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, and explain their occurrence.

• 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 rapid and serious consequences, including heart failure.

• Commonly occurs after infections (e.g., strep throat), autoimmune diseases, or as a result of medical treatments.

• Symptoms:

  • Shortness of breath

  • Chest pain

  • Low blood pressure

• Potential complications:

  • Heart failure

  • Arrhythmias

  • Valve damage

• Early recognition is vital for effective intervention.

Importance of Nursing Knowledge

• Nurses need to apply infection control, medication administration, pain management, and monitoring vital signs, recognizing how they relate to cardiac inflammation.

• Patients at risk include various age groups: pediatrics, adults, geriatric.

Examples of Inflammatory Heart Disorders

• Rheumatic heart disease: Child recovering from untreated strep throat.

• Infective endocarditis: Adult IV drug user.

• Pericarditis: Post-surgical patient.

Types of Inflammatory Heart Disorders

1. Endocarditis

• Definition: Infection and inflammation of the inner lining of the heart and valves.

2. Myocarditis

• Definition: Inflammation of the heart muscle itself.

3. Pericarditis

• Definition: Inflammation of the sack surrounding the heart.

• Classification:

  • Can be acute or chronic.

  • Acute cases are often infectious (due to bacteria, viruses, or fungi).

  • Non-infectious conditions include heart attacks or trauma post-surgery.

  • Classified further as adhesive (layers stick together) or due to fluid accumulation (serous fluid, pus, calcium, malignant cancer).

4. Rheumatic Heart Disease

• Chronic inflammatory condition causing damage to heart valves, following bacterial infections (especially in children).

5. Cardiomyopathy

• Group of diseases affecting the heart muscle leading to weakening, stiffening, and thickening.

In-depth Look at Pericarditis

Definition and Causes

• Acute pericarditis: inflammation of the pericardium, primarily due to infections or complications from other conditions (e.g., heart attack, trauma).

Clinical Manifestations

• Symptoms:

  • Severe, sharp chest pain (worsened by lying down, deep breathing, movement; relieved by sitting forward).

  • Dyspnea, fever, chills, diaphoresis, leukocytosis.

• Hallmark finding: Pericardial friction rub (sound resembling two balloons rubbing together).

Assessment and Diagnostic Testing

Subjective Data

• Patient's description of muscle aches, fatigue, and chest pain with sudden onset.

Objective Data

• Signs may include:

  • Elevated temperature and chills.

  • Non-productive cough, vital changes (rapid pulse, irregular heart rhythm).

Diagnostic Tests

• ECG: To assess baseline rhythm and changes.

• Echocardiogram: Identifies pericardial effusion (fluid in the pericardium).

• Labs:

  • WBC count over 10,000.

  • Elevated ESR for inflammation.

  • Blood cultures for pathogens.

  • CRP for inflammation markers.

  • Chest X-ray to assess heart size.

Medical Management

• Focused on underlying causes, severity:

  • Analgesia for pain relief.

  • Oxygen therapy to decrease myocardial workload.

  • Parenteral fluids to support therapies (increase preload filling pressure).

  • Antibiotics for bacterial infection; salicylates for fever; anti-inflammatories/corticosteroids for persistent inflammation.

Complications

Cardiac Tamponade

• Excess fluid accumulation restricts heart movement, potentially leading to a life-threatening situation.

• Management options:

  • Pericardiocentesis: Draining excess fluid via needle.

  • Pericardial fenestration: Creating an opening to drain fluid.

• Risks include:

  • Atelectasis (lung collapse).

  • Bacterial introduction into the bloodstream.

Nursing Interventions

• Monitor vital signs for subtle changes.

• Auscultate lung and heart sounds.

• Bed rest to promote healing.

• Evaluate respiratory comfort by elevating head of the bed.

• Administer prescribed medications (pain relief, diuretics, antibiotics).

• Monitor intake/output and restrict sodium intake.

Prognosis

• Good outcomes in patients with acute or viral pericarditis.

• Complications like cardiac tamponade are rare but challenging.

Infective Endocarditis

Definition and Risk Factors

• Infection/inflammation of the endocardium; commonly due to bacterial infection (80-90% of cases).

