Pericarditis.pptx

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

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.

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.

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

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

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

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.

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

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

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

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

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

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.

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.

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.

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

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.

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.

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.

Pericarditis.pptx

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Pericarditis.pptx