Inflammatory Diseases of the Heart

1. Inflammatory Diseases of the Heart

2. Objectives • Describe inflammatory disorders of the cardiovascular system • Explain the pathophysiology of common inflammatory disorders • Describe nursing interventions in caring for clients with inflammatory disorders

3. Rheumatic Heart Disease • Rheumatic Fever develops after an infection caused by group A beta-hemolytic streptococcal pharyngitis

4. Rheumatic Heart Disease • Inflammation of endocardium, myocardium, and/or pericardium  develops small areas of necrosis which when healed, leave scar tissue • Damage to the endocardium will later cause valve disease  nodules that become fibrous and incompetent. With healing, valves become thick and deformed  stenosis and insufficiency  development of heart murmur

5. Rheumatic Heart Disease • Treatment: PCN or –mycins, anti-inflammatory drugs

6. Endocarditis • Infective or bacterial endocarditis • An infection or inflammation of the inner membranous lining of the heart, esp. valves • Most common causes IV drug abuse, Rheumatic heart disease, prosthetic heart valves (within 60 days of surgery) • Also caused by dental procedures in vulnerable patients

7. Endocarditis • Infectious pathogen causes fibrin and platelets to aggregate on endocardium causing “vegetation” (friable and wart-like tissue) • Vegetation will cause ulceration and necrosis of tissue. Vegetations can also break off and embolize

9. Endocarditis • Diagnostic Tests • Positive blood cultures • Elevated WBC and ESR • Anemia • Positive Rheumatoid Factor • Echocardiogram • Electrocardiogram – a change will reveal HF and cardiomegaly

10. Endocarditis • Signs and Symptoms • Weight loss, anorexia • Malaise, fever, chills, night sweats, joint pain • Valve regurgitation/insufficiency (murmur)

11. Endocarditis • Splinter Hemorrhages: Short, thin, brown, linear streaks in the nails • Osler's nodes are painful, red, raised lesions on the fingers and sometimes seen on the soles of the feet. • Janesway lesions are non-tender, small erythematous or hemorrhagic macules or nodules in the palms or soles

12. Endocarditis Janesway lesions Osler’s Nodes Splinter Hemorrhages

13. Treatment of Endocarditis • PCN and usually Gentamycin • Rest – to ↓ workload • Bedrest if pt. has ↑ temp + s/sx HF • Rehydration • May require surgery for affected valves • If prosthetic valve is already in place it will need to be replaced

14. Endocarditis • Medical Goals: • Support cardiac function • Destruction of pathogen • Prevention of complications • ↑ risk emboli

15. Myocarditis • Inflammation of the myocardium caused by a pathogen – virus, fungi, bacteria • May also be caused by endocarditis or pericarditis • May lead to hypertrophy, fibrosis, and decreased contractility leading to dilation of the chambers and possibly damage the conduction system dysrrhytmias

16. Myocarditis Diagnostic Tests • X-ray shows enlarged heart • Elevated cardiac enzymes • Blood Cultures • Biopsy • EKG • Echocardiography

17. Myocarditis Signs and symptoms: • Fatigue, dyspnea, palpations • Mild to moderate, dull and continuous CP • Tachycardia • Mitral regurgitation-murmur • Pericardial friction rub • Heart failure

18. Treatment of Myocarditis • Antibiotics and Anti-inflammatory meds • Rest • Treatment of further complications: • Heart failure • Valvular insufficiency

19. Pericarditis • Inflammation of the pericardium – the sac that surrounds the heart • May be fibrous inflammation or collection of fluid • Fluid may be purulent, serous, or sanguineous • Caused by: • Damage from a pathogen and the immune response releasing inflammatory mediators • Malignancy

21. Pericarditis • Fibrous constriction and thickness  compression around the heart severe enough to prevent normal filling during diastole • As the inflammatory process continues, more fluid builds up in the pericardial space • Chronic pericarditis is a stiff pericardium caused by the damage of acute pericarditis

23. Pericarditis • Diagnostic Tests • EKG shows diffuse ST Elevation • Elevated cardiac enzymes • Elevated WBC, ESR, CRP • Positive blood cultures • Echocardiogram and CXR

24. Pericarditis • Signs and symptoms • Sharp chest pain • Fever, chills • Muffled heart sounds, friction rub (grating, scratching) • Heart failure- decreased cardiac output, Jugular venous distension, dyspnea, shallow respirations

25. Constrictive Pericarditis • Often unable to differentiate between Restrictive CM and Constrictive Pericarditis • Biggest difference: Constrictive Pericarditis can be cured with pericardial stripping.

26. Constrictive Pericarditis • Constrictive pericarditis is due to: • A thickened, fibrotic pericardium that forms a non-compliant shell around the heart. • This shell prevents the heart from expanding when blood enters it. • Constrictive Pericarditis can be cured with pericardial stripping.

28. Treatment of Pericarditis • Antibiotics • Anti-inflammatory medications • Bedrest • Pain medication for CP • Pericardiocentesis

29. Cardiac Tamponade • Too much fluid in the pericardial sac compresses the heart and impairs systole and diastole • Fluid may accumulate slowly or suddenly • Cardiac Output is significantly decreased • Patient will rapidly decline

30. Cardiac Tamponade • Diagnostic Tests • CXR widened mediastinum and enlarged heart • Echocardiogram shows pericardial effusion • Signs and Symptoms • Muffled heart sounds, s/s of low cardiac output, cyanosis • Restlessness, anxiety, impending doom • JVD • Tachycardia • Cough, SOB, Tachypnea, orthopnea

31. Cardiac Tamponade • Narrowed pulse pressure (SBP-DBP) • Beck’s Triad • Pulsus paradoxus • Muffled heart sounds • JVD • Pulsus Paradoxus • SBP decreases on inspiration

32. Nursing Implications • Goals - Treating S&S - Treating & preventing further infection - Minimizing cardiac demands - Comfort