endocarditis pericarditis myocarditis

OM VERMA
ASSISTANT PROFESSOR
MEDICAL-SURGICAL NURSING
GRACIOUS COLLEGE OF INSTITUTE

1. TOPIC
ENDOCARDITIS,PERICARDITIC
,MYOCARDITIS
PRESENTED BY -
MR.OM VERMA
ASSISTANT PROFESSOR
GRACIOUS COLLEGE OF INSTITUTE

4. INFECTION AND
INFLAMMATION OF
HEART

5. INTRODUCTION:
•World Heart Day is celebrated every year on
29th September with the intent of raising
awareness about cardiovascular disease. Every
year has a different theme which tackles
different aspects of heart disease. This year, the
theme on World Heart Day is creating heart-
healthy environments. This year the themeis
“Power yourlife”

6. TERMINOLOG IES:
•Infection:
•Inflammation:
•Dysrhythmias
•Endocarditis
•Myocarditis
•Pericarditis
•The process of infecting orthe
state of beinginfected
•A localized physical condition in which part of thebody
becomes reddened, swollen, hot, and often painful,
especially as a reaction to injury orinfection
•Abnormality in a physiological rhythm, especially inthe
activity of the brain orheart.
•Inflammation of theEndocardium
•Inflammation of theMyocardium
•Inflammation of thePericardium

7. REVIEWOF ANATOMYAND
PHYSIOLOGY OFHEART:
The wall of the heart is composed of three
distinct layers. From superficial to deep they
are:
Thepericardium
Themyocardium
Theendocardium

8. PERICARDIUM:
•The pericardium is the outer most
layermade up of twomembranes.
•The outer layer is the parietal
pericardium.Theinnerlayeristhe
visceralpericardium.
•It is made up of loose and dense
connectivetissue.

9. •The myocardium is composed of
specialized cardiac muscle found
only in the heart. It is not under
voluntarycontrol.
•It is made up of musclefibres.
•The myocardium is thickest at the
apex and thins out towards the
base.
MYOCARDIUM:

10. •This is the innerlayer.
•It is a thin, smooth membrane that
permits smooth flow of blood inside
the heart. It is made up of muscle
fibres.
•. It consists of flattened epithelial
cells and it is continuous with the
endotheliumlining the bloodvessels.
ENDOCARDIUM :

13. INFECTIVE DISORDERS OF HEART
There are 3 conditions underthe
infective disorders of heart
namely,
•ENDOCARDITIS
•PERICARDITIS
•MYOCARDITIS

14. STATISTICALREPORT
•30 millionheart patientsin India, 14 million reside
in urban areas and 16 million in ruralareas.
•"If the current trend continues, by the year 2020,
the burden of atherothrombotic cardiovascular
diseases in India will surpass that of any other
country in theworld."
•Today, cardiac hospitals in India perform over
2,00,000 openheartsurgeries per year, one of the
highest,worldwide.

15. ENDOCARDITIS:

16. ENDOCARDITIS :
infectionoftheendocarditis,isan
endocardialsurfaceoftheheart.The
endocardium,theinnermostlayerofthe
heart.Inflammationfromendocarditis
affectsthe cardiacvalves.

17. Endocarditis is a define as life-threatening
inflammation of the inner lining of your heart's
chambers and valves (endocardium). And caused by an
infection. Bacteria, fungi or other germs from another
part of body, such as mouth, spread through
bloodstream and attach to damaged areas in heart. It
is called endocarditis If it's not treated quickly,
endocarditis can damage or destroy heart valves.
According to lippen cott

20. CLASSIFICATION:

21. CLASSIFICATION:
•Acute form: healthy valves + endocarditis
mostly caused by S.aureus
•Subacuteform:pre-existingvalvedisease+
endocarditismostly caused byS.enterococci
•

23. ETIOLOGICAL FACTORS:
CardiacConditions:
•Prosthetic heartvalves
•Acquired valve disease (mitral valveprolapse)
•Cardiac lesions (e.g., ventricular septaldefect)
•Rheumatic heart disease (e.g., mitral valveregurgitation)
•Congenital heartdisease
•Pacemakers
•Marfan’s syndrome ( genetic disorder that affects the
body’s connectivetissue)
•Cardiomyopathy

24. NONCARDIAC CONDITIONS:
•Hospital-acquired bacteremia
•hospital-acquired heartvalveinfectionsare
beingcausedby staphylococcus bacteria—
which is very common inhospitalsand
canlead to heart failureor stroke in
endocarditis patients.

25. •IV drugabuse
•Endocarditisis often associated
with heart defects or abnormal
valves, but can also be formed by
using unsanitary needles to
injectdrugs. Thiscausesbacteria
from the needle to be released
directly into the bloodstream.

26. PROCEDURE -ASSOCIATEDRISKS
•Intravascular devices (pulmonary
arterycatheters)
•Intravascular catheter-related infections are
a majorcauseof morbidity and ...
valvularheartdisease or
anintravascularprostheticdevice, should
receive ... bacterialendocarditis,
septicpulmonaryemboli, and septic
thrombosis Removal ofvascular
cathetersthat are infected with S. aureus.

