PERICARDITIS

CLINICAL SCENARIO
NURSING HEALTH HISTORY:
PATIENT’S PROFILE
Name of Patient: Patient MA
Sex: Female
Age: 43years old
Religion: Roman Catholic
Civil Status: Married
Address: Sta. Maria, Bulacan
Nationality: Filipino
Chief complaint:“Sumasakit ang dibdib
ko at nahihirapan akong huminga”
Diagnosis: Pericarditis with Tamponade

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 CLINICAL SCENARIO
HISTORY OF PAST AND PRESENT ILLNESS:
Patient Ma is a 43-year-old woman with a past medical history notable only for tobacco use presented
herself to FUMC with her husband due to increasing chest pain and difficulty of breathing. The chest pain was
substernal, sharp, pleuritic, and radiated to both shoulders. It had been present for two days but became
progressively worse and was associated with dyspnea which prompted her to present for medical attention. She
also noted that she had an upper respiratory infection that started about a week before these symptoms began.
She had a family history of sarcoidosis but no personal history of any autoimmune disorder.Initial vital signs
were notable for tachycardia at 120 beats per minute and BP of 110/70. Physical exam was normal and no
friction rub was auscultated on exam.
Initial ECG (Fig 1) showed diffuse ST elevations with PR depression and an initial echocardiogram showed a
large circumferential pericardial effusion with right ventricular collapse (Fig 2). An erythrocyte
sedimentation rate was elevated at 60mm/h. She underwent urgent pericardiocentesis with removal of
400cc of straw colored fluid. Cytopathology noted many inflammatory cells with no malignant cells. A
viral respiratory panel was negative. Cardiac magnetic resonance imaging (Fig 3) after pericardiocentesis
suggested ongoing pericardial inflammation. 3
 Figure 1: 12 Lead ECG

CLINICAL SCENARIO
DIAGNOSTIC TEST:
- 12 Lead ECG shows diffuse ST elevations (most prominent in
leads V4-V6, II, aVF) with diffuse PR depressions (most notable in
V5-V6) and PR elevation in lead aVR.

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 Figure 2: Echocardiogram

CLINICAL SCENARIO
DIAGNOSTIC TEST:
- Transthoracic echocardiogram with subcostal window showing
right ventricular diastolic collapse (arrows).

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 Figure 3: Cardiac MRI

CLINICAL SCENARIO
DIAGNOSTIC TEST:
- Cardiac magnetic resonance image in the sagittal projection
with delayed hyper enhancement of the pericardium after
gadolinium administration. The markedly increased pericardial
signal (arrows) suggests ongoing inflammation.

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MY AND
PHYSIO
LOGY

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pericardium
(NORMAL)

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pericardium
(INFLAMED)

Pericarditis refers to an inflammation of the

pericardium, which is the membranous sac
enveloping the heart. It may be a primary illness, or
it may develop during various medical and surgical
disorders. For example, pericarditis may occur after
pericardiectomy (opening of the pericardium)
following cardiac surgery. Pericarditis also may
occur 10 days to 2 months after acute myocardial
infarction (Dressler syndrome) (Curry, 2014; Mannet
al., 2015). Pericarditis may be acute, chronic, or
recurring. It is classified either as adhesive
(constrictive), because the layers of the pericardium
become attached to each other and restrict
ventricular filling, or by what accumulates in the
pericardial sac: serous (serum), purulent (pus),
calcific (calcium deposits), fibrinous (clotting
proteins), sanguinous(blood), or malignant (cancer).
Pericarditis also may be described as exudative or 9
PATHOPH
YsIOLOG
Y
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Non-modifiable Risk Factor Modifiable Risk Factor
Family history of sarcoidosis Lifestyle (Smoking)

Cross-reactivity of
infectious antigens with
body’s own antigens.

Infection stimulates host

immune reaction (unknown
mechanism)

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Enlarged pericardium,
injury and inflammation
of pericardial sac.

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Nursing
care plan
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Thanks!
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THANK YOU