ENDOCARDITIS/PERICARDITIS Acquired Inflammatory Diseases of the Heart

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ENDOCARDITIS/PERICARDITISAcquired Inflammatory
Diseases of the Heart

• NPN 200
• Fall 2006

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Causes

• Acquired from bacteria, viruses, trauma
• Defined as and acute or chronic inflammation of
  the heart, and the heart valves
• Includes
• Pericarditis
• Endocarditis
• Myocarditis
• Rheumatic heart disease

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Pericarditis

• Causes
• Bacterial, fungal, or viral
• Neoplasms form lungs, breasts or other organs
• Autoimmune diseases (lupus, RA)
• Post cardiac injury
• Medications
• Aortic aneurysm leakage
• Post Mi (Dressler's syndrome)
• Description
• Inflammation of the pericardium which surrounds
  the heart
• Fluid accumulates in the pericardium
• Adhesions may occur
• Constriction can cause acute symptoms

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Pericarditis, cont.

• Subjective symptoms
• Sharp pain over the sternum, radiating to the
  back, neck, shoulders and arms
• Pain increases with deep inspiration
• May be relieved by sitting up
• Difficulty breathing
• Tachycardia
• Feeling of fullness in the chest

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Pericarditis, cont

• Objective symptoms
• Dyspnea
• Orthopnea
• Tachycardia
• Substernal chest pain
• Pallor, cool, clammy skin
• Hypotension
• JVD
• Pericardial friction rub
• Fluid retention, hepatomegaly, ascites (right
  sided heart failure)

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Pericarditis, cont

• Diagnostic tests
• History
• WBC
• ESR
• Cardiac enzymes
• Cardiocentesis
• EKG may show ST elevation
• Atrial fib may occur
• CK-MB may be elevated
• BUN
• Echocardiogram

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Pericarditis, cont

• Nursing interventions
• Assess pain and give RX
• HOB elevated for dyspnea
• Bedrest to decrease workload of the heart
• O2 as ordered
• Monitor Vitals including CVP
• May need pericardial window and then follow
  routine post op care

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Endocarditis

• Cause
• May occur after valve procedure
• Or a mitral valve prolapse
• Post strep or staph infection
• After septic thrombophlebitis
• May occur in IV drug uses from infected needles
• Description
• Acute inflammation of the endocardium, heart
  valves, or cardiac prosthesis caused by
  infectious organisms
• Usually fatal if not treated
• Patients with above problems should receive
  antibiotics before dental or invasive procedures
• Patients may have had recent dental work

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Endocarditis, cont.

• Subjective symptoms
• Anorexia, weight loss
• Malaise, weakness
• Chest pain
• chills
• Night sweats

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Endocarditis, cont

• Objective symptoms
• May have low grade to high grade fever (99-104)
• Positive blood cultures
• Heart murmurs
• Clubbing of fingers
• Petechiae
• Other organ symptoms R/T emboli reaching other
  organs (hematuria, pleuritic chest pain, left
  upper quadrant pain)

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Endocarditis, cont

• Diagnosis
• Usually hospitalized
• Physical assessment and history
• Blood cultures
• WBC
• ESR
• Echo
• EKG
• Cardiac output

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Endocarditis, cont

• Nursing interventions
• Monitor signs of heart failure
• Vitals
• Give antibiotics
• Monitor renal status
• Provide reassurance

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Rheumatic Heart Disease

• Description
• Inflammatory process that may affect the
  myocardium, pericardium, and endocardium
• May produce fatal CHF
• Usually results in the scarring and distortion of
  the valves
• Frequent cause of mitral stenosis

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Rheumatic Heart Disease, cont.

• Objective symptoms
• Temperature
• Murmurs
• Dyspnea
• Polyarthritis
• Subjective symptoms
• History of rheumatic fever
• Malaise, fatigue
• Pain, may or may not be present

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Rheumatic Heart Disease, cont.

• Diagnostic tests
• History and physical
• WBC and ESR
• C-reactive protein
• Cardiac enzymes
• EKG
• Chest x-ray
• Cardiac cath
• Cardiac output

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Rheumatic Heart Disease, cont.

• Nursing Interventions
• Vitals
• Provide quiet environment
• Provide rest
• Administer PCN, dig, and diuretics
• Provide nutrition
• Monitor I/O
• Explain disease process