Infective and inflammatory conditions and arrhythmia Flashcards
What can cause infective/inflammatory conditions of the heart
- Bacteria
- Viruses
- Autoummune conditions (esp. rheumatic fever, rhumatoid arthritis, SLE)
- Drug reactions
- In the immunosuppressed may also be caused by fungus (ESP. candida)
Endocarditis
inflammation of the endocardium
Endocardial lining of the heart is a continuation of the
Intimal layer of the BV and also lines the heart valves (tricupsid, aortic, mitral)
What is a complications of endocarditis
Vegetations
Vegetations are
lesions or clusters of the infecting organism or localization of autoimmune activity, often develops inside the cusp of the valves, they can be stable pr unstable
Vegetations of ___ or ____ origin are susceptible to breaking away the wall/valve under the hemodynamic pressure of the heart. They can create dangerous emboli
Bacterial or fungal
Unstable vegetation is referred to as
Friable
Types of endocarditis
Infective endocarditis, bacterial endocarditis, non-effective endocarditis
Infective endocarditis
occurs when microrganisms adhere to the endocardial surface of the heart, most commonlyu bacterial in origin but may also be fungal or viral or seconary to autoimmune disease
Bacterial endocarditis
often caused when bacteria are introduced to the bloodstream during dental surgery or other medical procedures,
Non-infective endocarditis
AKA as non-bacterial thrombotic endocarditis (NBTE)- formation of sterile and fibrin thrombi on previously undamaged cardiac valves and adjacent endocardium in response to trauma, circulating immune complexes, vasculitis or a hypercoagualable state
Acute disease (in endocarditis)
is more severe, associated with fever, systemic toxicity and death from sepsis in several days to weeks
Subacute disease (in endocarditis)
usually occurs in patients with prior valve disease. It is less severe, associated with a low grade fever, vague systemic complaints and various embolic phenomena
Signs and symptoms of Endocarditis
45% have musculoskeltal symptoms- arthalgia (pain in joints), arthritis, low back pain, myalgia
fever, chills, fatigue, sweating
acute valve damage, pulonary, edema SOB
-constant deep achy chest pain
Medical treatment with endocarditis
long term antibiotics, often four-six weeks or more, if valve damage has occured surgical repair or valve replacement may be required
RMT Concerns for endocarditis
- avoid treatment while the condition is active and the risk of embolism is high
- establish if there is a present risk of embolism
- PX nmay be taking anticoagulants which could increase bleeding/bruising
- Assess for CCHF status and adapt treatment accordingly
Myocarditis
an inflammatory condition of a heart muscle that can result from a variety of causes, most cases are viral in nature, but toxins, drug reactions, and autoimmune reactions are also common causes
Types of myocarditis
Acute myocarditis, viral mycarditis
Acute myocarditis
rare inflammatory disease, which may lead to the sudden onsite of cardiac failure and death
Viral myocarditis
is preceded many times by a flu-like illness or gastroenteritis.
Signs and symptoms of myocarditis
viral infections are often asymptomatic, may present as a constant deep pain similar to endocarditis or with fatigue, SOB, fever, and arthralgia, may also appear in the form of heart failure or sudden cardiac death, may disguse itself as ischemic, valvular or hypertensive heart disease
Medical treatment of myocarditis
no medical treatment is necessary with viral infection. Management is through rest and avoidance of physical exertion (to avoid additional stress to the heart), if bacterial infection is the cause (which is rare) antibiotics are introduced
RMT considerations of myocarditis
not considered to be an absolute C/I for massage in the active phases, awarness of CHF concerns if carsiomyopathy/CHF develop
Pericarditis
inflammation or irritation of the pericardium; the outer protective covering of the heart
The function of pericardium is
helps anchor the heart in place preventing excessive movement of the heart in the chest cavity with changes in body position, helps to protect the heart from infections and envading tumors
An increase in pericardial fluid is called an
effusion
Causes of pericarditis
- trauma or infection from heart surgery
- post myocardial infarction (MI) pericardial irritation (esp. if there is a slow bleed through a mural (wall) defect
- Autoimmune disease (rhumatoid arthritis or lupus)
- Cancer
- Kidney failure (irritation due to toxicity of the blood)
- Drug reactions
- radiation therapy
Cardiac tamponade
life threatening condition due to slow or rapid pericardial accumulation of fluid with subsequent compression of the heart
exudate in the ____ can result in _____ between the visceral and parietal layers. Friction during heart beats can cause pain and usually results in reinforcement of the continuously micro damaged adhesion
pericardium, adhesions
Signs and symptoms of Cardiac tamponade
- systemic symptoms of the original cause may be present
- irritability
- constant extreme chest pain
- Pain is generally felt below the sternum or below the ribd in the left side of the chest
What is considered to be the most painful heart condition
Cardiac tamponade
Pericardiocentisis
draining the effusion with a needle to relieve pressure on the heart
Concerns for the RMT with individuals who have cardiac tamponade
This condition is not worsened by massage, avoid increasing venous return, heart rate, painful stimuli
Arrhythmia/ Dysrhyhmia
disorders of the heart rate and rhythm caused by disturbances in the conduction systems, can lead to hypotension, heart failure and shock because of the big changes in circulatory dynamics
Bradycardia
slowness of the heart rate
What is the purpose of the SA node
aka cardiac pacemaker initiates and paces the heartbeat
Ventricular fibrillation
is a potentially lethal arrhythmia that can occur with one MI or to a heart that has been damaged by coronary artery disease (CAD)
Defibrillation
the ventricles quiver uselessly, instead of pumping blood requires resuscitation and emergency electrical counter shock
Atrial fibrillation (AF)
is the most common cause of dysryhmia, usually not lethal immediately but may increase the risk of heart failure and stroke. It is a total organization of atrial activity without effective contraction, which means that the upper chambers will quiver instead of contract and allow blood to pool and clots to form leading to possible embolism and stroke
Signs and symptoms of atrial fibrillation
- some people will report feelings of palpitations when they feel irregular heart actions
- dizziness, chest pain, fainting
- SOB during exercise and fluid accumulation in the feet and legs
Sinus Tachycardia
abnormally rapid heart beat, more than 100bpm, normal physiological response to stressers such as fever, hypotension, thyroxicosis (excessive thyroid hormone), anemia, anxiety
Sinus bradycardia
abnormally low heart rate, the sinus node discharges at a rate less than 60bpm,
sinus bradycardia is considered normal in
athletes or young adults
signs and symptoms of sinus bradycardia
syncope, sudden onset of weakness, sweating, nausea, pallor, vomiting, distortion of vision, moving a person into a horizontal position can help to quickly stop these symptoms
