Cardiac lecture 6: Inflammatory Heart Disease

Cardiac Lecture 6: Inflammatory Heart Disease

Objectives of the Lecture

• Differentiate between major types of inflammatory heart disorders.
• Recognize common causes and risk factors.
• Describe hallmark signs and symptoms associated with each disorder.
• Explain why these symptoms occur.
• Identify key nursing interventions and patient teaching points for managing inflammatory heart disorders.

Overview of Inflammatory Heart Disorders

• All cardiac tissues are susceptible to inflammation, which can lead to heart failure.
• Inflammatory heart disorders can stem from:
  • Infections (e.g., streptococcal infections)
  • Autoimmune diseases
  • Medical treatments
• Impact on patients:
  • These conditions can arise in patients across various healthcare settings (medical-surgical units, ER, ICU) and can cause the heart to pump less effectively, leading to symptoms like:
  • Shortness of breath
  • Chest pain
  • Low blood pressure
• Complications include:
  • Heart failure
  • Arrhythmias
  • Valve damage

Importance of Early Recognition

• Early recognition of inflammatory heart disorders is crucial for patient outcomes.
• Key nursing skills involved:
  • Infection control
  • Medication administration
  • Pain management
  • Vital signs monitoring
  • Patient education
• Nurses need to apply their knowledge comprehensively across patient demographics (pediatrics, adults, geriatrics).

Examples of Inflammatory Heart Disorders

• Rheumatic Carditis:
  • Can occur in children recovering from untreated streptococcal infections.
• Infective Endocarditis:
  • Common in IV drug users.
• Pericarditis:
  • May develop in post-surgical patients.

Types of Inflammatory Heart Disorders

1. Endocarditis
   • Infection and inflammation of the inner lining of the heart and valves.
2. Myocarditis
   • Inflammation of the heart muscle itself.
3. Pericarditis
   • Inflammation of the pericardium (sack surrounding the heart).
4. Rheumatic Heart Disease
   • Chronic inflammatory condition damaging heart valves.
5. Cardiomyopathy
   • A group of diseases affecting heart muscle function.

Details on Pericarditis

• Definition:
  • Inflammation of the sack surrounding the heart, which can be acute or chronic.
• Acute Pericarditis:
  • Associated with infections (bacterial, viral, fungal) or as a complication of non-infectious conditions (e.g., myocardial infarction, neoplasms, trauma).
  • Further classified into:
  • Adhesive pericarditis: layers adhere, limiting heart filling.
  • Pericardial effusion: fluid accumulation from various etiologies (serous, pus, calcium, malignant).
• Pathophysiology: Adhesions and fluid can restrict heart filling, impairing blood flow.
• Clinical Manifestations:
  • Chest pain (similar to myocardial infarction):
  • Aggravated by: lying supine, deep breathing, coughing, swallowing, trunk movement.
  • Alleviated by: sitting up and leaning forward.
  • Additional symptoms: dyspnea, fever, chills, diaphoresis, leukocytosis.
  • Hallmark finding: Pericardial friction rub (grating sound detected on auscultation).
  • Typical volume of pericardial fluid:
  • Normal: 15-50 mL
  • With pericarditis: 150-200 mL or more.
• Assessment & Diagnostic Testing:
  • Subjective data: muscle aches, fatigue, dyspnea, chest pain radiating to neck and shoulders.
  • Objective data: substernal chest pain, orthopneic position, facial grimacing, fever, chills, non-productive cough.
  • Vital sign changes: rapid pulse, possible arrhythmias.
  • Diagnostic tests:
  • ECG: baseline rhythm assessment.
  • Echocardiogram: detects pericardial effusion.
  • Labs: elevated white blood cell count, ESR, specific pathogen blood cultures, cardiac enzymes, CRP elevation, chest X-ray for heart size and position.
• Medical Management:
  • Based on severity and underlying causes:
  • Analgesics for pain relief.
  • Oxygen therapy to decrease myocardial workload.
  • Parenteral fluids to support therapies and preload.
  • Antibiotics for bacterial infection.
  • Anti-inflammatories/corticosteroids for persistent inflammation.
• Complications:
  • Cardiac tamponade: restricts heart movement, requiring procedures like pericardiocentesis or pericardial fenestration for fluid drainage.
  • Risks associated with procedures: atelectasis, bacterial introduction.
• Nursing Interventions:
  • Monitor vital signs closely for changes.
  • Auscultation for lung/heart sounds.
  • Bed rest and positioning to reduce dyspnea.
  • Management of elevated temperatures and patient anxiety.
  • Administer medications as prescribed.
  • Monitor intake and output; dietary sodium restriction to manage fluid retention.
• Prognosis:
  • Good in cases of acute or viral pericarditis.
  • Cardiac tamponade complications are rare but serious.

