Cardiac Infectious Disorders Flashcards
Cardiac Infectious Disorders?
-Interventions depend on cause and affected heart structure
-All have an inflammatory components and can progress to involve other organ systems
-Therapy depends on the cause
-Treatment includes symptom management
Myocarditis
-Myocarditis is Inflammatory cardiomyopathy , because the mayocardium enlarges during this problem.
-Most common cause of dilated cardiomyopathy, is a
virus (Meaning due to a virus) but sometimes it can be due to the following reasons:
* Lupus (an autoimmune disease), SLE (Systemic lupus erythematosus), hypersensitivity reactions, transplant rejection
* COVID 19 and other viruses including influenza
- Men and young people are the ones who are mostly affected. It’s the leading cause of death in young athletes.
- The most common cause is a virus. This is the etiology/patho. The virus damages the myocardium directly and then the inflammatory response that is generated by the immune system causes the secondary dammage. (overreaction)
–S & S
* Palpitations, SOB, chest pain, edema, CHF, arrhythmias.
* If the cause is a virus it will have the same symptoms are a virus (influenza, covid)
- Treatment:
* Identify and treat the cause, manage symptoms - Nursing care
* Cardiac monitor, assess for CHF (Congestive heart failure: A weakened heart condition that causes fluid buildup in the feet, arms, lungs, and other organs), BR, no straining, DVT prophylaxis,
progressive recovery, education
Endocarditis definition ?
- Inflammation/infection of the inside of the heart (inner mot layer)
- Infection forms vegetations/thrombi inside the heart that break off from the valve leaflet; emboli disseminate
- Destruction of valves, walls, chordae tendinae cause loss of function and impaired ventricular filling (decreased
CO) - Back up of blood causes lung congestion
Endocarditis Causes
- It can be native or prosthetic, it can happen in the left or right side of the heart.
The risk factors are: Age more than 65, anyone who is immunodeficient uses IV drugs, and has diabetes (anytime you have too much sugar in the blood you are at risk for infections) - Rheumatic heart disease (The disease results from damage to heart valves caused by one or several episodes of rheumatic fever, an autoimmune inflammatory reaction to throat infection with group A streptococci ), and a history of previous endocarditis
- Prosthetic valve in the heart
- IVDU (intravenous drug use )
- Contaminated invasive devices
- Hemodialysis patients
- Immunosuppression (the partial or complete suppression of the immune response of an individual)
- Dental caries or gum disease, piercings wherever they are in the body
- people who had repeated procedures
What’s it’s the pathophysiology?
it’s the infection of the innermost layer of the heart the endocardium and it almost always ends up affecting the heart valves. It starts with damage to the endothelial lining and which causes this turbulent blood flow. The turbulent flow is either caused by valvular dysfunction or the other way around; meaning that it’s the valvular dysfunction that causes the turbulence of blood.
-Then we have a lot of platelets and fibrin that deposit on this infected or injured area; when this happens infected agents get trapped here too and then they grow and form these clumps that are called vegetations which in turn damage the heart, which causes more turbulence which in turn causes more inflammation which is a vicious circle.
- We know that this is caused by some sort of bacteria and the most common one is stephalocacus and streptococcus. viruses and fungi are very rare. It’s very linked to invasive procedures such as dental work etc … as we said above. If you have been diagnosed with endocarditis once you are much more likely to have it again. Just remember it’s not just one simple exposure it’s multiple exposures. Some people have gotten it after acupuncture. Basically, it’s caused y any invasive procedure where your blood is exposed. Multiple piercings can cause it too.
- The clinical manifestations are: red painful nodes on the toes and fingers known oslors nodules . Painful spots on the palmes and soles known as janewane lesions. Hemoragges under the nails. MOst patients have a murmus due to that turbulence. They can also experience arrethymias , wheight loos and night sweats.
Other symptomps can be anything that indicate infecction; this can be fever fatigue, confusion especially in older adults.
