Cardiac - inflammation Flashcards
Endocardium
Inner most layer of the heart
Includes the heart valves
Myocardium
Thickest layer of the heart
Middle layer
Pericardium
Outer most layer of the heart and consists of two layers
What is ineffective endocarditis?
Infection of the innermost later of the heart (endocardium) and includes the heart valves
What is the pathology of endocarditis?
- Caused by blood turbulence in the heart which allows bacterial, fungal or viral organisms to infect valves or other endothelial surfaces
- Inflammation leads to vegetation formation as microbe stick to endothelial surfaces
- Infection spreads and damages the heart valves and supporting structure like the myocardium
What occurs when the heart valves are damaged?
Effects electrical conduction, leads to dysrhythmias and heart blocks
If endocarditis spreads to the myocardium what can happen?
heart failure
Vegetation on heart can cause…
It can cause an emboli in the blood stream because they are fragile and break off
The three categories of risk factors for endocarditis include?
- Cardiac
- Non-cardiac
- Procedural
Cardiac risk factors include? (6)
- Prior endocarditis
- Prosthetic heart valve
- valvular disease
- Rheumatic heart disease
- Congenital heart defects
- Pacemakers
How do cardiac issue put the patient at more risk for endocarditis?
Makes the heart more susceptible to pathogens
Basic procedure hold an additional risk due to this
Non-cardiac risk factors include?
- Hospital acquired infections
- IV drug abuse
Procedural risk factors include?
- Intravascular devices
- Dental work
- Tonsillectomy
- Wound infections
What is recommended for those at high risk for endocarditis when underling a procedure?
prophylaxic antibiotics
Why is endocarditis hard to diagnose?
the s/s are non-specific and they don’t occur in all cases
What are the clinical manifestations of endocarditis? (8)
- Fever
- New heart murmur or worsening heart murmur
- Flu-like symptoms
- AV heart block
- Vascular manifestations due to microembolization of vegetation
- Heart failure often r/t LS valve dysfunction (s/s look like LSHF)
- Decrease CO –> decreased UO, SOB
- Further damage to valves
Vascular manifestation: Oslers nodes
blotchy red patches on hands from endocarditis - mainly on fingers
Vascular manifestation: Janeway’s lesions
Small round bruise like dots on bottom of feet
Is left-sided embolization common? what valves does it affect?
Yes it is common
Affects the aortic and mitral valves so enters arterial circulation and s/s are based on where the blood goes
Spleen left embolization s/s
- Sharp LUQ pain
- Splenomegaly
- Abdominal rigidity
- Local tenderness
Kidney left embolization s/s
- Flank pain
- Hematuria
- Renal failure
Limbs left embolization s/s
- Ischemia
- Limb infarction
- Gangrene
Brain left embolization s/s
- Hemiplegia
- Ataxia
- Aphasia
- Visual changes
- Altered LOC
Is right side embolization common?
No
Lungs right embolization s/s
PE:
1. Dyspnea
2. Chest pain
3. Hemoptyosis
4. Respiratory arrest
What is endocarditis caused by?
systemic bacterium
How do you diagnose endocarditis?
- Patient history and physical
- Blood cultures
- Echocardiogram
- Chest X-ray
- ECG
- Cardiac Catheterization
Endocarditis: history and physical
invasive procedures in the last 6 months
Endocarditis: blood cultures
90% are positive
Indicates systemic bacterium
Endocarditis: Echocardiogram
visual vegetation on heart valve
Endocarditis: ECG
first or second degree block
When are antibiotics not effective for endocarditis?
Fungal and prothetic valve endocarditis so they are often candidates for early valve replacement
Treatment of endocarditis
- Antibiotics: IV at hospital, continued antibiotics at home
- Valve replacement
Nursing care endocarditis
- Assessment
- Goal - return to normal heart function
- Education
- Monitor for fever
- Maintain perfusion, body temperature, and increase activity intolerance
What should you include in the assessment for a patient with endocarditis?
Tells us how the treatment is working
1. Pain
2. Activity intolerance
3. Listen to heart to see if worsening murmur
4. Look for skin abnormalities
What education should be included or a patient with endocarditis?
- Prevention - those at high risk
- Oral hygiene
- Prophylactic therapies
- S/S of complications like PE, Stokes, HF
What is acute pericarditis?
Inflammation of the pericardial sac
How many layers is the pericardium composed of and what are they?
- Visceral/epicardium: covers the heart
- Parietal/pericardium: sac that contains the heart
What is the cause of pericarditis?
- infectious process like bacteria, fungal or viral
- non-infectious injury
- Hypersensitive/autoimmune response like a rheumatic fever
What is the pathology of pericarditis?
Inflammatory process that increases pericardial vascularity and leads to fibrin deposits on the pericardial sac
How many hours after an MI are you at an increased risk for acute pericarditis?
48-72 hours after
Clinical manifestations of pericarditis are?
- Progressive, sharp chest pain
- Dyspnea d/t pain with inspiration
- Pericardial friction rub
What makes the chest pain r/t pericarditis worse?
respiration and laying supin
Can radiate to back or shoulder
What is the chest pain r/t pericarditis relieved by?
sitting up and leaning forward
What does a pericardial friction rub sound like and where is it best heard?
- High pitched grating sound
- Best osculated over the lower left sternal border of the chest while patient is leaning forward
What are the complications of pericarditis?
- Pericardial effusion
- Cardiac tamponade
What is a pericardial effusion?
fluid in the pericardium - between the visceral and parietal layers
can compress nearby structures like that lungs or phrenic nerve
What can a pericardial effusion lead to?
cardiac tamponade
What is a cardiac tamponade?
- Develops as a pericardial effusion that increased in volume –> compression of the heart –> decreased CO
- Patient begins to report chest pain and appears anxious/ confused and experiences Becks triad
What is Becks triad and what is it associated with?
Hypotension, distended neck veins and muffled heart sounds
Associated with cardiac tamponade
Diagnostics for pericarditis is?
- ECG
- Echocardiogram
- Doppler imaging
- CT/MRI
- Chest x ray
- Elevated troponin
What does an ECG look like with pericarditis?
Widespread ST elevations
What does an echocardiogram show you with pericarditis?
most helpful to determine the presences or pericardial effusion or cardiac tamponade
What does a CT/MRI show you with pericarditis?
view of the pericardial space
What does a chest x ray show for pericarditis?
enlarged heart d/t pericardial effusion
What does an elevated troponin tell you with pericarditis?
indicates myocardial damage
What is the treatment for pericarditis?
- Identify and treat the underlying problem
- Antibiotics for infectious processes
- NSAIDS for pain and inflammation
- Corticosteroids for inflammation
- Pericardiocentesis
- Pericardial window
What is a pericardiocentesis procedure?
long needle inserted into pericardial space to remove fluids and relieve cardiac pressure
life saving procedure that is a definitive treatment for cardiac tamponade
Nursing care for a patient with pericarditis looks like
- Manage pain and anxiety
- Best rest - provide overbid table for patient to lean on for support
- HOB over 45 degrees
- Education - explain why the pain and all procedures to decrease anxiety
- Monitor for decreased CO and cardiac tamponade
What do you do if you suspect a cardiac tamponade?
notify the provider immediately
Is pain a priority for care for pericarditis
priority consideration
PQRSTU is essential
