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 Featured ArticleAcute Pericarditis: Best Practices for Nurse PractitionersIntroductionPericardial diseases may be encountered in both inpatient and outpatient clinical settings.1 These diseases include pericarditis, pericardial effusion, cardiac tamponade, and pericardial masses.1 Among these, pericarditis is the most common.2,3 In fact, acute pericarditis (AP) is responsible for approximately 5% of patients who present with acute nonischemic chest pain in the emergency department4,5 and for 0.2% of all hospital admissions related to cardiovascular diseases.1 Despite affecting patients of all ages and genders,3 AP occurs more commonly in men between the ages of 16 and 65,1 often requires hospitalization,6 and is associated with increased morbidity, mortality, and health care costs.6 Pericarditis can be categorized as acute, incessant, recurrent, or chronic based on the duration and recurrence of clinical manifestations.1,4 AP is the first episode of pericardial inflammation, which may be caused by an infectious or noninfectious etiology, resulting in a new onset of a specific combination of clinical symptoms and diagnostic findings.7 Appropriate diagnosis and treatment of AP are essential for symptom management and to reduce recurrence and complications. Section snippetsPresentationThe classic clinical manifestation of AP includes chest pain (>85–90%) that is sharp, pleuritic, and improves when sitting up and leaning forward. Also indicative of AP are pericardial friction rub (up to 33%), electrocardiogram (ECG) changes (up to 60%) with new global ST segment elevation and/or PR depression, and new or worsening pericardial effusion (up to 60%).1 Other clinical findings may be evident based on underlying etiology, which may include fever, dyspnea, leukocytosis, pleural DiagnosisIn 2015, the European Society of Cardiology (ESC) published updated guidelines that include precise diagnostic criteria for AP. Clinical diagnosis requires the presence of at least 2 of the 4 classic manifestations: pleuritic chest pain, pericardial friction rub, widespread ST elevation or PR depression, and new or worsening pericardial effusion.1,5 Chest pain is the most common symptom in AP patients; the pain is typically sharp, pleuritic, and alleviated by the tripod position.1 Pericardial ManagementRisk stratification is crucial in AP clinical management to determine the most appropriate clinical setting to safely monitor and treat patients. The risk of complications and poor outcomes is increased in patients whose specific AP etiology is identified and/or those with high-risk clinical features, including a fever greater than 100.4°F, a gradual presentation of symptoms, the presence of a large pericardial effusion as evidenced by an echo-free space larger than 20 mm, tamponade physiology, Interdisciplinary ConsiderationsA referral to a pericardial disease specialist may be necessary in patients who remain symptomatic with conventional treatment so that they can benefit from advanced therapies.18 Although an IL-1b receptor antagonist (anakinra) has been shown to reduce the risk of further recurrence in patients who are refractory to colchicine and dependent on a corticosteroid,19 its effect in AP has not been established.8 Anakinra along with other steroid-sparing agents, such as azathioprine and intravenous ConclusionAP is the most frequently encountered pericardial disease in clinical practice. Nurse practitioners in both inpatient and outpatient settings must accurately diagnose and manage patients to reduce the potential sequelae and recurrence of pericarditis. AP diagnosis can be accomplished if patients have 2 of the 4 classic clinical findings: pericarditic chest pain, pericardial friction rub, diffused ST elevation or PR depression, and new or worsening pericardial effusion. Antiinflammatory therapy Roathipoun Po, MSN, AGACNP-BC, is a graduate of Vanderbilt University School of Nursing, Nashville, TN, and can be contacted at [email protected].
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Roathipoun Po, MSN, AGACNP-BC, is a graduate of Vanderbilt University School of Nursing, Nashville, TN, and can be contacted at [email protected]. Courtney J. Cook, DNP, ACNP-BC, is an assistant professor, Vanderbilt University School of Nursing, Nashville, TN. View full text© 2020 Elsevier Inc. All rights reserved. What are the signs and symptoms of acute pericarditis?Other signs and symptoms of pericarditis may include:. Cough.. Fatigue or general feeling of weakness or being sick.. Leg swelling.. Low-grade fever.. Pounding or racing heartbeat (heart palpitations). Shortness of breath when lying down.. Swelling of the belly (abdomen). What findings would expect to see in a patient with pericarditis?The most common sign of acute pericarditis is chest pain, usually worsened when taking a deep breath. This pleuritic chest pain begins suddenly, is often sharp, and is felt over the front of the chest. Dull, crushing chest pain, similar to that of a heart attack, can also occur.
What is the most common complaint of a patient with acute pericarditis?Patients typically complain of sharp central chest pain that worsens with recumbency and is relieved by leaning forward. The pain associated with acute pericarditis may be pleuritic in nature and may radiate to the ridge of the trapezius, a sign very specific for pericardial inflammation.
What are the ECG hallmarks of pericarditis?Stage 1 accompanies the onset of acute pain and is the hallmark of acute pericarditis. ECG changes include diffuse concave upward ST elevation, except in leads aVR and V1 (usually depressed). T waves are upright in the leads with ST elevation, and the PR segment deviates opposite to P-wave polarity.
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Which of the following is a hallmark finding in a patient with acute pericarditis?
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