Infections heart,عفونی قلب، اکسترن کاردیو، مراقبت پرستاری

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بیماریهای عفونی والتهابی قلب Inflammatory and infecious Disorders 

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Overview * Endocarditis- infection of the endocardial surface of the heart * Myocarditis- a focal or diffuse inflammation of the myocardium * Pericarditis- inflammation of the pericardial sac (the pericardium) 

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Infective Endocarditis * Infection of the inner layer of the heart * Usually affects the cardiac valves * Was almost always fatal until development of penicillin 

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Causative Organisms * Causative organism -often bacterial * Streptococcus viridans * Staphylococcus aureus * Other Etiologies * Viruses- Coxsackie B + Fungi - Candida alibcans 

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Etiology and Pathophysiology * Occurs when blood turbulence within heart allows causative agent to infect previously damaged valves or other endothelial surfaces 

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Etiology and Pathophysiology * Vegetation - —Fibrin, leukocytes, platelets, and microbes — Adhere to the valve or endocardium — Embolization of portions of vegetation into circulation -—50% of patients with IE will have systemic embolization 

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Endocarditis An infection of the ic 

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Endocarditis Infection of the innermost layers of the heart May occur in people with congenital and valvular heart disease May occur in people with a history of rheumatic heart disease May occur in people with normal valves with increased amounts of bacteria 

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Classifications of Endocarditis Acute Infective Endocarditis — Abrupt onset - Rapid course — Staph Aureus Subacute Infective Endocarditis SBE — Gradual onset — Systemic manifestations Prosthetic Valve Endocarditis Or named by cause (, Fungal IE) 

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Risk Factors- endocarditis Hx of rheumatic fever or damaged heart valve- less common now (20% of cases) Prior history of endocarditis Aging (50% associated with aortic stenosis) Invasive procedures- (introduce bacteria into blood stream) (surgery, dental, etc) Permanent Central Venous Access IV drug users Valve replacements Renal dialysis 

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Nursing Assessment * Subjective Data — History of valvular, congenital — Previous endocarditis — Staph or strep infection —Immunosuppressive therapy — Recent surgeries and procedures 

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Nursing Assessment * Functional health patterns - ۱۷ drug abuse — Alcohol abuse 

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Nursing Assessment Nonspecific Clinical Manifestations — Weight changes — Chills —Low grade fever in 90% patients — Malaise 

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Nursing Assessment — Diaphoresis — Bloody urine — Exercise intolerance — Generalized weakness — Fatigue —Cough — Headache 

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Nursing Assessment — Dyspnea on exertion — Night sweats —Chest, back, abdominal pain —Also consider s/s related to embolization to specific organ —New or changing heart murmur 

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Assesment endocarditis * Infection and emboli — Emboli-spleen most often affected (splenectomy) - Osler’s nodes- painful, red or purple pea-sized lesions on toes and fingertips - Splinter hemorrhages- black longitudinal streaks on nail beds — Janeway lesions- fiat, painless, small, red spots on palms and soles — Roth spots- hemorrhagic retinal lesions — Murmur- most have murmurs - T above (blood cultures) and low-grade — Chills — Anorexia - Fatigue 

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Splinter hemorrhage * small areas of bleeding under the fingernails or toenails. * due to damage to capillaries by small clots neal 

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Janeway Lesions * flat, painless red spots on palms and soles 

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Roth’s Spots * hemorrhagic retinal lesions 

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Brain: stroke ie ‏تسم‎ ‎Myeatie aneurysm ~ Eye: Rt spots Heart Ski ‏مام امم‎ infected emotss, —_| Red nosttes (Oster noes) ‏اه موز‎ — Puraua (Janeway lesons) Kignoy: Spleen’ infarction, asco Fingamat peas: splnter heiortages 

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Diagnostic Tests * Blood Cultures- most likely positive unless recent antibiotic tx * Echocardiogram-TEE best- see vegetations * Other- WBC with differential, CBC,ESR, serum creatinine,CXR, and EKG 

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Medications * Antibiotics — IV for 4-8 weeks — Monitor BUN and Creatinine. - Evaluate effectiveness of treatment with repeated blood cultures. 

