inflammatory conditions of heart

INFLAMMATORY

CONDITIONS OF

HEART

Dr. Jayesh Patidarwww.drjayeshpatidar.blogspot.com

LAYERS OF THE HEART

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MYOCARDITIS

It is inflammation of heart muscle.

CAUSESCommonest cause a virus. Other infections sarcoidosis, immune disease, pregnancy


PATHOPHYSIOLOGY

Virus invades the muscle local inflammation.

After infection subsides, the body’s immune system continues

to inflict inflammatory damage to the heart muscle.

This immune response prolongs the myocarditis.


MYOCARDITIS


Sign & Symptoms

Mild and cause no noticeable symptoms. Pain in the chest. Serious heart failure SOB, fatigue, fluid accumulation in the

lungs & heart,rhythm irregularities inflammation or

scarring.

Diagnosis

Detect signs of irritation of heart muscle. Blood tests (CPK) EKG, Nuclear heart scan shows.9/15/2014 6www.drjayeshpatidar.blogspot.com

Treatment

Corticosteroids.No proven medications Treatment -Salt restriction, ACE

inhibitors, beta blockers treating as well as monitoring heart rhythm

abnormalities.


Prognosis

After initial phase of myocarditis -complete recovery

Chronic Heart Failure due to injured heart muscle.

Sudden unexpected, potentially fatal heart rhythm abnormalities.

Prevented with implantable defibrillators


ENDOCARDITIS

It is a serious infection of one of the four heart valves.


CausesGrowth of bacteria on one of the heart

valves, leading to an infected mass called a vegetation.

Infection may be bacteria in the blood stream after dental work, colonoscopy, and other similar procedures.

Persons at RiskHeart valves (Aortic stenosis, Mitral

stenosis, Mitral regurgitation etc) undergone valve replacements. etc).


Endocarditis


ENDOCARDITIS


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Sign & Symptoms

Fever

Fatigue

Chills

Weakness

Aching joints and muscles

Night sweats

Edema of feet and abdomen

Malaise

Shortness of breath

Occasionally scattered small skin lesions


Diagnosis

Echocardiography.

TEE (Trans Esophageal Echocardiography)

Identification of bacteria by blood culture.

Treatment

Antibiotics given intravenously for 4-6 weeks.

Valve replacement

Prognosis

Response to treatment is indicated by a reduction in fever, negative blood cultures and findings on echocardiography.


PERICARDITIS

Heart sits in the centre of the chest and issurrounded by a sac called thepericardium.

This sac has two layers one that fitstightly onto the heart muscle and anotherlooser layer surrounding the inner layer.

Inflammation of these tissue layerssurrounding the heart is referred to aspericarditis.


Etiology

Idiopathic – cause of illness is not identified

Mechanical injury to the heartHeart attack (MI) and Dressler’s

syndromeHeart surgery and post

pericardiotomy syndromeTrauma

InfectionBacterial, viral, fungal, HIV


Tumors/cancerPrimary (rare)Metastatic

Connective tissue diseaseRheumatoid arthritis, SLE,

Sarcoidosis, Scleroderma

Metabolic diseaseUremia, Hypothyroidism

Medication reactionsSide effects of: phenytoin,

hydralizine and procainamide.9/15/2014 19www.drjayeshpatidar.blogspot.com

Sign & Symptoms

Chest pain

SOB

Fever, chills, muscle aches, malaise


Diagnosis

Physical evaluation

Quality of pain,

Physical finding – pericardial friction rub

EKG

Chest x-ray

Ultrasound of the heart

Blood testing for specific causes (Leukemia, kidney failure, connective tissue disease or thyroid abnormalities).


Treatment Medicines that reduce inflammation

NSAID’s to decrease inflammation and fluid accumulation in the pericardial sac.

Narcotic pain medication for pain

Corticosteroids for immunologically mediated causes.

Pericardiocentesis /pericardotomy9/15/2014 23www.drjayeshpatidar.blogspot.com

Complications

Cardiac tamponade

Constrictive pericarditis


Nursing management

Psychological support

Assess heart sounds for new or worsening murmur.

If pt received surgical treatment, provide postsurgical care.


After surgery, monitor patient’s

temperature; a fever may be present for

weeks.

Assess for signs and symptoms of organ

damage such as stroke, CVA, meningitis,

heart failure, MI etc.

Instruct pt and family about activity

restrictions, medications, and signs and

symptoms of infection.


Nursing management

Reinforce that antibiotic prophylaxis is recommended for patients who have had infective endocarditis and who are undergoing invasive procedures.

Refer to home care nurse to supervise and monitor intravenous antibiotic therapy in the home.


inflammatory conditions of heart

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