Abstract
Pericarditis is an inflammatory disorder of the serous pericardium. The condition can caused by prolonged drug abuse, recent heart attack, chest trauma, heart damage, severe kidney failure, alcohol abuse, and autoimmune disorders. This paper presents an analysis of pericarditis that result from prolonged drug abuse although some generalities about the condition also contribute to the search for solutions to the condition. The paper explores the clinical manifestation of the condition as chest pains and pericardial rub or noise. A caregiver can help the patient to sit in an upright posture or give analgesics to ease the pains as methods or pre-hospital intervention. In addition, the paper states the ways in which a paramedic can detect the condition by using a stethoscope. Once the condition has been calmed, the physician can administer more analgesics or have the patient undergo Pericardiocentesis or the draining of fluid from the pericardial cavity. In conclusion, the paper presents the ways in which someone can prevent himself or herself from the condition through avoidance of drug abuse and in its place engaging in physical exercises.
Clinical presentation of pericarditis
Pericarditis is an inflammatory disorder of the serous pericardium. The serous pericardium is the one of the components that surrounds the heart. The serous pericardium has a space between its inner visceral and the parietal (outer) parts and it is this part that gets filled with 15 to 50 mls of plasma fluid or an inflammation when one has pericarditis (Narat and Narkath, 2007; Gati & Sharma, 2005). Some of the causes of pericarditis are prolonged drug abuse, recent heart attack, chest trauma, heart damage, severe kidney failure, alcohol abuse, and autoimmune disorders. This paper presents an analysis of pericarditis that result from prolonged drug abuse although it also has substantial consideration of the condition from a general point of view.
How pericarditis affects the human body
The most notable way in which pericarditis presents itself is through chest pains. The chest pains are sharp, sudden in inset and left sided in location. The pain exceeds when one lies down and subsides when one is sitting up or when one is leaning forward. At times, the victim may feel pain on the neck, the arms, and the left shoulder thereby causing the person difficulty in differentiating that pain from myocardial infarction (Narat and Narkath, 2007).
In addition, pericarditis may manifest itself as pericardial friction rub (Gati & Sharma, 2005). In this case, the patient’s chest produces a scratchy and superficial sound. The sound referred as a “pericardial rub” is often audible over the pericardium. The sound often changes with posture and a physician can use a stethoscope to detect the condition. Often the physician will require the patient to halt respiration for a few seconds (Gati and Sharma, 2005). According to Gati and Sharma, the pericardial rub results from maximal movement of the heart inside the pericardial sac.
How pericarditis develops due to long-term drug abuse
Numerous drugs have been associated with adverse health effects. The heart being a critical organ in the body suffers the brunt of drug abuse with alcohol abuse, heroine, cannabis Sativa among others promoting high blood pressure, cardiac arrests among other heart-related conditions. A drug that is commonly associated with pericarditis is cocaine. According to Nguyen, le and Nguyen cocaine use promotes the flow of effusions into cavities such as the pulmonary and the cardiac sacs. Cocaine induces a prothrombotic state, which may lead to pulmonary emboli or an air bubble or clot in the blood (Nguyen, le and Nguyen, 2009). The air bubbles or clots cause pericardial and pulmonary effusions. The presence of excessive effusions in the pericardium signals the inflammations. Alternatively, cocaine may cause direct pulmonary and cardiac toxicity. In addition, cocaine and other drugs, when used for a prolonged period lead to the activation of the sympathetic nervous system and consequent release of adrenergic neurotransmitters that can cause inflammation of the pericardial surfaces thereby leading to pericarditis (Nguyen, Le, and Nguyen, 2009).
Possible pre-hospital interventions
The pre-hospital interventions for pericarditis include adjusting the patient’s body posture and controlled breathing. The patient should sit in an upright position and avoid leaning forward or lying down. In some cases, the pain in the chest increases during inhalation. As such, the patient can avoid hard breathing or any activity that may lead to pressure on the chest. The best way would be to relax and find an upright posture where one can breathe in a relaxed manner.