27. PATHOPHYSIOLOGY

28. .
PATHOPHYSIOLOGY

30. CLINICAL
MANIFESTATIONS

31. The onset of symptoms is usually ~2 weeks or less from the initiating
bacteremiais the presence of bacteria in the bloodstream
Symptoms are -
High grade fever and chills
Arthralgias/ myalgias
ArthralgiaIs joint pain.Myalgiais muscle pain.
Abdominal pain
Pleuriticchest pain
Back pain
AnorexiaAn eating disorder characterized by markedly reduced appetite
Weight loss
Fatigue

32. Signs are –
Fever
Heart murmur –if no murmur with other
signs and symptoms may indicate right-
sided heart infection
Nonspecific signs –petechiae, "splinter"
hemorrhages, clubbing, splenomegaly,
neurologic changes
More specific signs -Osler's Nodes,
Janewaylesions, and Roth's Spots

33. Nonspecific signs –
Petechiae—conjunctiva, mucous membranes
Splinter hemorrhages in nail-beds
Clubbing of fingers and toes—primarily occurs in
patients who have an extended course of
untreated infective endocarditis.
Neurological changes -Localized headaches,
Transient cerebral ischemia, Altered mental
status, aphasia
Splenomegaly, Enlargement of spleen

34. More specific signs –
Osler's nodes—painful red nodes on palmdsof
fingers and toes; usually late sign of endocardial
infection
Janeway'slesions—flat painless and small red sport
in palm and sole several days 1 to 2 weeks; usually
an early sign of endocardial infection.
Roth's spots(retinal hemorrhages)

36. splinter hemorrhageis a small amount of bleeding underneath anail.
You may notice a dark red or brown line along yournail

37. Petechiae—bleeding conjunctiva, mucous membranes ,bucal
mucosa ,lips ankle and feet

47. COLLABORATIVE MANGEMENT:
DRUGS:
•IV antibiotic therapy, based on blood cultures,is
started.
•Fever may persist for several days after
treatment has been started and can be treated
with aspirin,acetaminophen
•Iv fluids

49. COMPLICATION
As a result,endocarditiscan cause several
majorcomplications, including
Heart failure.
Abscesses in the heart.
Heart rhythm problems.
Heart attack.
Stroke.
Infections in other organs such as the lungs, brain, or kidneys.

50. PERICARDITIS

53. PERICARDITIS:
Pericarditis is a condition caused by inflammation of
the pericardial sac (thepericardium)
According to Lewis

54. CAUSES OFPERICARDITIS
Infectious pericarditis:Pericarditisthat develops as
the result of a viral, bacterial, fungal or parasitic
infection.
adenovirus, mumps, hepatitis, varicella zoster, human
immunodeficiencyvirus
Pneumococci, staphylococci,streptococci,
gonorrhoeae, Legionella pneumophila,
Mycobacteriumtuberculosis
Histoplasma, Candidaspecies
Idiopathic pericarditis:Pericarditisthat does
not have a known cause.

55. Viral pericarditisis caused by a complication of a
viral infection, most often a gastrointestinal virus.
Bacterial pericarditisis caused by a bacterial
infection, including tuberculosis.
Fungal pericarditisis caused by a fungal infection.
Parasitic pericarditisis caused by an infection from a
parasite.
Some autoimmune diseases, such as lupus,
rheumatoid arthritis and scleroderma can cause
pericarditis.

56. Other causes
pericarditisinclude injury to the chest,
such as after a car accident (traumatic
pericarditis), other health problems such as
kidney failure (uremic pericarditis), tumors,
genetic diseases such as Family history, or
rarely, medications that suppress the
immune system.

57. Uremic pericarditisis thought to
result from inflammation of the
visceral and parietal layers of
thepericardiumby metabolic
toxins that accumulate in the
body owing to kidney failure.

58. Pericardiocentesis:A procedure performed to drain
excess fluid from the pericardium with a catheter.
Pericardiectomy:Surgical treatment of pericarditis
that involves the removal of a portion of the
pericardium.
Pericardial window:A minimally invasive surgical
procedure performed to drain fluid that has
accumulated in the pericardium. This surgical
procedure involves a small chest incision through
which an opening is made in the pericardium.

59. Pericardial effusion:Excess fluid
build-up in the pericardium.
Cardiac tamponade:A severe compression
of the heart that impairs its ability to
function. Cardiac tamponadeis a medical
emergency that requires prompt diagnosis
and treatment.Chronic pericarditis

60. SIGNS ANDSYMPTOMS

65. DIAGNOSTICSTUDIES:
ECG
Echocardiogram(echo) to see how
well heart is working and check for fluid
orpericardialeffusion around the heart.
Electrocardiogram(ECG ) to look for changes in heart rhythm. ..

