Class 15.5 *Not On Test 2 Flashcards
What is Infective Endocarditis?
infections are typically bacterial, viruses & yeast fungi are possible infectors. Smooth surface of endocardium, especially given constant movement of blood through each chamber, doesn’t normally encourage adherence of organisms to endocardial wall. Irregular surfaces, such as septal/mural defects, locations of scarring, & valve leaflet “pockets” (esp. if prolapsed or otherwise structurally different), are more susceptible to adherence & accumulation of organisms.
Colonies of bacteria & fungi, in particular, can become organized into clusters that are referred to as vegetations. Are irritating to host tissue & typically raised off surface to which they are adhered, so they can attract platelet activity leading to thrombosis.
Under hemodynamic pressures inside heart, these unstable vegetations (along with any attached thrombi), are susceptible to breaking away from wall/valve, meaning they are friable & can create dangerous emboli. Medical treatment will include strong anticoagulant therapy; person will be treated aggressively & monitored closely because of extreme embolism risk.
Post-infection: While endocardium usually repairs well, of major concern is risk of permanent valve damage.
What are Risk Factors Infective Endocarditis?
• Dental surgery, dental procedures with significant tissue bleeding
• Infection, wound, or procedure that risks bacteria entering bloodstream, incl. catheterization; risk is enhanced if person is immunosuppressed
• Congenital heart defects, degenerative heart conditions
• Existing valve damage/abnormalities
• Presence of prosthetic replacement valve
• Injection drug use
What is Non-Infective Endocarditis?
Non-infective endocarditis, sometimes called non bacterial endocarditis, most commonly caused by autoimmune disease, where endocardial tissue can be directly under attack (e.g., rheumatic fever, lupus) or circulating immune complexes can collect in tissue areas such as valve leaflets.
Other possible causes include: malignancies, HIV, vasculitis, hypercoagulability states
This type of endocarditis also typically involves vegetations, are non-infective & often look more like tissue erosions in acute state.
While these vegetations are not friable, they are most definitely platelet attractors, so thromboembolism risk is still high in noninfective endocarditis.
**To summarize, for both types, serious complications include:
• embolism caused by vegetation &/or thrombus material
• permanent damage to valves
• susceptibilities caused by valve replacement
• CHF secondary to valve damage
What are Signs/Symptoms of Endocarditis?
• Constant deep achy chest pain, doesn’t change with rest or activity
• May have general symptoms such as fatigue, fever, chills, fatigue, anorexia
• 45% have musculoskeletal symptoms such as arthralgia, myalgia; shoulder is most commonly affected, but low back pain & other locations can also occur
Medical treatment is directed at addressing specific cause.
What are Concerns for RMT for Endocarditis?
- Massage treatment is contraindicated while condition is active & embolism risk is high (consultation with MD is necessary before any treatment is begun).
- With hx of endocarditis, establish whether there is any present embolism danger.
- Person may be taking an anticoagulant for some time after an episode, or ongoingly. Also true for anti-inflammatories.
- Carefully assess for CHF status & adapt tx plan accordingly.
What is Myocarditis?
Inflammation of muscular layer of heart wall. Typically not caused by bacterial or fungal infection. Most common causes are: viral infection (including COVID), autoimmune disease, toxin or drug reactions, secondary to myocardial infarction. Myocarditis is also potential complication of some COVID vaccinations. It can present in both acute & subacute forms.
What are Signs/Symptoms of Myocarditis?
• viral infections may present quite mildly, while other causes tend to have more intense S/S
• constant deep pain similar to endocarditis
• may include fatigue, fever, musculoskeletal aches
• can include cardiac dysrhythmia
• onset of heart failure S/S can occur
Medical treatment is directed at specific cause. In case of viral infection, symptom management is usual only tx. Medications are most likely to include: anti-inflammatory, analgesic
In severe cases, myocarditis can lead to fatal acute CHF. However, most of the time condition can be resolved successfully. There is risk of some degree of permanent weakening of heart muscle that may or may not be clinically apparent. CCHF can develop over time as a result.
What are Myocarditis Concerns for RMT?
- Not considered dangerous for massage, but in acute phase benefits of massage should be carefully weighed against simply allowing the person to rest & heal.
- With myocarditis hx, awareness of CCHF status & any need for treatment adaptation.
What is Pericarditis?
Pericardium is serous sac that sits around heart. Inner wall (visceral pericardium) is attached to external heart wall, & outer wall (parietal pericardium) is adhered to diaphragm inferiorly & large vessels exiting superior heart. Some refer to fibrous pericardium layer as continuous with parietal layer on its outer surface. Inside pericardial sac there is small amount of fluid (10-30 cc). Inner surfaces of two layers are very smooth, & with thin fluid “buffer” between them, conditions permit heart to beat without friction while still firmly anchored in place.
Pericarditis is inflammation of pericardial tissues. Can be infective or non-infective & is accompanied by edematous fluid accumulation (hydropericardium or pericardial effusion).
What are Common Causes of Pericarditis?
• trauma/infection from heart surgery
• post MI pericardial irritation (esp. if there is a slow bleed through mural defect)
• autoimmune disease (e.g., RA, SLE)
• lung cancer (irritation from friction d/t fluid in lungs)
• kidney failure (irritation d/t toxicity of the blood-derived pericardial fluid)
• drug reactions
• radiation therapy (d/t burn injury)
• tuberculosis
Pericarditis can present as acute episode (e.g., post-MI), as recurrent condition (e.g., with autoimmune flare-ups), or as chronic condition.
What are S/S of Pericarditis?
• constant, severe pain - considered most painful heart condition
• pain is worse when lying down, inhaling deeply
or coughing; is bit better when sitting up
• pain can “spread” to the shoulder, neck
• heart palpitations, tachycardia
• shortness of breath, esp. when lying down
• cough may be present
• fatigue, malaise, general weakness
• possibly fever
• possibly ascites, lower limb edema
Medical treatment is related to cause.
If effusion volume begins to put stress on beating heart, some fluid can be removed by syringe.
What are Complications of Pericarditis?
- Exudate in pericardium can result in adhering between visceral & parietal layers. Friction during heart beating can cause pain & usually results in reinforcement of continuously microdamaged adhesions.
- Fibrosis in walls of pericardial sac can result in
thickened non-elastic regions which can cause friction, affect heartbeat, & if extensive enough, reduce CO. - Immediate risk of cardiac tamponade (fluid in pericardium compresses on ventricles & beat is suppressed/interrupted). Problem is worse on inhalation – heart may literally stop beating. Is very dangerous, potentially fatal.
What are Pericarditis Concerns for RMT?
Condition is not worsened by massage. RMT awareness of pain & malaise level is key. Massage treatment may not be comfortable (position, ease of breathing, etc.) vs. its potential benefits. Any signs of acute respiratory distress require immediate medical attention.
History of pericarditis, esp. with ongoing complications, should be followed up for CCHF status.
