Pericarditis.pptx

For 2nd year B.Sc. Nursing students

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

2. 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.

3. 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.

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

5. 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

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

7. 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.

8. 2) Non infectious factors : Uremia Acute Myocardial Infection Neoplasms : Lung cancer, Breast cancer, L eukemia , H odgkin’s Disease Trauma : thoracic surgery, pacemaker insertion, cardiac diagnostic procedures Radiation Dissecting Aortic Aneurysm Myxedema

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

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

11. 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 & E picardial 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

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

13. 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.

14. 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.

15. 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.

16. 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

17. 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.

18. 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.

19. 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.

20. Thank you