consists of P.E,cardiac tamponade and myocardial rupture and describes their definitions, pathophysiologies, clinical manifestations, dx, medical-surgical mgt and nursing mgt for more inquiries/feedback; gufuabdikadir96@gmail.com

1. Pericardial Effusion, Cardiac
Tamponade and Myocardial Rupture
Gufu Abdikadir,
BScN/2015/40718

2. Pericardial Effusion
…

3. Definition
• Abnormal accumulation of fluid around the
heart i.e. pericardial cavity >increase
intrapericardial pressure

4. Physiology pericardium
• Pericardium> tough layered sac. Contains
pericardial fluid. In heartbeat, pericardial fluid
provides lubrication for the heart.
• Pericardial fluid >yellow clear about 10-50ml
• Pericardial effusion > 100ml-2L

6. Pericardial Effusion
Etiologies/causes
• Trauma
• Pericarditis
• Fungi
• Bacteria
• Virus (immunocompromised patient)
• Carcinoma
• p

7. Pathophysiology
• Normal intrapericardial pressure approx. to intrapleural pressure . In a
disease , as more fluid accumulates in the pericardial space, of the
pericardium ability to stretch is eventually exceeded, and further fluid
accumulation subsequently results in increases in intrapericardial
pressure. When the intrapericardial pressure increases to the pressure of
the right atrium and ventricle (normally 4 to 8 mm Hg), cardiac
tamponade develops. Cardiac tamponade results in decreases in venous
return, ventricular filling, stroke volume, and cardiac output.Increases in
heart rate and peripheral vascular resistance can initially compensate for
these changes, thereby maintaining normal blood pressure. As the
intrapericardial pressure rises further, left atrial and left ventricular filling
are also compromised. Left-sided dysfunction results in cardiogenic shock
with a significant fall in cardiac output and peripheral blood pressure.
•

8. CONT…
• However, the pericardium can stretch when
pressure is slowly placed on it. The volume of
fluid required to cause cardiac tamponade varies
greatly, depending on the speed with which the
fluid accumulates. In experimental canine
models,13 as little as 25 to 100 ml of fluid rapidly
injected into the pericardial space can raise
intrapericardial pressure high enough to cause
tamponade. In contrast, pericardial effusion that
slowly increases in volume can result in a volume
as high as 2 L in a large-breed dog before cardiac
tamponade manifests.

9. Clinical Presentation
• Bacteria/fungal/virus>pericarditis(inflammation)>per
icardial effusion, the main symptom is chest pain.
worsens on breathing deeply and leaning forward.
• Other symptoms may include:
• fever
• fatigue
• Muscle aches
• Shortness of breath
• nausea, vomiting and diarrhea (if you have a virus)

10. Differential Dx PE & MI
PAIN EXERCISE LYING
DOWN
DEEP
BREATHING
HEART
SOUNDS
MI HEAVY INCREASE NOTHING OK LUB
DUB
PE SHARP NOTHING INCREASES HURTS LUB
LUB
DUB

11. Diagnosis
CXR – Heart silhoutte(outline of image)
Physical exam, auscultate- abnormal heart
sounds
Electrocardiography(EKG)- electrical signal will
show inflammation
Blood test> CRP (plasma protein increases with
inflammation)
CT scan

12. Complication;
Cardiac Tamponade
• If a lot of fluid accumulates ,
it will compresses your heart
, hinders its ability to pump
blood
• >cardiac tamponade

13. Medical mgt
• NSAIDs –e.g diclofenac
• Corticosteroids e.g predinsone
• Antibiotics
• Antifungals
• Surgical
Pericardiocentesis-sunctioning of excess
fluid
Pericardiotomy/pericardial window- small
incision made allow excess fluid drainage

14. Nursing interventions
• Comfortable siting position
• Constant checking VS
• Psychological support+prepare for surgery
• Post op. care
• Bed rest
• input output chart
• Reassure patient
• Help him try move back normal life activities

15. Nursing diagnosis
Ineffective breathing pattern related to
decreased lung capacity as evidenced by
shortness of breath.
Acute pain related to pleural membrane
inflammation as evidenced by the fact that
patient is complaining of a sharp, persistent
chest pain,

16. Cardiac
tamponade
……

17. Definition
• Complication/syndrome >excess accumulation
of fluid in pericardial space> applies pressure
to the heart and hinders ventricular filling of
the heart.

18. Causes
• Malignancy
• Infection - Viral, bacterial (tuberculosis), fungal
• Drugs - Hydralazine, procainamide, isoniazid
• Postcoronary intervention (ie, coronary
dissection and perforation)
• Trauma
• Cardiovascular surgery (postoperative
pericarditis)
• Postmyocardial infarction (free wall ventricular
rupture, Dressler syndrome)
• Iatrogenic - After sternal biopsy, trans venous
pacemaker lead implantation

20. Pathophysiology
• ^sed pericardial fluid> ^se intrapericardial
pressure’
• Intrapericardial pressure equalises to RV
diastolic pressure, then LV diastolic pressure>
decreased cardiac output.

21. Clinical manifestations
• Shortness of breath
• Chest pain
• Fatigue
• Increased heart rate
• Weakness
• Fever

22. Dx
• Electrocardiography- electrical alterations
• Chest XRAY – enlarged cardiac silhouette,
water bottle shaped heart.

23. Medical/Surgical management
• Percutaneous drainage- where needle gauge
16-18 inserted angle of 30-45° at xiphocostal
region left side and excess fluid removed
• dobutamine to enhance
myocardial contractility
and decrease peripheral
vascularresistance.

24. Nursing interventions
• Meanwhile as surgery is yet to be done do;
o Oxygen administration
o Volume expansion- IV /oral fluids
o Bed rest- elevated legs, promote venous
return.
o Monitor VS esp. BPs
o Monitor urinary output

25. Nursing Dx
• Decreased cardiac output related to reduced
ventricular filling secondary to ^sed
intrapericardial pressure.

26. Myocardial
Rupture
……

27. Definition
• Laceration/ tear of ventricular walls, atria,
intra atrial/intraventricular septum which can
lead to mixing of oxygenated and
deoxygenated blood.
• Mostly occurs secondary to myocardial
infarction/ trauma.

29. Causes
• Secondary to myocardial infarction
• Trauma
• Cardiac tumors
• hypertension
*more prone to elders(>60y) and men

30. Pathophysiology
• Ischemic myocardial rupture after Acute Myocardial
Infarction may involve left ventricular (LV) and right
ventricular (RV) free walls, ventricular septum, and LV ,
in decreasing order of frequency. .
• The consequences of myocardial rupture in the setting
of AMI can include the following:
• Pericardial tamponade
• Ventricular septal defect (VSD) with left-to-right shunt
• Acute mitral regurgitation (MR)
• Formation of a pseudoaneurysm

31. Clinical manifestation
• Persistent chest pain – on auscultation
• Syncope- temporary loss of conscious caused
by decrease in blood pressure
• distended jugular vein-rupture> interferes
with filling of ventricles >increase central
venous pressure.

32. Dx
• Echocardiography
• Physical examination
• Vital signs

33. Medical/Surgical mgt
• Early detection is essential and surgery of the
heart needs to be done to repair the defect.
• Meanwhile before surgery;
Analgesics e.g PCM


34. Nursing interventions
• It’s a medical emergency, patient should be
taken to theatre immediately

35. Nursing Dx
• Acute pain related to trauma as evidenced by
persistent chest pain.
• Loss of consciousness related to hypovolemia
as evidenced by low blood pressure.

36. …