Pericarditis

Question 1

layers of the pericardium

Answer 1

serous pericardium

• visceral layer/epicardium (inner layer)
• parietal layer (outer layer)
• the space in between these two is the pericardial space

fibrous pericardium - the outside covering of the heart (what you would see when looking at the heart)

Question 2

pericarditis

Answer 2

inflammation of the pericardium

Question 3

causes of pericarditis

Answer 3

• idiopathic
• post MI
• acutes exacerbations of systemic connective tissue diseases such as RA & SLE

Question 4

clinical manifestations of pericarditis

Answer 4

• substernal or left precordial pain that radiates to left side of neck, shoulder, and/or back
• grating & oppressive (hard to catch breath)
• aggravated by breathing (inspiration usually), coughing, & swallowing
• exacerbated when supine, relieved by sitting up/leaning over

Question 5

hallmark finding of pericarditis

Answer 5

pericardial friction rub

Question 6

T/F
Nitroglycerin decreases pain associated with pericarditis.

Answer 6

False.
No effect because there is no vessel involvement with pericarditis.

Question 7

Where is a pericardial friction rub best heard when listening with a stethoscope?

Answer 7

lower left sternal border

have patient hold their breath (eliminates breath sounds that could interfere, especially when trying to distinguish between pericardial or pleural friction rub)

patient should lean forward (brings heart closer to chest wall)

Question 8

complications of pericarditis

Answer 8

pericardial effusion

tamponade

Question 9

clinical manifestations of a pericardial effusion

Answer 9

cough
tachypnea
dyspnea
distant/muffled heart sounds

Question 10

clinical manifestations of cardiac tamponade

Answer 10

dyspnea
chest pain
restless
anxious
↓ CO
marked JVD
muffled heart sounds
narrowed pulse pressure
pulsus paradoxus

Question 11

pericardial effusion

Answer 11

build up of fluid in pericardium

Question 12

what causes cardiac tamponade

Answer 12

pleural effusion increases in volume

Question 13

pulse pressure =

Answer 13

SBP - DBP

Question 14

pulsus paradoxus

Answer 14

SBP 10 mm Hg or more higher on expiration than inspiration

OR

SBP 10 mm Hg or more lower on inspiration than expiration

Question 15

how to perform pulsus paradoxus (seasoned clinician)

Answer 15

• inflate cuff beyond palpable blood pressure
• deflate cuff gradually & note when sounds are first audible on expiration only
• id when sounds audible on inspiration AND expiration
• > 10 mm Hg, indication of pulsus paradoxus

Question 16

diagnostic tests of pericarditis

Answer 16

EKG changes (90% of time)
- diffuse widespread ST elevation (not just in "2 contiguous leads" - but in many leads)

Echocardiogram
- determine if complications of either pericardial effusion or cardiac tamponade have occurred

Labs
- ↑ WBC, ↑ ESR, ↑ CRP

Question 17

collaborative care of pericarditis

Answer 17

-bedrest with HOB 45 degrees; anxiety reduction
-Abx if bacterial pericarditis
-NSAIDS for inflammation
naproxem
high dose ibuprofen
colchicine for recurrent pericarditis
-prednisone taper (only if NSAIDS ineffective)
-pericardiocentesis

Question 18

treatment for tamponade

Answer 18

pericardiocentesis

removal of 5-10 ml may ↑ SV by 25-50%