Nursing care
Pericarditis nursing care: what to assess and what to do first
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Pericarditis nursing care starts with recognising sharp, pleuritic chest pain that eases when the patient leans forward and worsens lying flat, a pattern that distinguishes it from a myocardial infarction before any troponin or ECG confirms it. Priorities are pain relief, monitoring for a friction rub, and watching for the early signs of tamponade.
What it is and why it happens
Pericarditis is inflammation of the pericardial sac surrounding the heart, most often triggered by a preceding viral illness, though it can also follow myocardial infarction (Dressler syndrome), cardiac surgery, autoimmune disease, or renal failure with uremia. The inflamed layers rub against each other with every heartbeat, which is the source of both the pain and the friction rub heard on auscultation.
Because the pericardium sits directly against the heart, inflammation here can produce chest pain that mimics cardiac ischemia closely enough to trigger a full cardiac workup. Understanding the cause matters clinically, since idiopathic and viral cases are usually managed with anti-inflammatory therapy and rest, while post-MI or uremic pericarditis point toward a different underlying problem that also needs addressing.
How it presents — what you will actually see
The hallmark symptom is sharp, stabbing chest pain that is pleuritic, meaning it worsens with deep inspiration, coughing, or swallowing, and radiates to the trapezius ridge or left shoulder. The key distinguishing feature is positional: pain worsens when the patient lies supine and eases significantly when they sit up and lean forward, because this position shifts the heart away from the inflamed anterior pericardium.
On auscultation, listen for a pericardial friction rub, a high-pitched, scratchy, grating sound best heard at the left lower sternal border with the patient leaning forward and holding their breath in exhalation. The rub can be intermittent, so its absence on one exam does not rule out pericarditis. Low-grade fever is common, and the ECG classically shows diffuse ST-segment elevation across multiple leads rather than the localized elevation typical of an MI.
Nursing assessment priorities
Take a careful pain history focused on position and quality, because the sitting-forward relief is the detail that separates this from acute coronary syndrome at the bedside, before enzymes or imaging return. Ask specifically whether the pain changes with breathing or position, since ischemic cardiac pain typically does not.
Auscultate heart sounds for a friction rub with the patient upright and leaning forward, and assess for muffled heart sounds, which can signal an evolving pericardial effusion. Monitor vital signs closely, watching for the trend rather than a single reading, and obtain a baseline and serial ECGs since the pattern evolves through recognised stages as the inflammation progresses.
Interventions and what to do first
Position the patient upright, leaning slightly forward, or high Fowler's, which is both a comfort measure and a diagnostic clue if it relieves the pain. Administer NSAIDs as ordered, which are first-line for pain and inflammation in pericarditis, and colchicine is frequently added to reduce recurrence. Avoid anticoagulants in this population unless clearly indicated for another reason, since bleeding into an inflamed pericardial sac can worsen effusion or precipitate tamponade.
Monitor for pulsus paradoxus, an exaggerated drop in systolic blood pressure of more than 10 mmHg during inspiration, which is an early warning sign of tamponade and should prompt immediate provider notification. Keep the patient on continuous cardiac monitoring, limit exertion to reduce cardiac workload, and reassess pain frequently to track whether interventions are working.
Complications to watch for
The most urgent complication is cardiac tamponade, where fluid accumulates in the pericardial sac faster than it can stretch to accommodate, compressing the heart and impairing filling. Watch for Beck's triad: hypotension, muffled heart sounds, and jugular venous distension, alongside pulsus paradoxus and narrowing pulse pressure. This is a medical emergency requiring pericardiocentesis.
Chronic or recurrent pericarditis can progress to constrictive pericarditis, where the pericardium scars and stiffens over time, restricting ventricular filling long after the acute inflammation resolves. Signs include peripheral edema, ascites, and exertional dyspnea developing weeks to months later, so patients with a history of pericarditis should be told to report these symptoms even after they feel recovered.
Patient teaching before discharge
Teach patients to take NSAIDs or colchicine exactly as prescribed and to complete the full course even as symptoms improve, since stopping early is a common driver of recurrence. Explain that mild activity restriction is expected until inflammation resolves, typically confirmed by symptom resolution and normalising inflammatory markers, and that returning to strenuous activity too soon can prolong recovery.
Instruct patients to seek immediate care for worsening shortness of breath, chest pain that no longer responds to position change, or swelling in the legs or abdomen, since these can signal tamponade or progression to constrictive disease. Reinforce that leaning forward relieving the pain was a useful clue at diagnosis, but a return of pain that behaves differently, especially pain that is now constant regardless of position, warrants prompt reassessment rather than waiting it out.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our cardiovascular practice questions are the closest set to what this page covers.
Common questions
How do you tell pericarditis pain from a heart attack at the bedside?
Pericarditis pain is pleuritic, worsens lying flat, and eases when the patient sits up and leans forward. MI pain is typically unaffected by position or breathing. This positional clue is available immediately, well before troponin or ECG results return.
What does a pericardial friction rub sound like?
It is a high-pitched, scratchy or grating sound, often described as similar to leather rubbing together, best heard at the left lower sternal border. It is most audible with the patient leaning forward and can come and go, so a normal exam does not exclude pericarditis.
What is pulsus paradoxus and why does it matter in pericarditis?
It is a drop in systolic blood pressure of more than 10 mmHg during inspiration, caused by exaggerated ventricular interdependence when the pericardial space is compromised. It is an early warning sign of cardiac tamponade and should be reported immediately.
Why are anticoagulants avoided in pericarditis?
Anticoagulation increases the risk of bleeding into the inflamed pericardial sac, which can convert a simple effusion into a hemorrhagic one and precipitate cardiac tamponade. Unless there is a separate clear indication, anticoagulants are generally withheld.
Can pericarditis come back after treatment?
Yes, recurrence is common, particularly if NSAID or colchicine courses are stopped early or tapered too quickly. Recurrent or chronic inflammation can also progress to constrictive pericarditis, so patients should be told to report late-onset swelling or dyspnea even after apparent recovery.
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