In case the patient is having extreme pain chest pain and discomfort, s/he can take aspirins, ibuprofen, or a nonsteroidal anti-inflammatory drug (NSAID). According to Gati and Sharma (2005), anti-inflammatory drugs such as NSAID remain the first line of treatment for many uncomplicated cases. Analgesics and bed rest can promote pain relief. These drugs can be procured over the counter. Most importantly, the patient and the caretaker can consult or call for advice from a qualified physician and obtain another relevant advice prior to presenting the patient to a hospital.
How can a Paramedic identify a patient with pericarditis?
A paramedic can identify a patient with pericarditis by enquiring about the patient’s medical history and the listening to the heart beating. When the paramedic hears a scratchy or grating noise, often called a pericardial rub, the person is most likely suffering from pericarditis. The paramedic will use a stethoscope to listen to the condition at the left sternal border (Gati & Sharma, 2005). While listening, the paramedic will often tell the patient to lean forward, sit upright, or breathe harder, softer or hold the breath. All the listening helps the paramedic to distinguish the pericarditis condition from other pulmonary and heart conditions that may exhibit similar or closely related symptoms. For instance halting of respiration for a few seconds can help to distinguish a pericardial rub from a pleural rub (Gati & Sharma, 2005)
Treatment that the patient will receive once in the ER
Once the patient has been taken to the Emergency Room (ER) in cases of acute pericarditis, the physician conducts some tests to verify the most appropriate action to take. The physician should conduct a full physical examination, which entails blood tests, observation of tamponade or increment in pressure within the pericardial cavity because of fluid accumulation. Other tests can include an electrocardiogram (ECG). The ECG checks for characteristic changes in the heart and the blood vessels. The ECG, therefore, shows the extent of any pericardium effusion, which can necessitate other procedures such as pericardiocentesis.
In most cases, acute pericarditis is self-limiting since it is either viral or idiopathic (arising from an unknown cause). In such cases, the physician will recommend NSAIDs and pain relief drugs such as aspirin and ibuprofen (Gati & Sharma 2005). The analgesics often promote quick recovery. Physician can also employ empirical treatment using steroids in case the patient fails to respond to NSAIDs or in case the symptoms are prolonged, recurrent, or severe.
The physician can also conduct Pericardiocentesis or the draining of fluid from the pericardial cavity. Patients with pericardial tamponade or the swelling of the pericardial cavity due to fluid accumulation should undergo pericardiocentesis (Lange and Hillis, 2004). In addition, the procedure can be performed on those suspected to have neoplastic or purulent pericarditis (Lange and Hillis, 2004).
Once a patient has healed from pericarditis, they should keep off from activities that can cause a recurrence of the problem. For instance, person should avoid abusing drugs such as cocaine since it has been proven to promote the occurrence of pericarditis. Moreover, a person should avoid taking alcohol since it has been associated with promoting poor cardiac health. In addition, a person can engage in physical exercises that promote cardiac health. In addition, one should consume plenty of fruits and vegetables that have numerous benefits to cardiac and overall healthy.
References
Gati, Sabiha, & Sharma S. (2005) Pericarditis University Hospital Lewisham, Lewisham High Street, London SE146LH. Orphanet. Retrieved 4 November 2014 from https://www.orpha.net/data/patho/GB/uk-Pericarditis.pdf
Nguyen, H., Nguyen, H., and Le, C. (2009) "A Case of Large Pericardial and Pleural Effusions Associated With Pulmonary Emboli in a User of Crack Cocaine." The Permanente Journal 13.1. 53–56. NCBI. Retrieved 4 Nov. 2014. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC
Narat R. and Karnath, B. (2007) Clinical signs of acute pericarditis and its complications. Hospital Physician. Retrieved 04 November, 2014 from http://www.turner-white.com/memberfile.php?PubCode=hp_jan07_acute.pdf
Lange, R., and Hillis D. (2004) Acute Pericarditis the New England Journal of Medicine. 351:2195-202. 2004. Massachusetts Medical Society.
