Take these steps if you suspect pericarditis
If a patient presents with sharp, stabbing chest pain, this doesn't necessarily mean a myocardial infarction. Your patient might have pericarditis, which can be life-threatening if myocarditis or cardiac tamponade develops.
"Although progression to either of those disease states is rare, if this does occur it becomes a serious situation," says Dee Fontana, RN, MSN, ACNP-BC, ED nurse manager and nurse practitioner at University of Illinois Medical Center in Chicago.
Here are three assessment tips if you suspect pericarditis, from Karen Sylvester, RN, CEN, clinical coordinator for the ED at Abington (PA) Memorial Hospital:
- Listen for a pericardial friction rub. "This is most easily heard at the lower left sternal boarder when the patient is sitting and leaning forward," says Sylvester. "If you are having a difficult time hearing, you can ask the patient to hold their breath."
- Check for a paradoxical pulse over 10 mmHg. "Extra beats can be detected on cardiac auscultation, during inspiration, when compared to the radial pulse," says Sylvester.
- Inquire about recent upper respiratory infections. Ask patients if they have had a runny nose, cough, or scratchy throat.
MI or pericarditis? Ask these questions
The precipitating factors for pericarditis are viral or bacterial illness, says Karen Sylvester, RN, CEN, clinical coordinator for the ED at Abington (PA) Memorial Hospital.
Sylvester recommends asking these questions if you suspect pericarditis:
- When did the pain begin? Was it associated with exertion or activity?
- What makes your pain worse? Exercise, deep breathing, changing positions?
- Have you had any upper respiratory infections lately? Runny nose, cough, scratchy throat? "These are signs and symptoms of viral or bacterial illnesses, which would prompt you to think of pericarditis," says Sylvester.
- What makes your pain better: rest, deep breathing, or changing positions?
- Does leaning forward make the pain decrease any? "Typically, with pericarditis, the chest pain is relieved when the patient sits up and leans forward," says Sylvester. "This does not occur with cardiac pain, which remains constant regardless of position."
Precipitating factors for myocardial infarction are effort-related activity, large meals, and emotional stress, says Sylvester. "An EKG [electrocardiogram] within 10 minutes of arrival will help to determine your next step," she says.
Ask these questions if you suspect your patient is having a myocardial infarction:
- Are you experiencing palpitations, shortness of breath, nausea, vomiting, or diaphoresis?
- What were you doing when the pain began?
- Does anything make the pain worse?
- Is your pain constant? What makes it better?
- How long have you had the pain? Have you had this pain in the past? What was the resulting diagnosis?
- What interventions already have been taken prior to your arrival in the ED: medications, oxygen, and/or antacids?
- Have you had any relief with nitrates?
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