Page 746 - Cardiac Nursing

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CHAPTER
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P P P P Pericardial, Myocardial, and
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E E E E Endocardial Disease
Margaret M. McNeill
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Pe P ricardial, myocarddial, and endocardial diseases impact the Pericarditis
health of populations across the globe, and can have a signifi-
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cant impactt on cardiac functionn andd therefore qualityy of lifee. Pe Pericarditis iss thee inflflammation of the periicarddium surrounding
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These diseases translate into a tremendous economic burden; the heart. The acute inflammatory process can produce either
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thus, it is therefore imperative for nurses to know the best prac- serous or purulent fluid, or a dense fibrinous material. The pos-
tices for management of patients with pericardial, myocardial, sible sequelae of pericarditis include cardiac tamponade, recurrent
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and endocardial disorders in order to optimize patient out- pericarditis, and pericardial constriction.
comes. Acute clinically noneffusive or “dry” pericarditis refers to pericar-
dial inflammation without a significant symptom-causing effu-
sion, and is the most commonly recognized pericarditis. Acute in-
flammatory pericarditis usually lasts 1 to 3 weeks and does not
PERICARDIAL DISEASE lead to further problems. Acute effusive pericarditis is pericarditis in
which an effusion is present in the pericardium.
The pericardium is a double-layered fibroserous sac that envelops
the heart, covering almost the entire surface and part of the great
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vessels. The pericardium is composed of two layers, the serosa Etiology
and the fibrosa, which contain nerves, blood vessels, and lym- Pericarditis is caused by many different conditions. The etiolog-
phatics. The fibrous outer layer, also called the parietal peri- ical classification of pericardial diseases comprises infectious
cardium, is attached to the sternum, great vessels, and diaphragm. pericarditis, pericarditis in autoimmune diseases, postmyocar-
The phrenic nerves innervate most of the parietal pericardium. A dial infarction syndrome, and auto-reactive (chronic) pericardi-
serosal layer of cuboidal cells one-cell-layer thick lines the peri- tis. 11 There has been a sharp decline in infectious pericarditis in
cardium. The monocellular serosa directly covers the heart sur- the last few years, except in immunocompromised individuals,
faces and is also known as the visceral pericardium or the epi- such as those with acquired immunodeficiency syndrome
cardium. The pericardial space between the layers normally (AIDS). 12
contains 15 to 35 mL of serous pericardial fluid produced by the Viruses associated with pericarditis include influenza, cox-
visceral pericardial cells. 2,3 sackie A or B, varicella, mumps, hepatitis B, mononucleosis,
The pericardium is a relatively inelastic covering and it exerts and human immunodeficiency virus (HIV). Idiopathic peri-
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a powerful restraining effect on the size of the heart in situations carditis is thought often to be the result of viral pericarditis
of acute volume overload. 2,4 The pericardium also exerts a me- where the virus is never identified. Bacterial infections, such as
chanical effect that enhances normal ventricular interactions that tuberculosis, are rare in the United States, but have surged in
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contribute to the balance of right and left cardiac outputs. The incidence in regions of the world where HIV and AIDS are epi-
pericardium maintains the heart in a stable position and func- demic. Other bacteria that cause pericarditis include Staphylo-
tionally optimum shape within the mediastinum. It acts as a bar- coccus, Pneumococcus, and Streptococcus species. Aspergillosis and
rier to inflammation from contiguous structures and contains de- histoplasmosis are among the fungal infections that can cause
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fensive immunologic components. The layer of pericardial fluid pericarditis.
reduces friction on the epicardium and equalizes gravitational, hy- Frequently, the patient’s history indicates that a viral infec-
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drostatic, and inertial forces over the surface of the heart. While tion preceded the pericarditis. Sometimes the pericarditis itself is
the pericardium serves several functions, cardiac activity is normal the first presenting symptom of a systemic disease, such as sys-
if the pericardium is missing due to congenital absence or surgical temic lupus erythematosus or malignancy. In viral pericarditis,
removal. the pericardial fluid is most commonly serous, of low volume,
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Almost every known medical and surgical pathologic process and resolves spontaneously. Exudative, hemorrhagic, and leuko-
can contribute to pericardial disease, either primarily involving the cyte-filled large effusions may be associated with neoplastic, tu-
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pericardium or with an indirect impact. For unknown reasons, berculous, and purulent pericarditis. 6
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there is a predominance of men with pericardial disease. The spec-
trum of pericardial diseases ranges from congenital defects, peri-
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carditis, neoplasms, and cysts. Pericarditis, pericardial effusion, Assessment Findings
The onset of symptoms can be acute, as is commonly seen in vi-
and car diac tamponade ar e the most impor tant pericar dial condi The onset of symptoms can be acute as is commonly seen in vi
and cardiac tamponade are the most important pericardial condi-
tions to understand. ral pericarditis, or insidious, as seen in uremic pericarditis. Acute
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