Infections of the Heart Flashcards
Infections named after the layer of the heart that is affected
Endocarditis
-Infective Endocarditis (IE)
-Rheumatic Endocarditis
Myocarditis
Pericarditis
- Infective Endocarditis (IE)
Definition:
_______ infection of the endothelial surface of the heart
Its ____, but has a ___ mortality rate
14-22% die during hospital stay
Up to 40% die within 1yr of diagnosis
Endothelial- inner lining of the heart- includes:
Microbial (bacterial)
rare
high
valves (likes to affect the valves)
Infective Endocarditis (IE)~Risk Factors
Implanted devices (pacemakers),
IV drug users,
branding,
tattoo,
piercings,
Dialysis,
older adults
dental procedures,
IV drug users- Staph infections
Infective endocarditis pathophysiology
Deformity or injury of the endocardium
–Leads to _____ on the endocardium
Infectious organisms: ____, ____, _____ invade the clot
—Cause ____ on the endocardium
—Can ____ through the endocardium
Clot grows & conceals infection
—______ may occur
Onset insidious, _____ complaints
clot formation
staphylococci, streptococci, fungi
vegetations
erode
Embolization
vague flu-like
IE
Right sided infections –
PE- severe chest pain with inspiration
signs & symptoms of Infective endocarditis:
Fever
Heart murmur
Roth spots- in eyes
Osler nodes- painful spots on fingers
Clusters of petechia
Splinter hemorrhages on finger nails
Janeway lesions - not painful spots on feet
More signs & symptoms of IE:
Chest pain
Dyspnea
Tachycardia
Fatigue
Chills
Loss of appetite
_________
Unexplained weight loss
Potential complications with IE
most
frequent:
Heart failure
–Most frequent complication
Cardiomegaly
AV blocks
Splenomegaly
–Metastatic foci infection develops into splenic abscess
CNS involvement: headache, stroke
Embolization of other organs
–Kidney damage
–Pulmonary embolism
Diagnosis of IE
Minimum of two sets of blood cultures
–drawn from different venipunctures sites
–over a 24-hour period
–Must be at least 2 hours apart
—-Negative BC do not definitely rule out IE
Other labs:
-elevated WBC
-anemia
-+ rheumatoid factor
-elevated ESR or CRP
Echocardiogram
Transesophageal echocardiography (TEE)
Prevention of IE:
For high risk patients:
avoidusing:
Our role as nurses
IV catheters & invasive procedures
Finish all antibiotics
What else?
Antibiotic prophylaxis
–recommended before and sometimes after dental procedures
–Indicated for patients having manipulation of infected tissue (wound debridement)
–Good oral hygiene + regular professional oral care
Avoid using toothpicks, nail biting, body piercing, tattooing, IUDs
Nursing & Medical Management of IE
Antibiotic therapy (____ usually), or antifungal, or antiviral
Home health
Psychosocial support
Surgical intervention (d/t: HR, recurrent embolization’s, intra-cardiac abscess, meds not working)
Monitor:
Fluids, rest, good hand hygiene, NSAIDS
IV access care (PICC)
PCN
temperature, heart and lung sounds
Nursing & Medical Management of IE
Assess:
Pt education:
-heart sounds and for worsening of murmurs
-S&S pulmonary infarction & infiltrates
-S&S or organ damage (stroke, MI, HF, glomerulonephritis, splenomegaly)
infection control, antibiotic prophylaxis, high risk patient precautions
Endocarditis~Rheumatic Endocarditis
Rheumatic Fever:
Can lead to mitral valve stenosis or regurgitation
Murmurs
Cardiomegaly
Pericarditis
HF
Most often in ________
S&S:
Group A Beta-Hemolytic Strep
School-aged children
sore throat, painful swallowing, fever, petechiae in mouth, swollen tonsils & lymph nodes
Endocarditis~Rheumatic Endocarditis
Risk factors:
Prompt tx with antibiotics can prevent rheumatic fever
________ first line antibiotics
malnutrition, overcrowding, poor hygiene, low socioeconomic status
PCN & Amoxicillin
Myocarditis:
-
-
Mortality depends on severity
-Mild (recover completely)
-HF and cardiomegaly
-SCD
Inflammatory
-Heart dilation
-Thrombi (on the heart wall, or around the coronary vessels)
-Degeneration of the muscle fibers
