Page 80 - Critical Care Notes

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CV
Management
■ Administer antimicrobial therapy.
■ Priorities include supporting cardiac function, eradicating the infection, and
preventing complications, such as systemic embolization and heart failure.
■ Do not give anticoagulants because of risk of intracerebral hemorrhage.
Pericarditis
Pericarditis is inflammation of pericardium that can cause fluid to accumulate
in the pericardial space resulting from idiopathic causes, infection (viral,
bacterial or fungal), MI, autoimmune reactions, certain drugs, cancer thera-
pies, or trauma. Dressler’s syndrome is a type of pericarditis following
damage to heart tissue or the pericardium, such as a heart attack, surgery, or
traumatic injury.
Pathophysiology
Primary illness of medical or surgical disorder can be the etiology → pericardi-
um becomes inflamed → can lead to excess fluid accumulation or increased
pressure on the heart leading to tamponade.
Clinical Presentation
Sharp, constant chest pain that is located in the midchest (retrosternal) is the
most common symptom. A hallmark sign of pericarditis is if the patient leans
forward while sitting to relieve chest pain. Pain may radiate to the neck, shoul-
ders, and back; radiation to the ridge of the left trapezius muscle is specific for
pericarditis. ECG changes are new widespread ST elevation or PR depression,
and pericardial effusion may be present.
Depending on the cause, patient may also have fever, malaise, tachypnea,
dyspnea, JVD, and tachycardia. Pericardial friction rub, heard in the lower ster-
nal border, is the most important physical sign.
Diagnostic Tests
■ ECG
■ Echocardiogram
■ Chest x-ray
■ Lab work: cardiac markers, erythrocyte sedimentation rate (ESR), serum
C-reactive protein
■ Serum electrolytes, BUN, creatinine
■ Complete blood count
■ Urinalysis
■ Blood cultures
■ Additional lab work may include tuberculin skin test, antinuclear antibody
titer (ANA), and/or HIV serology
■ Transesophageal echocardiogram (TEE)
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