INFLAMMATORY CONDITIONS OF HEART

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INFLAMMATORY CONDITIONS OF HEART
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LAYERS OF THE HEART
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MYOCARDITIS

• It is inflammation of heart muscle.
• CAUSES
• Commonest cause a virus.
• Other infections sarcoidosis, immune disease,
  pregnancy

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PATHOPHYSIOLOGY

• Virus invades the muscle local inflammation.
• After infection subsides, the bodys immune
  system continues to inflict inflammatory damage
  to the heart muscle.
• This immune response prolongs the myocarditis.

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MYOCARDITIS
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• Sign Symptoms
• Mild and cause no noticeable symptoms.
• Pain in the chest.
• Serious heart failure
• SOB, fatigue, fluid accumulation in the lungs
  heart,
• rhythm irregularities inflammation or scarring.
• Diagnosis
• Detect signs of irritation of heart muscle.
• Blood tests (CPK)
• EKG,
• Nuclear heart scan shows.

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Treatment

• Corticosteroids.
• No proven medications
• Treatment -Salt restriction, ACE
  inhibitors, beta blockers treating as well as
  monitoring heart rhythm abnormalities.

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• Prognosis
• After initial phase of myocarditis - complete
  recovery
• Chronic Heart Failure due to injured heart
  muscle.
• Sudden unexpected, potentially fatal heart
  rhythm abnormalities.
• Prevented with implantable defibrillators

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ENDOCARDITIS

• It is a serious infection of one of the four
  heart valves.

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Causes Growth of bacteria on one of the heart
valves, leading to an infected mass called a
vegetation. Infection may be bacteria in the
blood stream after dental work, colonoscopy, and
other similar procedures. Persons at Risk Heart
valves (Aortic stenosis, Mitral stenosis, Mitral
regurgitation etc) undergone valve replacements.
etc).
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Endocarditis
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ENDOCARDITIS
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Sign Symptoms

• Fever
• Fatigue
• Chills
• Weakness
• Aching joints and muscles
• Night sweats
• Edema of feet and abdomen
• Malaise
• Shortness of breath
• Occasionally scattered small skin lesions

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• Diagnosis
• Echocardiography.
• TEE (Trans Esophageal Echocardiography)
• Identification of bacteria by blood culture.
• Treatment
• Antibiotics given intravenously for 4-6 weeks.
• Valve replacement
• Prognosis
• Response to treatment is indicated by a
  reduction in fever, negative blood cultures and
  findings on echocardiography.

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PERICARDITIS

• Heart sits in the centre of the chest and is
  surrounded by a sac called the pericardium.
• This sac has two layers one that fits tightly
  onto the heart muscle and another looser layer
  surrounding the inner layer.
• Inflammation of these tissue layers surrounding
  the heart is referred to as pericarditis.

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Etiology

• Idiopathic cause of illness is not identified
• Mechanical injury to the heart
• Heart attack (MI) and Dresslers syndrome
• Heart surgery and post pericardiotomy syndrome
• Trauma
• Infection
• Bacterial, viral, fungal, HIV

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• Tumors/cancer
• Primary (rare)
• Metastatic
• Connective tissue disease
• Rheumatoid arthritis, SLE, Sarcoidosis,
  Scleroderma
• Metabolic disease
• Uremia, Hypothyroidism
• Medication reactions
• Side effects of phenytoin, hydralizine and
  procainamide.

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Sign Symptoms

• Chest pain
• SOB
• Fever, chills, muscle aches, malaise

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Diagnosis

• Physical evaluation
• Quality of pain,
• Physical finding pericardial friction rub
• EKG
• Chest x-ray
• Ultrasound of the heart
• Blood testing for specific causes (Leukemia,
  kidney failure, connective tissue disease or
  thyroid abnormalities).

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Treatment

• Medicines that reduce inflammation
• NSAIDs to decrease inflammation and fluid
  accumulation in the pericardial sac.
• Narcotic pain medication for pain
• Corticosteroids for immunologically mediated
  causes.
• Pericardiocentesis /pericardotomy

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Complications

• Cardiac tamponade
• Constrictive pericarditis

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Nursing management

• Psychological support
• Assess heart sounds for new or worsening murmur.
• If pt received surgical treatment, provide
  postsurgical care.

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After surgery, monitor patients temperature a
fever may be present for weeks.Assess for signs
and symptoms of organ damage such as stroke, CVA,
meningitis, heart failure, MI etc.Instruct pt
and family about activity restrictions,
medications, and signs and symptoms of infection.
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Nursing management

• Reinforce that antibiotic prophylaxis is
  recommended for patients who have had infective
  endocarditis and who are undergoing invasive
  procedures.
• Refer to home care nurse to supervise and monitor
  intravenous antibiotic therapy in the home.

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