Cardiac Disorders
Endocarditis
Description: Endocarditis is infection of endocardium or heat valves resulting
from invasion of bacteria or other organisms. It may be acute, sub- acute ,or
chronic
Etiology
1. Causative organisms
* Bacteria (eg, Streptococcus viriclans,
Staphylococcus aureu
* Fungi (eg, Candida albicans, Aspergillus)
* Rickettsiae
Predisposing factors
History of valvular heart disease
Prosthetic valve replacement surgery
Debilitation
Indwelling, catheter placement
Prolonged intravenous antibiotic therapy
Intravenous drug abuse
Dental surgery
Path physiology: Ineffective organisms travel through the bloodstream and are
deposited on heart valves or other portions of the endocardium.This triggers fibrin
and platelet aggregation, which engulfs the organisms, forming friable verrucous
vegetations.
The vegetations typically form on valves but also may extend to,
endocardium.Vegetations covering the valve surface can lead to ulceration and
necrosis with subsequent deformity and dysfunction of the valve leaflets.
Clinical manifestations
1.Weakness and fatigue
2.Weight loss and anorexia
3.Fever, with chills and diaphoresis
4.Cough
5 .Arthralg
6.Splenomegaly
7.Petechiae of the anterior trunk , and mucosa
8. New heart murmur or a change in an existing murmur, especially in the
presence of fever
9- Splinter hemorrhage of nail pad
10.Skin changes such as Roth spots, osler nodes or Janeway lesions
Janeway lesion
2. Laboratory and diagnostic study findings
a. Blood analysis findings
Positive blood cultures for causative organisms
Elevated WBC count and erythrocyte
Anemia
sedimentation rate (ESR)
b. Echocardiogram shows valvular damage
c. ECG identifies changes indicating arrhythmias and cardiomegaly
Nursing management
Administer prescribed medications, which include antibiotics
Provide ongoing assessment.
Monitor temperature at regular intervals.
Draw blood for serial cultures to evaluate the effectiveness of therapy.
Observe for signs and symptoms of CHF, cerebral vascular complications, and
valve stenosis or regurgitation
Prepare the client for possible valve replacement/ which greatly improves the
prognosis for clients with severely damaged heart valves.
Provide client and family teaching :
a. Discuss the need for prophylactic antibiotics before dental work , birth;
genitourinary, gastrointestinal, or gynecologic procedures procedure or event that can
cause transient bacteremia.
B. Review signs and symptoms of complications to watch for and report.
C. Discuss the need for regular temperature monitoring.
Pericarditis
Definition: What is pericarditis?
Pericarditis is an inflammation of the lining sac surrounds the heart. It can be
associated with a collection of fluid (pericardial effusion) in the space between the
heart and the Pericardium. Pericarditis accounts for approximately 1 in 1,000 in
hospital admission. It is found in about 5% of patients at autopsy. It occurs without
symptoms severe enough to come to medical attention.
What causes pericarditis?
In most patients with pericarditis, no specific cause can be found, and the
condition is termed idiopathic pericarditis.
Specific diseases known to cause pericarditis. These disease damage the ,
pericardium, thereby triggering the body's immune defenses to attack pericardium
tissue and cause pericarditis. These includes
Infections (virus, bacteria, fungus, and tuberculosis)
Heart attack that damages the whole thickness of the heart muscle wall
Kidney failure, uremia
Cancer (usually lung, breast, and lymphoma)
Radiation therapy to the chest
Trauma involving the chest
Drugs, including hydralazine (Apresoline), and phenytoin (Dilantin)
Diseases of connective tissue (lupus and rheumatoid arthritis)
Cardiac surgery
Myxedema cholesterol deposits in the pericardium
What is the path physiology of pericarditis?
°Acute pericarditis: may be fibrinous or effusion, producing serous or hemorrhagic
exudates.
