INFLAMMATORY
CONDITIONS OF HEART
LAYERS OF THE HEART
MYOCARDITIS
 It
is inflammation of heart muscle.
CAUSES
Commonest 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.
Treatment
 Corticosteroids.
 No
proven medications
 Treatment -Salt restriction, ACE
inhibitors, beta blockers treating as
well as monitoring heart rhythm
abnormalities.
Prognosis




After initial phase
complete recovery
of
myocarditis
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.
Causes
Growth 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 Risk
Heart valves (Aortic stenosis, Mitral
stenosis, Mitral regurgitation etc)
undergone valve replacements. etc).
Endocarditis
ENDOCARDITIS
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 is
surrounded
by
a
sac
called
the
pericardium.
This sac has two layers one that fits
tightly onto the heart muscle and another
looser layer surrounding the inner layer.
Inflammation of these tissue layers
surrounding the heart is referred to as
pericarditis.
Etiology
Idiopathic – cause of illness is not
identified
Mechanical injury to the heart
Heart attack (MI) and Dressler’s
syndrome
Heart surgery and post
pericardiotomy syndrome
Trauma
Infection
Bacterial, viral, fungal, HIV
Tumors/cancer
Primary (rare)
Metastatic
Connective tissue disease
Rheumatoid arthritis, SLE,
Sarcoidosis, Scleroderma
Metabolic disease
Uremia, Hypothyroidism
Medication reactions
Side effects of: phenytoin,
hydralizine and procainamide.
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 /pericardotomy
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.