Myocarditis – pathophysiology:
Viral (most common)
-Coxsackieviruses A & B
-HIV
-Influenza A
Bacterial, fungal, parasitic (Chagas disease)
Spirochetal
-Lyme disease
Immune related
-After acute systemic infections
Related to autoimmune disorders
-lupus
Inflammatory reaction to toxins
-Pharmacologic agents
Myocarditis – pathophysiology
May start in a small area of myocardium and then spread throughout
___ and ___ latent manifestations
DCM and HCM
Myocarditis – S&S:
______ (resolves on its own)
Mild to moderate
-Fatigue
-Dyspnea
-Syncope
-Chest pain / palpitations / tachycardia
-Upper abdomen discomfort
Most common symptoms are ____
May develop ____ and ___
Asymptomatic
flulike
HF and SCD
Myocarditis Diagnosis & prevention:
Cardiac MRI
Endocardial biopsies
Elevated WBC, CRP, leukocyte count, and ESR
Early treatment and recognition
ECG
-May develop sudden arrhythmias
-ST-T wave changes
Antibiotics (tx underlying cause)
Immunizations (influenza, hepatitis)
Myocarditis Diagnosis
Clinical assessment
Friction rub
Gallop heart sound
Murmur
Faint heart sounds
Myocarditis Nursing & Medical Management
CV assessment for s/sx ____ & _____
Continuous cardiac monitoring
Anti-embolism stockings, passive & active exercises,
anticoagulants
Sensitive to ____ (increased mortality)
do not use _____ for pain control*
Bedrest to decrease cardiac workload and myocardial damage
May require: ACE inhibitors, ARBs, beta blockers, diuretics ~ to reduce heart’s workload
Specific treatment for underlying cause (severe cases: IV meds, VAD, IABP, ECMO) Ventricular assistive device, extra-corporal membrane oxygenation, intra-aortic balloon pump
heart failure and dysrhythmias
digoxin
NSAIDs
pericarditis
Inflammation of the sac surrounding the heart
Adhesive (constrictive) or by what accumulates in the pericardial sac (serous, purulent, calcific, fibrinous, sanguineous, or malignant
5% ER visits due to chest pain
Acute, chronic, or recurrent
Infectious or noninfectious
can occur after _____ or ______
pericardiectomy or 10-2 months after MI
Pericarditis
Primary (________)
Secondary to:
Prolonged –
idiopathic, viral infection
medical and surgical disorders (lupus, MI, cancer, radiation, and uremia)
thickening and decreased elasticity
-Restricts hearts ability (constrictive)
Pericarditis
Potential complications:
Pericardial effusion, cardiac tamponade, peripheral edema, hepatic failure
Pericarditis causes:
Infection
-Viral (enteroviruses, herpes, adenoviruses, parvovirus)
-Bacterial (mycobacterium tuberculosis)
-Fungal (histoplasma, aspergillus, candida)
-Parasitic (tapeworm, toxoplasma)
Autoimmune disorders
-Rheumatic fever, rheumatoid arthritis, sarcoidosis, etc.
Disorders of adjacent structures
-MI, pneumonia, dissecting aneurysm
Metastasis from lung or breast cancer
Chest trauma
Metabolic
-Uremia, anorexia, myxedema
Radiation therapy
Pericarditis Clinical Manifestations
chest pain
-Usually constant
-worse with deep inspiration and positional
Creaky or scratchy friction rub (main)
-Heard left lower sternal border
Mild fever, increased WBC, ESR, and CRP, anemia
May have nonproductive cough, hiccups
Dyspnea & respiratory splinting
Increased heart rate
s/sx of heart failure
Pericarditis Diagnostics
Most often diagnosed by: _______
Echocardiogram (can detect inflammation, pericardial effusion, tamponade, HF)
Echo can also be used to guide in pericardiocentesis
CT can help to determine the size and location of the pericardial effusion, and my be used to guide pericardiocentesis
MRI (detect adhesions, and inflammation)
Video assisted pericardioscope – guided biopsy
12 lead – shows concave ST elevations, depressed PR intervals
history, and S&S
Treatment of pericarditis
Goals of treatment:
Reduce-
Treat-
Check for complications (cardiac tamponade requires _______; constrictive pericarditis may require surgery)
Rest
pain and inflammation (anti-inflammatory & antispasmodic meds)
underlying cause, if it is known (antibiotics)
pericardiocentesis
