 Hi, welcome to Nursing School Explained and this video on pericarditis. As a refresher, the heart has three layers. The innermost layer is the endocardium and also includes the heart valves. The middle layer, the actual muscle layer, is called the myocardium and the pericardium is the outermost layer that surrounds the heart. In between the pericardium and the myocardium, there's pericardial fluid that provides for lubrication so the two surfaces don't rub against each other just as we have in the pleural cavity between the visceral and the parietal pleura. Now pericarditis is inflammation of the pericardium and normal volume of that fluid around the myocardium or between the myocardium and the pericardium is usually about 10-15 milliliters. Now causes for pericarditis can be viral such as Epstein-Barr, varicella, HIV, and hepatitis or it can be non-infectious causes such as trauma from pacemaker insertion or any kind of cardiac diagnostic procedure. Radiation treatments or any radiation to the chest can cause inflammation of the pericardium. The dissecting aortic aneurysm can cause pericarditis as well as myxodema which is a complication of hypothyroid. Autoimmune disorders are also known to cause pericarditis and this will be something like rheumatoid arthritis, lupus, scleroderma or any kind of drug reaction that the patient might experience. Signs and symptoms of pericarditis are basically a progressive sharp chest pain that radiates the neck, arms and shoulders. So sounds pretty similar as angina or acute coronary syndrome. So sometimes it is very difficult to distinguish between the two which is why the tests a lot of times are the same to rule out MI. What's different about pericarditis the pain is usually worse with inspiration and when the patient is laying flat and it's better when the patient is sitting up or leans forward and that is basically because the fluid just expands as you lay flat and with inspiration the chest cavity, the pressure in the chest cavity expands putting more pressure on the heart because it kind of compresses the structures and that's why the pain is worse and it's better when you sit up which kind of relieves the heart and when you lean forward it kind of also takes again the pressure off that myocardium. And then the patient probably will have a pericardiofriction rub and that again is because now we've lost the lubrication fluid because of this inflammation and now we can hear the myocardium and the pericardium rubbing against each other. Now a pericardiofriction rub might be very difficult to distinguish from a pleurofriction rub which is more of a lung issue. And the easiest way to determine if you're hearing a rub to see is it coming from the heart or lungs is for to have asked the patient to hold their breath that way you just eliminate the noise of the lungs and if you still hear that rub then it's probably a pericardiofriction rub rather than a pleurofriction rub. Just remember to tell the patient to continue breathing when you're done with listening to their heart. Patients from pericarditis include pericardial effusion and effusion basically means there's extra amounts of liquid in that pericardial sac because remember with any inflammation pericarditis is inflammation the white blood cells the lymphocytes the mast cells will get there trying to battle the inflammation which leads in more fluid accumulation. And then the patient can be short of breath complain of a cough or a hoarseness because this pericardial effusion now basically enlarges the cardio sac which can put pressure on surrounding structures in the chest such as the lungs and the trachea and maybe even all the way up into the voice box. And the patient then will have muffled heart sounds because now this pericardial sac the small area around here is filling up with fluid which compresses the myocardium and then we cannot the sounds will not transmit as normal. Now pericardial effusion can lead to what's called a cardiac tamponade and tamponade just means pressure so now we have so much fluid in that pericardial sac accumulating that it constricts the heart's ability to contract and expand and produce the cardiac output which means so this deep increase of the effusion compresses the heart signs and symptoms again is chest pain but now the patient will be more ill they might have signs and symptoms of decreased perfusion to the brain such as confusion and anxiety they will have signs and symptoms of decreased cardiac output so that blood pressure will drop we will still have those muffled heart sounds and the patient will have a narrowed pulse pressure their respiratory rate and heart rate will go up because now the body is trying to compensate by activating the sympathetic nervous system for the low cardiac output and low perfusion and because we have so much fluid around the heart now that it can't really handle all that fluid that's being pumped back into the heart it's going to back up causing JVD and maybe even peripheral edema that would be more of a later sign so cardiac tamponade is a medical emergency diagnostic tests for pericarditis as well as effusion and tamponade are EKG which might show ST changes echocardiogram chest x-ray CT and MRI imaging studies to see exactly the extent of the pericarditis effusion or tamponade we will definitely want to look at CBC results inflammatory markers ESR and CRP as well as troponin which might be elevated because now the myocardium is not able to contract and there might be damage to the myocardial cells the treatment for the effusion and the tamponade is pericardial synthesis so removal of that excessive fluid that has now accumulated in the pericardial sac now and the way that this is done is the provider will insert a needle right below the sternum at about a 45 degree angle where they will with ultrasound guidance insert the needle to come from the bottom right up into the pericardial sac here and synthesis they will with a syringe aspirate that fluid into their syringe and then send it off to the lab now sometimes if this is a more chronic condition which mostly occurs from patients undergoing radiation therapy they will need what's called a pericardial window which basically means that this needle that has been inserted into their chest is now converted into kind of like a catheter where they will have a collection chamber sitting here so they have this window that's basically open and that allows the fluid to drain so you can imagine that is a very delicate procedure because if that needle gets past the pericardial space it can puncture the myocardium it could irritate it so that it will cause this rithmias you could basically cause a pneumothorax puncturing along with that needle or even lacerate the myocardium in terms of medication treatments because we are dealing with inflammation of the heart muscle and sets and steroids are usually indicated nursing care for a patient with pericarditis always involve cardiac monitoring management of pain elevating the head of the bed decreasing the anxiety and then monitoring the patient for any signs and symptoms of decreased cardiac output by ensuring that the vital signs are stable and if they have this pericardial window conscious monitoring of eyes and nose to see how much output the patient is having thanks for watching this video on pericarditis please also see the other videos on endocarditis and myocarditis so that you really have a good understanding of all the different inflammatory disorders of the heart thanks for watching nursing school explained