Treatment and care for people with pericarditis

Treatment of pericarditis requires early and rapid implementation to avoid complications of acute tamponade. The care regime for patients with pericarditis also needs to be focused.

The article is professionally consulted by Interventional Cardiologists, Vinmec Hai Phong International General Hospital.

1.1. Principles of treatment: - Reduce pain and reduce inflammation of pericarditis
- Treat the cause of acute pericarditis
- Check for complications: acute cardiac tamponade, constrictive pericarditis,...
1.2. Initial treatment evaluation The following are clinical features of acute pericarditis in high-risk subjects requiring hospitalization for evaluation and treatment:
Fever > 38 degrees Celsius Already have symptoms of cardiac tamponade Acute Severe pericardial effusion (right preventricular echo space in the subcostal view > 20 mm) Have an autoimmune disease History of being treated with a vitamin K antagonist Has an acute injury Poor response to antibiotic therapy NSAIDs for 7 days Elevated cardiac enzymes (differential diagnosis of myocarditis). If the patient does not have the above clinical features, it can be treated as an outpatient.
1.3. Treatment of pericardial effusion according to the cause Depending on the cause of the disease, the doctor will prescribe different treatment measures:
Acute viral pericarditis: Antibiotics and anti-inflammatory corticosteroids can be used within 2 - 3 weeks Tuberculosis pericarditis: Treatment according to anti-tuberculosis regimens, often in combination with anti-tuberculosis drugs. Dosage depends on the patient's weight. Typically, patients receive a loading dose within the first two months followed by 6 months of a consolidation dose. Follow-up after treatment takes place within 1 to 2 years. If constrictive pericarditis is present, the patient should be operated on soon. After treatment Purulent pericarditis: it is necessary to treat purulent drainage early, use specific antibiotics according to the results of the antibiogram. To prevent complications of chronic constrictive pericarditis, early surgical removal of the pericardium is recommended. 1.4. Symptomatic treatment of chest pain: Pain can be reduced by drugs such as aspirin, diclofenac, tranquilizers,... Anti-inflammatory pericardial adhesions with some drugs such as αchymotripsin, indomethacin, prednisolone,... Week stagnation Complete pericardial effusion, release of cardiac tamponade will help reduce and stop venous stasis. Diuretics and inotropes are used in some specific cases (if necessary). 1.5. Surgical treatment In case the patient has chronic constrictive pericarditis, pericardial dissection is the main measure to improve the hemodynamic status. When performing heart surgery, it is best to remove the entire pericardium that has been thickened, if the prognosis is poor, only a few areas can be peeled off.
For patients treated for pericarditis at a late stage, the pericardium has become quite thick, hard, sticking close to the heart muscle, the ability to thoroughly remove the pericardium will be very difficult because it is easy to tear the heart muscle and high risk of serious complications after surgery.

2.1. Help the patient relieve chest pain Stabilize the posture: For the patient to sit, it is best to sit on the bed, lean back against the wall or sit on a recliner (because in a sitting position with back rest, the patient will be less painful and more convenient. when moving).
Implement medication orders:
Analgesics: Can relieve chest pain for patients with pericarditis with intravenous Morphine, but it is necessary to pay attention to counting the breathing rate before doing it, because Morphine has an effect. used to depress the breathing center; Antibiotics if due to bacterial infection; Anti-inflammatory drugs. 2.2. Prevention and management of cardiac tamponade In cases where the patient does not respond to the treatment regimen, pericardial fluid is at risk of increasing and accumulating between the 2 pericardial leaves, leading to pericardial effusion. This fluid, if present a lot and suddenly, will make the heart unable to relax, causing a decrease in myocardial contractility and a serious decrease in cardiac output.
Nurses need to be aware of the early signs and symptoms of cardiac tamponade, including:
Clamp blood pressure: The patient has a decrease in arterial blood pressure, often systolic blood pressure decreases, while blood pressure decreases. diastolic pressure does not change, leading to a decrease in blood pressure gradient; Distended neck veins; Heart sounds become faint; Peripheral and central venous pressures are elevated. The cause of these symptoms is that blood continues to be transported from the periphery through the venous system back to the heart, but the heart cannot dilate to receive blood and pump blood into the systemic circulation.
In the process of taking care of patients with pericarditis, if they notice the above signs, the nurse must immediately notify the treating doctor, and at the same time prepare all the necessary tools and means to work together. The doctor performed a pericardial puncture.
After completing the pericardiocentesis, the nurse will stay with the patient to continue to monitor and record any abnormal signs, if any, until the doctor prescribes a new treatment.

Pericarditis, if diagnosed and treated early, can reduce the risk of dangerous complications.
To help patients determine the cause, complications and grade of pericarditis, Vinmec International Hospital now has a Cardiovascular Screening Package - Basic Cardiovascular Examination, for the following subjects: Cold limbs. ; heart palpitations; Rapidly breath; Anxiety, insomnia; Shoulder, wrist pain; Unexplained fatigue; Sweating, indigestion; Swollen feet; Frequent migraine headaches; There is a feeling of tightness when walking; Family with heart disease...
Advantages of cardiovascular screening at Vinmec International General Hospital include:
Medical team - doctors are leading experts, highly qualified , devoted and wholeheartedly for the benefit of the patient, bringing high efficiency in medical treatment; Comprehensive and professional medical examination, consultation and treatment services; A system of modern equipment, supporting effective diagnosis and treatment; Modern, civilized, luxurious and sterile medical examination and treatment space.