Inflammatory Heart Disease: Infective Endocarditis, Pericarditis, and Rheumatic Fever

Comprehensive practice flashcards covering Infective Endocarditis, Pericarditis, and Rheumatic Fever from NSC 386 Adult Health II, testing etiology, diagnostic criteria, clinical manifestations, complications, and nursing interventions.

What is infective endocarditis (IE), and what are the two most common causative microorganisms?

Infective endocarditis is an infection of the endocardial layer of the heart that, if untreated, can result in valve destruction and heart failure. It is most commonly caused by Staphylococcus aureus and Streptococcus viridans.

How do embolizing vegetations differ in their target organs based on whether infective endocarditis is left-sided or right-sided?

Left-sided vegetation embolization affects systemic organs and the extremities, whereas right-sided vegetation embolization affects the lungs.

Which heart valves are most frequently affected in infective endocarditis?

The mitral valve and the aortic valve.

What are the primary risk factors and causes associated with infective endocarditis?

Major risk factors include intravenous (IV) drug use, recent dental procedures (specifically poor dental hygiene), indwelling IV lines (such as central venous catheters), presence of a prosthetic heart valve or cardiac device (such as a pacemaker), prior infective endocarditis, and Rheumatic Heart Disease.

What cardiovascular physical assessment finding is a key clinical sign of infective endocarditis?

A new or changing systolic heart murmur.

What clinical manifestation of infective endocarditis is pictured on this nail bed?

Splinter hemorrhages, which present as thin, reddish-brown lines of blood running vertically beneath the fingernails.

What peripheral cutaneous finding of infective endocarditis is shown here on the palms, and how is it characterized?

Janeway's lesions, which are flat, painless erythematous macules located on the palms or soles.

What peripheral manifestation of infective endocarditis is pictured here on the digit, and how is it characterized?

Osler's nodes, which are raised, painful, erythematous nodules located on the pads of the fingers or toes.

What ophthalmologic complication of infective endocarditis is shown on this retinal examination?

Roth spots, which are hemorrhagic retinal lesions with pale centers that can cause visual impairment.

What specific signs indicate septic embolization from infective endocarditis to the spleen, kidneys, lungs, brain, and peripheral arterial vessels?

• Spleen: Left upper quadrant (LUQ) abdominal pain
• Kidneys: Decreased urine output, hematuria, elevated BUN and creatinine
• Lungs (PE): Sudden shortness of air (SOA), chest pain, dyspnea
• Brain: Stroke-like signs (facial droop, slurred speech)
• Peripheral arteries: Occlusion causing pallor and pulselessness

What major diagnostic finding of infective endocarditis is demonstrated on this echocardiogram?

Mitral valve vegetation and endocardial involvement.

What is the recommended procedure for obtaining blood cultures to diagnose infective endocarditis prior to starting antibiotic therapy?

Obtain $2-3$ sets of blood cultures drawn from separate venipuncture sites to identify the organism and prevent contamination before administering broad-spectrum antibiotics.

What essential patient teaching should be provided to patients with valvular dysfunction or prior infective endocarditis regarding dental care?

Patients must maintain good dental hygiene and inform their healthcare provider or dentist about their heart valve condition, as they may require prophylactic antibiotics before dental procedures to prevent bacteremia.

How are acute, subacute, and chronic pericarditis defined based on onset and duration?

• Acute: Develops rapidly; the pericardial sac becomes inflamed with effusion before the body can adjust.
• Subacute: Develops weeks to months after an inciting event; the body has time to compensate.
• Chronic: Pericarditis persisting for more than $6\text{ months}$.

What are the common etiologies of pericarditis?

Myocardial infarction ($5\%-8\%$ of acute cases), infectious agents (viral, bacterial, fungal), neoplasms/cancers, radiation therapy, and rheumatic diseases/Rheumatic Fever.

What are the classic characteristics of chest pain in acute pericarditis, and how does position affect it?

The pain is typically progressive, severe, and sharp, often radiating. It worsens with deep inspiration and lying flat, and it is characteristically relieved by sitting up and leaning forward.

How can a nurse distinguish between a pericardial friction rub and a pleural friction rub during auscultation?

Have the patient hold their breath. If the scratchy, grating, high-pitched rub is still heard while the patient is not breathing, it is a pericardial friction rub.

What typical electrocardiogram (ECG) change is seen across leads in acute pericarditis?

Diffuse ST-segment elevation.

Why is nitroglycerin ineffective for relieving the chest pain of pericarditis?

Pericarditis pain is caused by inflammation of the pericardial sac rather than myocardial ischemia, so it does not respond to vasodilators like nitroglycerin. It requires anti-inflammatory agents such as NSAIDs (e.g., ibuprofen, indomethacin) or corticosteroids.

What clinical triad of signs defines Beck's triad in cardiac tamponade?

1. Hypotension
2. Jugular venous distension (JVD)
3. Distant, muffled heart sounds

What is pulsus paradoxus, and what measurement change characterizes it in cardiac tamponade?

Pulsus paradoxus is an abnormal decrease in systolic blood pressure of $10\text{ mmHg}$ ($10\text{ points}$) or more during inspiration.

What emergency procedure is depicted here to treat acute cardiac tamponade, and what two major complications must be watched for?

Pericardiocentesis (needle insertion into the pericardial sac to drain excess fluid). Complications to monitor include pneumothorax (collapsed lung) and cardiac dysrhythmias.

Why must the nurse monitor a pericarditis patient for an ineffective breathing pattern?

Pain with deep inspiration causes shallow breathing, which can lead to atelectasis and subsequently pneumonia.

What is Rheumatic Fever (RF), and what infection precedes it?

Rheumatic Fever is an inflammatory disease that can affect all heart layers, occurring as a complication $2-3\text{ weeks}$ after an untreated or poorly treated group A streptococcal pharyngitis (strep throat).

Which age demographic is most commonly affected by Rheumatic Fever?

Children and adolescents aged $5-15\text{ years}$ old.

What is the most common clinical finding in Rheumatic Fever, and which joints are typically involved?

Joint pain (polyarthritis), which most frequently affects the knees, ankles, elbows, and wrists.

What dermatologic manifestation of Rheumatic Fever is shown on this child's chest and abdomen?

Erythema marginatum, which presents as bright pink, nonpruritic macular lesions with clear centers located mainly on the trunk and proximal extremities that intensify with heat.

What conduction abnormality is characteristically observed on an ECG in a patient with Rheumatic Fever?

A prolonged PR interval.

What is the primary antibiotic of choice for treating Rheumatic Fever, and what is the long-term management strategy to prevent recurrence?

Penicillin is the antibiotic of choice. Long-term secondary antibiotic prophylaxis (which may need to continue lifelong) is administered to prevent recurrent group A streptococcal infections and worsening Rheumatic Heart Disease.