Med-Surg - Cardiovascular System, part 10: Pericarditis, Tamponade, Cardiomyopathy
by Cathy Parkes October 06, 2021 Updated: April 24, 2022 5 min read
Hi, I'm Cathy with Level Up RN. In this video, we are going to cover pericarditis, cardiac tamponade, as well as cardiomyopathy. Be sure to stay till the end of the video because I'm going to give you guys a quiz to test your understanding of some of the key facts I will be covering in this video. Also, if you have our Level Up RN medical surgical nursing flashcards, definitely pull those out so you can follow along with me.
First up, we have pericarditis, which is inflammation of the pericardium, which is the sac that surrounds the heart. So if you break that word down, peri means around, card is short for cardiovascular, pertaining to the heart, itis means inflammation of. So we have inflammation of the sac that surrounds the heart.
This inflammatory response can be triggered by an infection from an autoimmune disorder or some kind of trauma.
So signs and symptoms of pericarditis may include chest pain. So this chest pain will be worse when the patient is laying flat on their back in a supine position, and it will be better when they sit up and they lean forward. When you listen to their heart, you may hear a friction rub. Other signs and symptoms include fever, dysrhythmias, as well as dyspnea, so difficulty with breathing.
In terms of diagnosis, if we do an EKG, we may see some abnormalities there, specifically ST or T spiking. We can also use an echocardiogram to help diagnose pericarditis. And then if the pericarditis is due to a bacterial infection, then the patient's white blood cell count will be elevated.
In terms of medications that can be used, we can use NSAIDs as well as corticosteroids, which will help to decrease the inflammation. We can also use antibiotics for bacterial pericarditis.
In terms of procedures, it may be necessary to do a pericardiectomy, which is removal of part or all of the pericardium.
And then in terms of nursing care, we're going to want to monitor for complications such as a cardiac tamponade, which I'm going to talk about next.
Next up, we have a cardiac tamponade, which is the accumulation of fluid in that pericardial sac, and that puts pressure on the heart such that blood flow is impaired and we have a decrease in cardiac output.
So this disorder can be caused by an MI, as well as an infection and a variety of inflammatory or autoimmune disorders.
So signs and symptoms include hypotension, which makes sense because if we're putting pressure on that heart, that heart is not able to pump blood effectively and we're going to have a decrease in blood pressure. Also, that blood is going to back up, right? Because it's not being pumped through the heart effectively. So we're going to have jugular vein distension.
In addition, when we listen to the patient's heart, we're going to hear muffled heart sounds because there's going to be fluid between your stethoscope and the patient's heart, so you won't be able to hear those heart sounds as well.
In addition, the patient may have what's called paradoxical pulse, so this is a decrease in their systolic blood pressure of 10 mm hg or more during inspiration. In addition, they may have something called electrical alternans. So if we do an EKG on the patient, we may see some variation in the QRS amplitude or height between the different heartbeats. And that's because the heart is kind of swinging back and forth in this fluid, the sac that's filled with fluid. And so that QRS amplitude is going to vary depending on the position of the heart. Other side effects include dyspnea as well as fatigue.
In terms of diagnosis, certainly an EKG can help shed some light. If we see that electrical alternans, then that would be indicative of cardiac tamponade. In addition, we can use a chest X-ray and an echocardiogram to help diagnose this condition.
Treatment includes a pericardiocentesis, which is removal of that fluid from the pericardial sac. So I once had a patient with this condition. She had a lot of trouble breathing with all that fluid surrounding her heart, so she went in and got a pericardiocentesis. They removed a bunch of fluid, and that really provided a lot of relief for that patient.
Next, let's talk about cardiomyopathy, which is a disease of the heart muscle that can lead to pulmonary edema, dysrhythmias, as well as heart failure. There are three main types of cardiomyopathy.
The first is dilated, which is the most common type. This is where the ventricles enlarge and weaken, and it primarily affects systolic function.
Then we have hypertrophic cardiomyopathy. This is where the ventricles and the septum enlarge and thicken, which affects diastolic function and also restricts blood outflow.
And then we have restrictive cardiomyopathy. This is where the ventricles become stiff and rigid, which restricts filling during diastole.
Signs and symptoms of cardiomyopathy include shortness of breath, fatigue, dizziness, as well as arrhythmias and murmurs.
In terms of diagnosis, we can use an echocardiogram, an EKG, and a coronary angiogram may also be necessary.
Medications that are helpful in the treatment of cardiomyopathy include diuretics, as well as digoxin, antidysrhythmic agents, and antihypertensive agents.
For procedures, we can do what's called a septal myectomy. This is where we remove part of the heart muscle in the septum to try to make that septum thinner. We can also do what's called a septal ablation, which is where we inject alcohol into that heart muscle, into the septum, which helps to-- basically kills off that heart muscle and it allows for the septum to be thinner. The patient may require an implanted device, such as a pacemaker or an LVAD, which is a left ventricular assist device, and then they may also require a heart transplant as well.
All right. Quiz time. First question for you. A patient with pericarditis will feel most comfortable in what position? The answer is sitting up and leaning forward, so laying down in a supine position will be most painful. So that chest pain is relieved when they sit up. Question number two What is the treatment for a cardiac tamponade? The answer is a pericardiocentesis. So this is where we're draining the fluid out of that pericardial sac. Question number three. What condition is characterized by the enlargement and thickening of the ventricles of the heart and the septum? The answer is hypertrophic cardiomyopathy.
All right. I hope you did well on that quiz, and I hope this video is helpful. Take care and good luck with studying.
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