Infective Endocarditis

• Definition: Infection or inflammation of the endocardium (inner lining of heart chambers and valves).
• Etiology:
  • 80-90% bacterial; <1% fungal infections.
• Risk Factors:
  • Healthcare-acquired (infections linked to medical care) vs. community-acquired.
  • Direct bacteria introduction with IV drug use due to non-sterile injection practices.
• Clinical Manifestations:
  • Initial symptoms: fever, chills, malaise, fatigue, anorexia, headache, generalized weakness.
  • Local symptoms: chest pain, dyspnea, decreased exercise tolerance, orthopnea.
  • New or changed heart murmur may occur due to valvular incompetence.
• Assessment & Diagnostic Testing:
  • Subjective data: flu-like symptoms and chest pain.
  • Objective data: shortness of breath, swelling in legs, new heart murmurs, splinter hemorrhages, non-tender macular lesions.
  • Diagnostic imaging: echocardiograms (vegetation on valves), TEE for clearer images, blood cultures for pathogens, MRI/CT for assessment, and lab work for infection indicators.
• Medical Management:
  • Support cardiac function, pathogen destruction, and complication prevention.
  • Bed rest to decrease heart workload.
  • Blood cultures guide antibiotic therapy (1-2 months treatment).
  • Prophylactic antibiotics for at-risk individuals (prior history, dental work, surgeries).
• Nursing Interventions & Patient Teaching:
  • Monitor vital signs closely.
  • Maintain calm environments; encourage rest.
  • Provide nutritional support and prevent further inflammation/infection.
  • Educate on signs/symptoms of endocarditis, dietary advice, and activity level management.
  • Regular medical checkup adherence and prophylactic antibiotic importance prior to invasive procedures.
• Prognosis:
  • Historically poor before antibiotics; improved survival rates with treatment.

Myocarditis

• Definition: Inflammation of the myocardium (middle muscle layer of heart).
• Etiology: Relatively rare and often follows other infections (viral, bacterial, fungal) or inflammatory conditions.
• Signs/Symptoms: Present with flu-like symptoms that may progress to chest pain, heart failure characteristics, tachycardia, murmurs, and cardiac enlargement.
• Assessment & Diagnostic Testing:
  • Tests include chest X-rays, ECGs, echocardiograms, MRIs, cardiac catheterization.
• Medical Management:
  • Supports symptomatic treatment; similar to other inflammatory conditions (bed rest, oxygen, antibiotics, anti-inflammatories).

Cardiomyopathy

• Definition: A group of diseases affecting heart muscle function and structure not related to coronary artery disease or other external factors.
• Classification:
  • Primary: Heart muscle itself is the main issue.
  • Secondary: Heart damage due to external causes (hypertension, alcohol use, infections).
• Signs/Symptoms: Includes angina, syncope, fatigue, dyspnea on exertion, signs of heart failure (ascites, edema, hepatic dysfunction).
• Diagnostic Testing: Diagnosed via clinical manifestations and non-invasive cardiac procedures (ECGs, X-rays, echocardiograms, CTs, MRIs).
• Medical Management:
  • Treat underlying causes; manage heart failure and symptoms with medications (diuretics, ACE inhibitors, anti-dysrhythmics, etc.).
  • Referral for cardiac transplantation in advanced cases.
  • Stress the importance of avoiding strenuous activities due to risks of arrhythmias.
• Prognosis:
  • Severe progression; many patients may die within two years of symptoms onset, while some may stabilize or improve.
  • 85% survival rate post-cardiac transplant, with many living beyond 10 years post-procedure.

Rheumatic Heart Disease

• Definition: Results from rheumatic fever, which follows inadequately treated streptococcal infections.
• Epidemiology: Decline in prevalence due to antibiotics; however, still serious in developing countries.
• At-Risk Population: Children aged 5-15 years, less common in younger than three or adults.
• Symptoms Onset: Usually sudden after a sore throat, occurring 1-5 weeks post-infection.
• Effects on Cardiac Tissues: Can affect pericardium, myocardium, and endocardium, leading to hypertrophic scarring and valvular damage (stenosis/insufficiency).
• Assessment:
  • Subjective data: joint pain, chest pain, fatigue.
  • Objective data: erythematous skin manifestations, possible heart murmurs (stenosis/insufficiency).
• Diagnostic Tests/Management:
  • Diagnosis via signs/symptoms and lab results (elevated white blood cells, ESR, CRP).
  • Rapid treatment of pharyngeal infections with prolonged antibiotics to prevent rheumatic fever.
  • Patients may be ambulatory soon after symptoms subside; symptomatic treatment necessary.
• Nursing Interventions & Patient Education:
  • Focus on activity levels, nutrition, and preventing further infections.
  • Daily prophylactic penicillin to prevent future infections and teaching about risk during surgeries and dental work.

Key Takeaways

• Differentiate between major inflammatory heart disorders: endocarditis, myocarditis, and pericarditis.
• Recognize signs, symptoms, causes, complications, and nursing interventions.
• Understand the critical role of nursing in early detection, prevention of complications, and patient education for better long-term health outcomes.

Closing Remarks

• Encourage questions and discussion in the Q&A session following the lecture.