• Risk Factors:

  • Healthcare-acquired versus community-acquired infections.

  • IV drug use leading to bacteria introduction into bloodstream.

Clinical Manifestations

Systemic Symptoms

• Fever, chills, malaise, fatigue, anorexia, headache, generalized weakness.

Localized Symptoms

• Chest pain, dyspnea, decreased exercise tolerance, orthopnea.

• Heart failure symptoms may present with a new or changed heart murmur.

Assessment and Diagnostic Testing

Subjective Data

• Complaints of flu-like symptoms, joint pain, recurrent fevers.

Objective Data

• Signs include shortness of breath, changes in heart murmurs, splinter hemorrhages, and non-tender macular lesions.

Diagnostic Tests

• Echocardiograms: Identify vegetation (bacterial growth on valves).

• TEE: Clearer images for assessing heart chamber involvement.

• Blood cultures: Identify pathogens.

• MRI/CT scans: Visualize heart structures.

• CBC: Assess for infection markers.

Medical Management

• Support cardiac function, destroy pathogens, prevent complications.

• Risk of embolization due to vegetation on valves=> potential clots to organs (brain, lungs, etc.).

• Bed rest, blood culture-guided antibiotics, long-term therapy for at-risk patients.

• Prophylactic antibiotic treatment for those with past history during high-risk procedures.

Nursing Interventions

• Observe changes in respiratory/cardiac status.

• Monitor vital signs, especially during increased activity.

• Ensure adequate nutrition and rest during hospitalization.

• Educate on signs, symptoms, dietary recommendations, and gradual activity increases.

Prognosis

• Historical high mortality rates prior to antibiotics; now many survive with proper treatment.

Myocarditis

Definition

• Inflammation of the myocardium (heart muscle layer); typically rare.

Causes and Symptoms

• Often develops following infections (viral, bacterial, fungal) or other inflammatory heart conditions.

• Symptoms may resemble upper respiratory infections, followed by cardiac issues (e.g., heart failure).

Diagnostic Tests and Therapy

• Tests include chest X-rays, ECGs, echocardiograms, MRIs, cardiac catheterization.

• Symptomatic therapy follows similar management as endocarditis.

Cardiomyopathy

Definition

• A group of diseases affecting heart muscle's functional capacity.

• Types:

  • Primary: Heart muscle itself as the main issue.

  • Secondary: Weakness due to another underlying health issue (e.g., uncontrolled hypertension).

Clinical Manifestations

• Symptoms: angina, fatigue, dyspnea on exertion, severe exercise intolerance, heart failure signs (ascites, peripheral edema).

Diagnostic Tests

• Diagnosis via clinical symptoms and non-invasive cardiac procedures (ECGs, imaging).

Medical Management

• Focused on treating underlying causes.

• Manage heart failure symptoms via medication (diuretics, ACE inhibitors, beta blockers).

• Cardiac transplant may be considered for severe cases.

Nursing Interventions

• Symptom relief, observe for complications, provide emotional support.

• Educating patients on lifestyle adjustments and monitoring fluid intake.

Prognosis

• Most patients face a severe and deteriorating course, with risk of sudden death from arrhythmias.

• Cardiac transplantation offers an improved survival rate (approximately 85%).

Rheumatic Heart Disease

Causes and Clinical Manifestations

• Resulting from rheumatic fever due to inadequately treated throat infections, impacting children ages 5-15.

• Symptoms include fever, joint pain, anemia, skin manifestations/erythema, and murmurs.

Diagnostic Tests and Management

• Diagnosis based on history, supported by lab results (elevated ESR, WBC, CRP).

• Education regarding early treatment of throat infections (prophylactic antibiotics) is vital.

Nursing Interventions

• Focus on gradual activity increases and nutritional advice.

• Provide prophylactic antibiotics (e.g., penicillin) for those with heart valve deformities before any procedures.

Key Takeaways

• Differentiate between endocarditis, myocarditis, and pericarditis.

• Recognize signs, symptoms, risks, and nursing contributions in managing these potentially life-threatening disorders.

• Importance of early detection, progression prevention, and patient education for long-term health outcomes.