Endocarditis Features
- May lead to TIA’s, CVA, shock, death
- Rapid recognition and response
- VS, ECG monitor for dysrhythmias
- Assess for symptoms of heart failure
- Maintain gas exchange
- Breath sounds, RRED, oxygen therapy to maintain saturation
- Monitor labs
- WBC shift left, anemia
- BUN/Cr (long term ABX)
- Evaluate FEN status
- Assess & maintain vascular access
- CVC
- ABX 4-6 weeks on schedule with peak/trough
- Symptom management
- HA, fever, anorexia, nausea, position of comfort, modify
activity
Endocarditits S & S
- Vague flu-like to heart failure with conduction defects,
back pain, and sometimes include symptoms from other
organ systems depending on the spread - Anorexia, weight loss, fever, chills, night sweats, new
murmur, HF development systemic embolization,
pleuritic CP, cough, Oster nodes (late), Janeways lesions
(early), > 6 weeks splenomegaly, clubbing - Diagnosed with blood cultures, echocardiogram which can identify the valve dysfunction because it can see the vegetative growth. Any abscesses any changes in the heart size etc…
*CBC
Endocarditis Treatment and complications
IV antibiotics:
- It takes a long time 4 to 6 weeks
- We have a problem with antibiotic resistance so we use a combination therapy here
- We retest/repeat blood cultures until they are negative.
- We look at what the infective agent is before prescribing an antibiotic
- There is a surgical option.
Complications:
- Embolism is the biggest one because the vegetation breaks off and travels to another part of the body with the bloodstream. It can end up in organ tissue it can obstruct blood flow to the kidneys, to the brain, and anywhere in the body. So we look at every organ system to see how it’s functioning and see if there is a decreased perfusion.
Endocarditis Nursing Care
- Monitor for organ failure, emboli, serial blood cultures,
progressive exercise, education, and rehabilitation
Pericarditis. Inflammation/alteration
in pericardium
-Can be acute or chronic as well. The problem here is that the pericardium becomes thickened from inflammation and then it scars and becomes stiff and a stiff pericardium is not going to expand and contract and it will not let blood fill the heart and if becomes very constricted and we call that cardiac tamponade which means that the ECG looks normal PQRST but because the heart is not allowed to fill up with blood or eject you have no pulse. The only way that you are going to get a pulse is if that LV fills with blood and the pressure from contraction expends the artery and then we can feel the pulse.
* The chronic condition (constrictive) the inflammation
causes pericardial thickening, leading to stiffness
* The acute condition leads to cardiac tamponade with
pulseless electrical activity (PEA)
*
Causes of Chronic
Pericarditis
80% of cases are of unknown etiology. We presume that it’s from a viral infection but it’s more common after an MI. We know that occurs more in middle aged men.
Causes of Acute
Pericarditis
- Trauma, viral infections (influenza, Coxsakie A or B), uremia,
post cardiac surgery - 10-14 days post MI (Dressler’s
Syndrome), post radiation therapy, neoplasms (tumor
invasion (bronchus, breast, lymphoma) - Connective tissue/systemic autoimmune diseases (lupus,
scleroderma, sarcoidosis, rheumatoid arthritis), acute
rheumatic fever, hypothyroidism
Pericarditis Pathophysiology
The heart is surounded by these 2 layers that protect the heart (The two layers of the pericardium are called the outer fibrous/parietal pericardium and the inner serous/visceral pericardium.) The parital is the outer most layer and it’s tough and fibrus and the inner one is visceral. The space between these 2 has pericardial fluid. This fluid prevents the friction between these 2 layers. However, when the pericardium becomes inflamed it displaces that fluid and that’s how you get that pericardial friction rub. The most common symptom is pleuritic chest pain in about 90% of cases. YOu can defereinciate this type of pain from an MI because it’s relived when someone sits up and leans forward. EKG changes.
