Pericarditis & Cardiac Tamponade Nursing Care

Pericarditis is inflammation of the pericardial sac — most often viral/idiopathic, but also from MI (Dressler’s), uremia, autoimmune disease, cancer, or after cardiac surgery. It causes sharp, pleuritic chest pain and a friction rub. The feared progression is a pericardial effusion — fluid in the sac — that, if it accumulates fast enough, compresses the heart so it can’t fill: cardiac tamponade. Tamponade drops cardiac output and is rapidly fatal without drainage (pericardiocentesis).

Pericarditis: sharp pleuritic chest pain better leaning forward, a friction rub, low-grade fever, and diffuse ST elevation on ECG. Developing tamponade: rising heart rate, falling blood pressure, JVD, muffled heart sounds, pulsus paradoxus, narrowing pulse pressure, dyspnea, anxiety/restlessness, and signs of poor perfusion. Echocardiography confirms an effusion and tamponade physiology. Distinguish pericarditis from MI (positional, pleuritic, diffuse ST elevation vs the pressure-like, localized picture of ischemia).

Chest pain is frightening, and patients often fear they are having a heart attack — explain how pericarditis differs and that the positional relief is reassuring. If tamponade develops, the situation moves fast; communicate calmly and clearly while acting, and keep the patient and family informed about the need for urgent drainage. After recovery, address anxiety about recurrence (pericarditis can recur) and the importance of finishing anti-inflammatory therapy.

Teach that sitting up and leaning forward eases the pain and that NSAIDs/colchicine must be taken as prescribed (often for weeks) to prevent recurrence — don’t stop early. Teach the warning signs to seek emergency care: worsening shortness of breath, lightheadedness/fainting, rapid heartbeat, or swelling of the neck veins — these can signal a building effusion. Review the underlying cause and its management (e.g., dialysis adherence for uremic pericarditis), and the plan for follow-up echocardiograms.