Acute Pericarditis Diagnosis

Acute Pericarditis Diagnosis

Acute Pericarditis Diagnosis

Acute Pericarditis Diagnosis Question
The nurse assesses a client diagnosed with acute pericarditis.  Which assessment would require immediate follow-up?

Client reports chest pain that is worse with deep inspiration
Distant heart tones and jugular venous distension
ECG showing ST-segment elevations in all leads
Pericardial friction rub auscultated at the left sternal border

Acute Pericarditis Diagnosis Answer
Correct answer
2 -Distant heart tones and jugular venous distension
Acute Pericarditis Diagnosis Explanation
Acute pericarditis is an inflammation of the pericardium, the double-walled, membranous sac that surrounds the heart.  The inflammation can cause pericardial effusion, a buildup of fluid between the pericardial layers.  A serious, sometimes fatal, complication of acute pericarditis is cardiac tamponade, in which large amounts of pericardial fluid cause the heart to be squeezed and unable to contract effectively.  Heart tones become muffled, cardiac output and blood pressure drop, pulse increases, and the client develops jugular venous distension, pulsus paradoxus, and narrowed pulse pressure.  This life-threatening condition requires emergency pericardiocentesis (insertion of a needle into the pericardial sac to remove the fluid).

(Option 1)  In acute pericarditis, the inflamed layers of the pericardium rub against the heart and cause pain.  This pain is often worse with deep breathing or in the supine position and is relieved by sitting upright and leaning forward.  The client should be placed in Fowler’s or high Fowler’s position for comfort.
(Option 3)  In acute pericarditis, ST-segment elevation is seen in almost all leads (as the entire pericardium is inflamed).  This is in contrast to acute myocardial infarction, in which ST-segment elevation is seen in localized leads (depending on which vessel is occluded).
(Option 4)  Pericardial friction rub is an expected finding with acute pericarditis.  The rubbing together of the inflamed pericardial layers causes the characteristic high-pitched, leathery, and scratchy sound.
Acute Pericarditis Diagnosis Educational objective:
A potentially lethal complication of acute pericarditis is cardiac tamponade.  Signs of tamponade include jugular venous distension, distant heart sounds, and decreased blood pressure.

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