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CEN, CCRN, and PCCN Tip - Acute Pericarditis

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  1. Inflammation of the pericardial sac from infection, MI (Dressler’s Syndrome), renal failure (uremia), etc.

  2. S/S: Sudden onset of retrosternal chest pain exacerbated by inspiration, activity, and supine position; and relieved by leaning forward or sitting up; pericardial friction rub at left sternal border; tachycardia and tachypnea; low-grade fever.

  3. DX: Chest x-ray and echocardiogram.

  4. 12 lead ECG: global (diffuse, widespread), concave ST segment elevation in most or all leads without reciprocal changes; tall, peaked T waves in all leads except aVR; PR depression; downsloping TP segment (Spodick's sign).

  5. TX: Anti-inflammatory agents (ibuprofen, aspirin, indocin, etc.), not NTG; allow to lean forward.

  6. Monitor for cardiac tamponade, pleural effusion, constrictive pericarditis.


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