Pericardial Disease for NP
Pericardial Disease for the Nurse Practitioner Licensing Exam
Types of Pericardial Disease
Pericardial disease includes acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis, each with specific clinical and diagnostic features.
Acute Pericarditis
- Etiology:
- Infectious: Primarily viral (e.g., Coxsackievirus), but also bacterial (e.g., tuberculosis).
- Non-infectious: Post-myocardial infarction (Dressler syndrome), autoimmune disorders (e.g., lupus), uremia, neoplastic, and certain medications.
- Clinical Presentation:
- Chest Pain: Sharp and pleuritic, relieved by sitting up and leaning forward.
- Pericardial Friction Rub: Classic finding on auscultation.
- Diagnosis:
- ECG: Diffuse ST-segment elevation and PR-segment depression.
- Blood Tests: Elevated inflammatory markers (e.g., CRP, ESR).
- Management:
- NSAIDs or Aspirin: First-line therapy.
- Colchicine: Added to reduce recurrence.
- Glucocorticoids: Reserved for refractory cases.
Pericardial Effusion
- Etiology: Often secondary to pericarditis, hypothyroidism, malignancy, or trauma.
- Clinical Presentation:
- Dyspnea and chest discomfort; large effusions may compress nearby structures.
- Diagnosis:
- Echocardiogram: Primary diagnostic tool, showing fluid accumulation around the heart.
- Management:
- Observation: For small, asymptomatic effusions.
- Pericardiocentesis: Indicated for large, symptomatic effusions or signs of tamponade.
Cardiac Tamponade
- Pathophysiology: Rapid fluid accumulation increases intrapericardial pressure, restricting cardiac filling.
- Clinical Presentation:
- Beck’s Triad: Hypotension, distended neck veins, muffled heart sounds.
- Pulsus Paradoxus: Decrease in systolic blood pressure >10 mm Hg with inspiration.
- Diagnosis:
- Echocardiogram: Shows diastolic collapse of right heart chambers.
- Management:
- Urgent Pericardiocentesis: Immediate drainage is needed to relieve tamponade.
Constrictive Pericarditis
- Pathophysiology: Pericardial scarring restricts ventricular filling, causing symptoms of heart failure.
- Clinical Presentation:
- Right Heart Failure Signs: Edema, ascites, hepatomegaly.
- Kussmaul’s Sign: Jugular venous pressure rises on inspiration.
- Management:
- Diuretics: For volume control.
- Pericardiectomy: Definitive treatment in refractory cases.
Key Points
- Acute Pericarditis: Presents with pleuritic chest pain and pericardial rub; treated with NSAIDs, colchicine, and occasionally corticosteroids.
- Pericardial Effusion: May be asymptomatic; echocardiography is diagnostic. Observation or pericardiocentesis based on severity.
- Cardiac Tamponade: Presents with Beck’s triad and pulsus paradoxus; requires urgent pericardiocentesis.
- Constrictive Pericarditis: Causes right heart failure signs; managed with diuretics and pericardiectomy if severe.