Question

A patient who is 4 days post–coronary artery bypass surgery reports she is having new chest pain that is “different from my angina pain.” The pain’s onset was 5 or 6 hours ago upon first waking up in the morning. The patient has a new pericardial friction rub and a low-grade fever of 100.5°F. The patient is diagnosed with acute pericarditis. a. Why was this patient at risk for developing pericarditis? b. Why is this patient now at risk for cardiac tamponade? c. What are the signs or symptoms that would be indicative of cardiac tamponade in this patient? What is the underlying pathophysiology of these signs and symptoms?

Answer 1

A. Why was this patient at risk for developing pericarditis?

Pericarditis following coronary bypass surgery is an unusual complication with occurrence rate of 0.2~0.3%.The pathogenesis of pericarditis after cardiac surgery remains unknown. Howeve,r it is believed to be an autoimmune response against damaged cardiac tissue . This is supported by excellent response to immunosuppressive (steroid) therapy.

B. Why is this patient now at risk for cardiac tamponade?

Cardiac tamponade is a serious medical condition in which blood or fluids fill the space between the sac that encases the heart and the heart muscle.  Cardiac tamponade is usually the result of penetration of the pericardium. pericardial penetration or fluid accumulation may be due pericarditis- an inflammation of the pericardium.

C-What are the signs or symptoms that would be indicative of cardiac tamponade in this patient? What is the underlying pathophysiology of these signs and symptoms?

SIGN & Symptoms:

• Beck triad-Hypotension, Muffled heart sounds, Distended neck veins
• anxiety and restlessness
• low blood pressure
• weakness
• chest pain radiating to your neck, shoulders, or back
• trouble breathing or taking deep breaths
• rapid breathing
• fainting, dizziness, and loss of consciousness

Pathophysiology-

Pericardial fluid collection (bloody or serous) → ↑ pressure in the pericardial space → compression of the heart → interventricular septum shift toward the left ventricle chamber → decrease ventricular diastolic filling → ↓ stroke volume (and venous congestion) → ↓ cardiac output leads to hypotension and other symptoms.