Chronic constrictive pericarditis: is marked by progressive pericardial thickening
1. Chest pain is the most common symptom. Chest pain is usually felt behind the
breast bone (sternum). The pain is described as sharp, often aggravated by deep
breathing or coughing, and worsened by lying down. Onset of pain Varies, may be
preceded by "flu-like" symptoms for several days to weeks quality of pain
Pleuritic Sharp, stabbing, relived by Sitting up, Shallow breathing and NSAIDs
2. Unlike the chest pain experienced with coronary insufficiency (angina), the
pain of pericarditis is constant and unrelated to exertion.
3. Patients often report shortness of breath, in part due to their shallow breathing
to minimize chest pain.
4. Patients may also notice weakness, fever, and chills. Additional symptoms are
often due to the underlying disease process.
5. Fast heart rhythms (tachycardia).
6. Rarely the patients develop rapid accumulation of fluid in the pericardial sac ..
This fluid causes compression of the heart muscle chambers, thereby limiting the
amount of blood pumped to the rest of body and causing shock. This lifethreatening condition, called pericardial tamponade,' can occur in up to 15% of
patients with percarditis
The doctor notes the symptoms of chest pain and examines the chest area. Further
evaluation can include chest x-ray, ECG, and echocardiogram, as well as
consideration of any underlying predisposing disease processes.
When a stethoscope is placed on the chest, a scratchy, rubbing sound (pericardial rub)
can sometimes be heard with each heart beat. This is believed to come from the
friction of the inflamed pericardial sac rubbing against the beating heart. A pencardial
rub can be heard in about 50 to 75% of patients with pericarditis.
When a sizable fluid collection (pericardial effusion) is present, the chest x-ray
shows an enlarged heart shadow, often with a more circular configuration than
normal.
An echocardiograrm:This test is useful in detecting and measuring the amount of
fluid around the heart and assessing the effect of this fluid on the heart chambers.
Since not all patients with pericarditis develop pericardial fluid, an
echocardiogram cannot be used alone in making the diagnosis.
Blood tests for underlying diseases, such as lupus and rheumatoid arthritis are
evaluated. Skin tests can be performed to detect tuberculosis and other fungal
infections.
When pericardial tamponade causes low blood pressure or shock, a needle can be
used to withdraw fluid from the pericardial space
Removal of the fluid relieves pericardial tamponade, , reverses shock, and improves
blood pressure. The aspirated fluid can be examined for infection and cancer
How is pericarditis treated?
When the cause of the pericarditis is known, treatment is directed toward the
underlying disease. For example, if bacteria are found in the pericardial
fluid,(intravenouse antibiotic given. When systemic diseases such as lupus and
rheumatoid arthritis are responsible for the pericarditis, anti-inflammatory drugs
and medications that suppress the immune system.
Idiopathic pericarditis and pericarditis following heart surgery usually respond to
no steroidal anti-inflammatory drugs such as aspirin ,ibuproden. When the pain is
not controlled with these drugs, corticosteroids , Prednsone an be used and are
generally effective. Corticosteroids have powerful anti-inflammatory effects.
Unfortunately, long term use of corticosteroids can lead to side ' effects such as
one bone thinning ,high blood pressure increase blood sugar, It usually given in
large doses daily until symptoms resolve, and then rapidly tapered over 7 to 14
days.
When the treatment of pericarditis is successful, the inflammation and any
pericardial fluid usually resolve over 2 to 6 weeks. Patients are often initially
hospitalized for 24 to 48 hours to exclude a possible heart attack or infectious
condition
Blood thinning medications (anticoagulants)] are generally avoided in patients
with pericarditis in order to minimize the risk of bleeding into the pericardial sac,
thereby causing tamponade.
In rare cases, scarring of the pericardial sac around the heart causes constrictive
pericarditis. In this condition, the scarred pericardial sac causes constriction of heart
chambers, leading to impaired heart pumping similar to tamponade. Surgical removal
of the constricting pericardial sac may be needed to improve symptoms.