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Additional Treatment Fungal infections- poor responsive to drug therapy May require valve replacement Relapses are common Bedrest usually not indicated unless febrile, HF or other complications 

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Nursing Diagnoses Decreased cardiac output r/t valve insufficiency and altered rhythm Activity intolerance r/t alternation in 02 transport system secondary to valve dysfunction Hyperthermia r/t infection of endocardium Risk for Ineffective Tissue Perfusion- emboli Ineffective Health Maintenance 

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Complications Emboli (50% incidence) - Right side- pulmonary emboli (esp. with IV drug abuse) — Left side-brain, spleen, heart, limbs, etc CHF-check edema, rales, VS Arrhythmias- A-fib, conduction blocks Death 

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Myocarditis Myocarditis is an uncommon inflammation of the heart muscle ( myocardium). This inflammation can be caused by infectious agents, toxins, drugs or for unknown reasons. It may be localized to one area of the heart, or it may affect the entire heart. 

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(9 + Myocarditis — Virus, toxin or autoimmune response causes necrosis of the myocardium — Most often caused by viral infection — Frequently caused by Coxsackie A and B virus — Frequently follows an upper respiratory infection or viral illness — Can result in decreased contractility — Can become chronic and lead to dilated cardiomyopathy- heart transplant or death 

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Risk factor-myocarditis Hx of upper respiratory infection Toxic or chemical effects (radiation, alcohol) Autoimmune or immunosuppresents- 10% HIV develop it Metabolic-lupus Heat stroke or hypothermia 

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Myocarditis- Assessment * Early s/s — Fever, fatigue — Malaise, mylagias — Dyspnea, lymphadenopathy — Nausea, vomiting 

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Myocarditis- Assessment * Cardiac s/s 7-10 days after viral infection —Pleuritic chest pain (pericardial friction rub) + Pericarditis frequently occurs with myocarditis- check friction rub — Tachycardia —Arrhythmias- PVCs, PACs, Atrial Tachycardias, * Signs of heart failure -late cardiac s/s —§3 heart sound, crackles, JVD, syncope, 

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Myocarditis- Assessment * Sudden Death- —In young adults Myocarditis is the cause of up to 20% of sudden cardiac death 

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Diagnostic Tests EKG- Non-specific T-wave abnormalities CK-MB and Troponin may be elevated Endomyocardial biopsy- there are risks and not used for every case but is definitive for myocarditis Chest X-Ray- Variable (Normal to Cardiomegaly) Echocardiogram Cardiovascular Magnetic Resonace A safe and sensitive noninvasive diagnostic test to confirm the diagnosis is not available 

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Myocarditis Treatment ٠ Manage cardiac symptoms * Viral - antibiotics for secondary * Treatment Goal — Decrease workload of the heart so it can heal 

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Medications Digoxin- use cautiously! — Improves CO but causes dysrhytmias in these patients HF drugs- ACE, diuretics, beta blockers etc Immunosupressive therapy —IVIG, prednisone, etc — Evidence inconclusive Anticoagulants- — Reduces risks of thrombus in low EF 

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Other Treatments Bedrest and activity restrictions- Why important?? **Activities may be limited for 6 months- 1 yr. 02 Intraaortic balloon pump Ventricular assist device Transplant 

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Nursing Diagnoses Activity Intolerance Decreased CO Anxiety Excess fluid Volume — watch for signs of heart failure; adventitious lung sounds; complications 

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Pericarditis * Pericarditis is an inflammation of the pericardium, the thin, fluid-filled sac surrounding the heart. It can cause severe chest pain (especially upon taking a deep breath) and shortness of breath.