Infectious Diseases of the Heart (Endocarditis, Myocarditis, Pericarditis)

rheumatic endocarditis

• common in children; may develop after an episode of group a beta-hemolytic streptococcal pharyngitis

• causative agent: bacteria (Group A Streptococcus)

1. malnutrition, overcrowding, poor hygiene, lower socioeconomic status

2. new heart murmur, cardiomegaly, pericarditis, heart failure

rheumatic endocarditis

1. RF: (MOPL)

2. Clinical Manifestations: (NCPH)

infective endocarditis

• 14-22%; 60%

• microbial infection of the endothelial surface of the heart

• rare but has high mortality rate: __ of pts die during hospital stay, ___ pts. die within 1 yr of diagnosis

• common in older pts & pts who has right-sided heart failure

1. illicit IV drugs, debilitating disease, indwelling catheters, hemodialysis pts.

2. petechia, osler nodes, janeway lesions, roth spots, splinter hemorrhages, systemic embolization (presenting Sx)

infective endocarditis

1. RF: (IDIH)

2. Clinical Manifestations (onset is insidous): (POJRSS)

1. petechia

2. osler nodes

3. janeway lesions

4. roth spots

5. splinter hemorrhages

6. systemic embolization

1. Tiny, pinpoint, non-blanching red or purple spots on the skin or mucous membranes

2. Painful, red, raised nodules found on the pads of fingers and toes

3. Painless, small, erythematous or hemorrhagic macular lesions on palms and soles.

4. retinal hemorrhages with a pale or white center seen on fundoscopic exam

5. Thin, linear, reddish-brown streaks under the nails (nail beds)

6. The process in which fragments of infected or thrombotic material (vegetations) break off and travel through the bloodstream

1. echocardiogram

2. 2 separate blood culture

endocarditis Assessment and Diagnosis Findings

1. Definitive: __

2. __ - one aerobic & one anaerobic culture; drawn from diff. venipuncture sites over a 24hr period — each set at least 2hrs apart

clot formation in a deformed or injured endocardium > invasion of infectious organism in the clot & endothelial lesion > vegetation (may embolize to other vessels) > expansion of clot > infection erodes into underlying structures (e.g., valve leaflets) > tears of deformities of valve leaflets, dehiscence of prosthetic valves, deformity of chordae tendineae, or mural abscesses

Endocarditis pathophysiology

• antibiotic prophylaxis

• good oral hyigene

• nurse must ensure meticulous hand hygiene and maintain aseptic technique

Endocarditis prevention

(AGN)

1. antibiotic therapy (IV for 2 wks), parenteral therapy w/ high serum, antipyretic (NSAIDs)

2. valve repair & replacement, debridement of vegetations, surgical valve replacement

3. mon’ temp, administer antibiotic antifungal, or antiviral as prescribed, rest periods should be planned

endocarditis

1. medical management (APA)

2. surgical management (VDS)

3. nursing management (MAR)

pericarditis

1. 5%

2. acute, chronic, recurrent

3. infectious, non-infectious

4. Dressler’s Syndrome

• inflammation of the pericardium

• (1)_ of emergency room visits for chest pain

• (2)classification: __,__, __

• (3)etiology: __ or __

• may occur 10 days - 2 mos after acute MI ((4) __)

chest pain (in clavicle, neck, left trapezius region), mild fever, non-productive cough or hiccup, dyspnea

Pericarditis Clinical Manifestations

• CMND

• may be asymptomatic

1. echocardiogram

2. TEE

3. CT imagine

4. cardiac MRI

5. video-assisted pericardioscope

6. 12-lead ECG

Pericarditis Assessment and Diagnosis Findings

1. __ - confirmatory dx

   • detect inflammation, pericardial effusion or tamponade, & HF

   • guides pericardiocentesis (needle or catheter of the pericardium to remove fluid; assist to identify the cause or relive Sx of HF & tamponade)

2. T__ -

3. __- best dx tool to determine the shape, size & location of the pericardial effusions; guides pericardiocentesis

4. __ - detection of adhesions & inflammations

5. __ - guided biopsy of the epicardium — obtain tissue samples for culture & microscopic exam

6. __ - show concave ST elevations, depressed PR segments or atrial arrythmias

1. bed rest

2. aspirin, indomethacin, ibuprofen

3. corticosteroids (Prednisone)

4. colchicine

Pericarditis Medical management

1. B__

2. NSAIDs (__, __, __)

3. __ - alternative when NSAIDs are contraindicated

4. __ - if pericarditis is severe; additive therapy to NSAIDs

1. pericardial fluid

2. pericardial window

3. pericardiectomy

4. cardiac tamponade

5. beck triad

1. cultured if bacterial, tubercular, or fungal dse. is suspected; a sample is sent to cytology if the neoplastic dse. is suspected

2. small opening made in pericardium to allow continuous drainage into the chest cavity

3. surgical removal of tough encasing pericardium to release both ventricles from constrictive & restrictive inflammation & scarring

4. Suggestive: lightheadedness, orthostasis, tachycardia; initial: SOB, chest pain, dizziness

5. hypotension, muffled heart sounds, elevated jugular venous pressure

   • useful dx parameter of severe tamponade

1. forward leaning or sitting position

2. pain is not due to heart attack; to have a healthy lifestyle

3. activity restrictions

4. HF, S/Sx of cardiac tamponade

Pericarditis Nursing Management

1. __ to relieve pain

2. educate: __

3. __ until pain & fever subsides

4. mon; for __, __

myocarditis

• inflammation involving the myocardium

• can cause heart dilation, thrombus on the heart wall (mural thrombi), infiltration of circulating blood cells around the coronary artery vessels & between the muscle fibers, degeneration of muscle fibers

• some pts develop cardiomyopathy & HF

fatigue, dyspnea, palpitations, congestive HF (fulminant myocarditis)

Myocarditis clinical manifestations

(FDPC)

1. endomyocardial biopsy

2. cardiac MRI, CBC, C-reactive protein, Leukocyte count, ESR

3. Penicillin, NSAIDs

MYOCARDITIS

assessment and dx findings

1. __ - definitive

2. C__, C__, C__, L__, E__

medical management

3. __ - anti-inflammatory, prophylaxis

1. tachycardia, fever

2. HF, arrythmia

3. anti-embolism stockings, passive & active exercises

MYOCARDITIS nursing management

1. assess for resolution of __, __, or other clinical manifestations

2. assess cardiovascular for S/Sx of __ & __

3. __ & __

1. pericardium

2. myocardium

3. endocardium

1. The outermost covering of the heart.

   • Protects the heart, anchors it in the chest, and reduces friction during contractions.

2. middle and thickest layer of the heart wall.

   • Responsible for the pumping action of the heart (contractions).

3. innermost lining of the heart chambers and valves.

   • Provides a slick surface for blood to flow, preventing clot formation.

1. 1.8-2.6 mEQ/L

2. 3.5-5 mEQ/L

3. 135-145 mEQ/L

4. M: 0.06-1.2 mg/dL; F: 0.04-1.0mg/dL

5. 8-20 mg/dL

6. 42-52%

7. 36-48%

8. _< 200 mg/dL

9. M: Over 40 mg/dL; F: over 50 mg/dL

10. < 100 mg/dL

11. < 150 mg/dl

normal values

1. Mg+

2. K+

3. Na+

4. creatinine

5. BUN

6. Hct

7. Hmg

8. total cholesterol

9. HDL

10. LDL

11. Tri