Pericardial Pearl — Pericarditis & Cardiac Tamponade
Sharp chest pain that eases leaning forward, then muffled heart sounds and a falling BP — the pericardial sac is filling
Pearl comes in with sharp substernal chest pain that worsens lying flat and eases when she leans forward, and days later she returns with muffled heart sounds, distended neck veins, and a blood pressure of 84/58.
Pearl's pericarditis begins as sharp, pleuritic chest pain relieved by sitting up and leaning forward, with a friction rub audible on auscultation. Left untreated, inflammation can lead to a pericardial effusion that compresses the heart — cardiac tamponade — announced by Beck's triad of muffled heart sounds, jugular venous distention, and hypotension, plus pulsus paradoxus. Tamponade is an emergency requiring immediate pericardiocentesis to relieve pressure and restore cardiac output.
Read Pericardial Pearl's full story →The story arc
The setup
Pearl had a viral upper respiratory infection two weeks ago and now develops sharp, stabbing chest pain that worsens with deep breathing and lying flat.
The turn
On auscultation the nurse hears a scratchy, high-pitched pericardial friction rub, and Pearl's ECG shows diffuse ST-segment elevation.
The crisis
Days later Pearl returns with muffled heart sounds, jugular venous distention, hypotension at 84/58, and pulsus paradoxus of 15 mmHg on exam.
The save
The nurse recognizes the emergency, ensures emergency pericardiocentesis equipment is ready, and supports the provider in draining the pericardial sac to relieve pressure on the heart.
NCLEX study section — Pericarditis & Cardiac Tamponade
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Cardiovascular
Take this chapter into practice questions on the same topic.