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.

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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.

  1. Why was this patient at risk for developing pericarditis?
  • Post cardiac surgery is a risk factor to developing acute pericarditis. Some of the symptoms of acute pericarditis include pericardial friction rub, chest pain and changes in electrocardiogram. The patient’s findings are indicative of this.
  1. Why is this patient now at risk for cardiac tamponade?
  • The fact that this patient has an infection and inflammation predisposes to the accumulation of fluid in the pericardial cavity thus compressing the heart and making it difficult for blood to circulate properly. Pericarditis is a risk factor for cardiac tamponade.
  1. 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?
  • Signs and symptoms of cardiac tamponade include chest pain, dizziness, anxiety, confusion, low blood pressure, distended neck veins, and muffled heart sounds. The underlying cause of cardiac tamponade in this patient is the pericarditis, once this is resolved then the cardiac tamponade can be also addressed.
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