* Collection of WBCs, platelets, fibrin and
fluid (pericardial effusion) builds up in
pericardial sac which restricts filling.
* Fibrotic changes restrict filling and
therefore decrease CO
Pericarditis types (No need to know)
- Fibrinous (dry)
- Chronic Constrictive
- Adhesive
- Restrictive
- Ischemic
- Neoplastic
- Tuberculosis
- Effusive (wet)
- Hemorrhagic
- Purulent
Pericarditis. S & Sx and Assessment Findings
Chest pain that varies with respirations Usually gets worse with
inspiration, cough, swallow and in supine position), substernal, may
radiate to neck, shoulder or back, RELIEVED BY SIITTING FORWARD
* Pericardial friction rub
* Auscultate with patient sitting forward with breath held during
expiration
* High pitched, scratching, crunching during systole or both phases
* Increased WBCs
* Fever, tachypnea, dyspnea, tachycardia
* Pericardial friction rub
* ECG ST segment elevation
* Pulsus paradoxus if cardiac tamponade
* Atrial fibrillation, SVT, VT
* Pericardial effusion on echocardiogram
Pericarditis. Diagnosis / Treatment and medications
Diagnosis and tests :
- We can use an ECG
- Chest xray
-echocardiogram (fluid=sound)
- CT or MRI -
- The hallmark are ECG ST-segment elevation
Tretment:
* Depends on the cause
* Pericardiocentesis if tamponade
* Surgical pericardectomy is indicated for chronic fluid accumulation
(pericardial window)
Medications:
- We try to treat the pain and the inflammatory process; so we give aspirin, non-steroidal antiinflammatories. If aspirin does not work we use corticosteroids. Then depending on the etiology we can use antibiotics if it’s due to bacteria.
Complications:
- Pericardial effusion and that’s just the accumulation of fluid in the pericardial space. -
- We might have to extract the extra fluid by doing a pericardiocentesis.
Pericarditis Nursing Care * Nursing Care
- Assess & monitor VS, RRED, WBC, cardiac rhythm
& ST segment for elevation - Observe for signs of pericardial tamponade
(increase pressure, decreased filling, decreased
CO) - Distant heart sounds, JVD, increased HR with
hypotension, decreased pulse
amplitude/strength, change in LOC and AMS - Assess and manage pain
- Patient position (Fowler’s forward leaning or
side lying
*Analgesic, anti inflammatory
Cardiac Tamponade? (Pericarditis can be divided into non-constructive and constrictive pericarditis. Pericarditis is commonly associated with pericardial effusion that can sometimes worsen to cardiac tamponade. Cardiac tamponade is a grave condition that happens after sudden and/or excessive accumulation of fluid in the pericardial space.)
- Blood, fluid or
exudates have leaked
into the pericardial sac - Causes include MVA,
RV biopsy, pericarditis,
post operative
hemorrhage in CABG - Pericardial fluid in the
sac squeezes the
chambers of the heart
Cardiac Tamponade Signs & Symptoms
- Decreased cardiac output
- increased CVP: Central venous pressure
- BP: Systolic will drop during inspiration which is your pulses paradoxes and as the heart becomes more squeezed the BP will be inexistent because it can’t fill with blood and therefore it can’t eject.
- Heart sounds muffled and the neck veins are going to be distended
- Neck veins distended
- Pressure in all 4 chambers are the same
- Shock
- Pulses paradoxus
- Narrowed pulse pressure
Cardiac Tamponade. Treatment and nursing considerations
- Treatment and nursing considerations
- Monitor mediastinal CT drainage
- JVD with normal lung sounds
- Assess for pulsus paradoxus and PAWP
- Pericardiocentesis
- Surgery
Cardiac Tamponade. Treatment and nursing considerations
- Treatment and nursing considerations
- Monitor mediastinal CT drainage
- JVD with normal lung sounds
- Assess for pulsus paradoxus and PAWP
- Pericardiocentesis
- Surgery
