Cardiac inflammatory disease Flashcards
blood flow of the heart
- right side: un oxygenated
inferior and superior vena cava –> RA –> Tricuspid –> RV –> pulmonic valve –> pul. artery –> lungs - left side: oxygenated
Lungs –> pul. veins –> LA –> mitral –> LV –> aortic valve –> body
endocardium
-innermost layer and has heart valves
myocardium
-thickest layer between endocardium and pericardium
pericardium
-2 layers and the outermost layer of the heart
infective endocarditis
- infection of the innermost layer of the heart (endocardium) which encompasses the heart
- treated with ABX but used to be fatal!!!!
Patho of endocarditis
- blood turbulence within the heart allows organisms (virus, bacteria, fungi) to infect the valves or other endothelial surfaces
- causes inflammation in response that forms vegetation’s on the surface
- vegetations form as the microbes stick to the endothelial surface
- infection spreads and disrupts the electrical conduction of the heart= dysrhythmias and heart blocks and damages the heart valve and supporting structures
*this could spread to the myocardium (thickest layer of the heart= heart failure
issues with these vegetation’s
-they are fragile and can break off = emboli in blood stream and travel to other parts of the body
risk factors for endocarditis
- divided into cardiogenic, non cardiogenic, and procedural
cariogenic risk factors for endocarditis
- make the heart susceptible to pathogens
- prior endocarditis
- prosthetic heart valves
- valvular disease
- rheumatic heart disease
- congenital heart defects and pacemakers
non-cardiogenic risk factors for endocarditis
- hospital acquired infections and IV drug abuse
procedural risks for endocarditis
- intravascular devices
- dental work
- tonsillectomies
- wound infections
prophylactic ABX for endocarditis
- may be prescribed for those @ risk for developing endocarditis due to procedure
clinical manifestations of endocarditis
- fever
- new heart murmor or change in existing murmur (systolic murmur)
- flu-like symptoms: arthralgia, anorexia, fatigue, malaise
- A/V heart blocks
- vascular manifestations due to of vegetations
why can endocarditis be hard to diagnose
- manifestations are non specific and not present in all cases
why do you get a new heart murmur or change in existing one
- as the valves are damaged further = decreased CO and cardiac murmurs worsen = decreased UO and SOB
what are the vascular manifestations from microembolism of vegetations
- splinter hemorrhages
- petechiae
- oslers nodes (reddened finger tips)
- janeways lesions (dark small spots on feet)
- roths spots
embolization
- occurs in 50 % of the pt. with endocarditis
- vegetations most commonly originate in aortic and mitral valves –> embolization from valves enter arterial circulation and cause symptoms (depending on where its occluded)
Right sided embolization
- rare but could cause PE
- dyspnea, chest pain, hemoptysis, respiratory arrest
left sided embolization: spleen
-Sharp LUQ pain, splenomegaly, abdominal rigidity, local tenderness
left sided embolization: kidneys
Flank pain, hematuria, renal failure
left sided embolization: limbs
Ischemia, limb infarction, gangrene
left sided embolization: brain
Hemiplegia, ataxia, aphasia, visual changes, altered LOC
DX of endocarditis
- pt. history and recent procedures
- blood cultures
- echocardiography
- chest x ray
- ECG
- cardiac catheterization
why is patient history so important for DX of endocarditis
- checking for risk factors
- needs to be in last 6 months
why are blood cultures so important in DX of endocarditis
- will be positive in 90 % of people
- shows systemic bacteremia that causes endocarditis
Why is echo important for DX of endocarditis
- visualizes the vegetations on the heart valve
why is ECG important for dx of endocarditis
- shows 1st and 2nd deg block due to the valves proximity to AV node
treatment of endocarditis
- Antibiotics based on blood culture results:
- started in the hospital and continued @ home
- can take 4-8 weeks
- effectiveness is measured with blood cultures - Valve Replacement
- ABX not effective with fungal and prosthetic valve endocarditis
endocarditis care
-Pain assessment and activity intolerance can give insight as to the effectiveness of treatment
- Education – Prevention is key for those at risk
-Those at risk must be educated on the importance of good oral hygiene and given information on prophylactic therapy.
Patients and family should be educated on the symptoms of stroke, pulmonary embolism, and heart failure. - Monitor for fever and assess for skin abnormalities and cardiac murmurs
- Maintain perfusion, body temperature, and increase activity tolerance
complications of endocarditis
- Myocardial erosion
- Valvular stenosis
- Decreased cardiac output due to heart failure
Function of the pericardium
- Pericardium is composed of 2 layers
- Anchors the heart to the mediastinum, lubricates to decrease friction, and prevents excessive stretching of the heart.
visceral layer “epicardium”
-covers the heart
parietal layer “pericardium”
-Sac that contains the heart
patho of acute pericarditis
- Caused by infectious process, Non-infectious injury, or hypersensitive/autoimmune response
- inflammatory response that increases pericardial vascularity and leads to fibrin deposits on the pericardial sac
- Acute Pericarditis may occur 48-72 hours post MI
causes of acute pericarditis
- can be caused by an infectious injury resulting from invading bacteria, fungus, or a virus.
- can also be caused by a hypersensitivity reaction such as rheumatic fever.
- Post MI patients are at increased risk 49-72 hours post injury.
manifestations of acute pericarditis
-Progressive, sharp chest pain: increases with respiration and when laying supine.
-Pain is relieved by sitting up and leaning forward
Pain may radiate to the back or shoulder
- Dyspnea: due to the pain with inspiration
- Pericardial Friction Rub: It is a high pitched grating sound that is best auscultated at the lower left sternal border of the chest while the patient is leaning forward.
complications of acute pericarditis
- Pericardial Effusion
- Cardiac Tamponade
pericardial effusion
- can occur as the disease process progresses.
- Fluid collects in the pericardium between the visceral and parietal layers. -This fluid can compress the lungs or phrenic nerve.
cardiac tamponade
- As the pericardial effusion increases in volume the fluid begins to compress the heart muscle and leads to decreased cardiac output.
- The patient will begin to report chest pain and appear confused/anxious.
- Becks Triad – clinical manifestations
1. Hypotension
2. Distended Neck Veins
3. Muffled Heart sounds
DX for pericarditis
- ECG - Widespread ST elevations
- Echocardiogram
- Doppler Imaging
- CT Scan
- MRI
- Chest X-ray
- Elevated Troponin
EKG for DX of pericarditis
will show widespread ST elevation indicative of pericardial inflammation.
echo for DX of pericarditis
most helpful in determining the presence of pericardial effusion or cardiac tamponade.
CT or MRI for DX of pericarditis
make it possible to view the pericardial space
chest x ray for DX of pericarditis
helpful in the case of an enlarged heart due to pericardial effusion.
troponin for DX of pericarditis
Elevated troponin levels are indicative of myocardial damage.
TX of pericarditis
- Goal = identify and treat the underlying problem
- Antibiotics for infectious processes
- NSAIDS for pain and inflammation
- Corticosteroids: for inflammation
- Pericardiocentesis
- Pericardial Window
Pericadriocentesis
- a procedure in which a long needle is inserted into the pericardial space to remove fluid and relieve cardiac pressure.
- This can be a lifesaving procedure and is the definitive treatment for cardiac tamponade.
nursing care for pericarditis
- Manage pain and anxiety
- Bed rest with HOB greater than 45 degrees– provide overbed table to lean on for support
- Education – provide simple complete explanation of pain
- Monitor for decreased CO and cardiac tamponade (If tamponade is suspected…immediately notify the provider)
