Reducing Discomfort

1. Give prescribed drug regimen for pain and symptomatic relief.

2. Relieve the anxiety of patient and family by explaining the difference between pain of pericarditis and pain of recurrent MI. (Patients may fear extension of myocardial tissue damage.)

3. Explain to patient and family that pericarditis does not indicate further heart damage.

4. Encourage the patient to remain on bed rest when chest pain, fever, and friction rub occur.

5. Assist patient to the position of comfort.

Maintaining Cardiac Output 

1. Assess heart rate, rhythm, BP, respirations at least hourly in the acute phase; continuously if 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. Keep pericardiocentesis tray at bedside.

4. Assess for signs of heart failure.

5. Monitor closely for the development of dysrhythmias.

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Patient Education and Health Maintenance

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.

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