66. COMPUTET-
TOMOGRAPHY
CHEST
X-RAY

67. Chest X-ray to see the size
of your heart and any fluid
in lungs.

69. COLLABORATIVE MANAGENMENT:
MEDICATION:
•Non-steroidal anti-
inflammatorydrugs
Example:Ibuprofen
•Corticosteroids:Example:
Prednisolone

71. SURGICALPROCEDURE :
PERICARDIOCENTESIS

72. Pericardiocentesisis aproceduredone
to remove fluid that has built up in the
sac around the heart (pericardium). It's
done using a needle and small catheter
to drain excess fluid. A fibrous sac
known as the pericardium surrounds
the heart.

76. MYOCARDITIS
•Myocarditisisaninflammationof
themyocardium,themiddlelayer
oftheheartwall.
•Myocarditis can affect both the
heart's muscle cells and the heart's
electrical system, leading to
reduction in the heart's pumping
function and to irregular heart
rhythms.

77. Myocarditisit is a define as disease marked by the
inflammation of the heart muscle known as the
myocardium —the muscular layer of the heart wall.
This muscle is responsible for contracting and
relaxing to pump blood in and out of the heart and to
the rest of the body.
According to lippen cott

80. ETIOLOGICAL FACTORS:
VIRUSES:Coxsackie virus, ParvovirusB19,
Herpes simplexvirus
BACTERIA: Staphylococcus, streptococcus
PARASITES:Toxoplasma
FUNGI:Aspergillus

81. Viral infection
is the most common cause of myocarditis. When you have one,
your body produces cells to fight it. These cells release
chemicals. If the disease-fighting cells enter yourheart, some
chemicals they release can inflamationheart muscle.
Some things that can cause myocarditisinclude:
CoxsackieB viruses
Epstein-Barr virus (EBV)
Cytomegalovirus (CMV)
Hepatitis C
Herpes
HIV
Parvovirus

82. Chlamydia(acommon sexually transmitted
disease)
Mycoplasma(bacteria that cause
alunginfection)
Streptococcal (strep) bacteria
Staphylococcal (staph) bacteria
Treponema(the cause ofsyphilis)
Borrelia(the cause ofLyme disease)

83. Alcohol
Drugs
Lead
Spider bites
Wasp stings
Snakebites
Chemotherapyandradiation therapy
Anautoimmune diseasethat
causesinflammationthroughout your body,
likelupusorrheumatoid arthritis, may also lead to
myocarditis.

84. Autoimmune diseases
Autoimmune diseases that cause
inflammation in other parts of the
body, likerheumatoid arthritisor
SLE, can also sometimes cause
myocarditis

85. PATHOPHYSIOLOGY
Due to the risk etiological factors the
inflammatory process causes an infiltrateto
build up in the cardiac myocytes, resulting
in injury to myocardialcells.
That infective agents forming abscess and
an autoimmune injury may occur whenthe
immune system destroys both invading
organism and myocardialcells
Heart Enlarges: LVEDV

86. CardiacOutput
Damage of the long term effecton
heartfunction

87. SIGNS ANDSYMPTOMS
•Chest pain (often described as "stabbing"
incharacter).
•CHF
•Palpitations (due toarrhythmias).
•Suddendeath
•Fever (especially wheninfectious)

90. Signs and Symptoms
Myocarditisoften has no symptoms. In fact, most people
recover and never even know they had it.
If you do have symptoms, they may include:
Shortness of breath duringexerciseat first, then at night
while lying down
Abnormal heartbeat, which causesfaintingin rare cases
Light-headedness
A sharp or stabbingchest painor pressure, which may
spread to your neck and shoulders
Fatigue

91. Signs of infection, such as
Fever
Muscle aches
Sore throat
Headache
Diarrhea
Painful joints
Swollen joints, legs, or neck veins
Small amounts of urine

92. DIAGNOSTICEVALUATION:
•ECG: Diffuse ST segmentchanges
•LABORATORY FINDINGS: Increased ESR
erythrocyte sedimentation rateand CRP c-reactive
protein levels, elevated levels ofmyocardial markers
such astroponin
•CHESTRADIOGRAPHY :Cardiomegaly
•MRI: localization ofinflammation

95. Electrocardiogram (ECG).This noninvasive test shows your
heart's electrical patterns and can detect abnormal rhythms.
Chest X-ray.An X-ray image shows the size and shape of your
heart, as well as whether you have fluid in or around the
heart that might indicate heart failure.
MRI.Cardiac MRI will show your heart's size, shape and
structure. This test can show signs of inflammation of the
heart muscle.
Echocardiogram.Sound waves create moving images of the
beating heart. An echocardiogram might detect enlargement
of your heart, poor pumping function, valve problems, a clot
within the heart or fluid around your heart.

96. Blood tests.These measure white and red blood
cell counts, as well as levels of certain enzymes
that indicate damage to your heart muscle. Blood
tests can also detect antibodies against viruses
and other organisms that might indicate a
myocarditis-related infection.
Cardiac catheterization and endomyocardial
biopsy.A small tube (catheter) is inserted into a
vein in your leg or neck and threaded into your
heart. In some cases, doctors use a special
instrument to remove a tiny sample of heart
muscle tissue (biopsy) for analysis in the lab to
check for inflammation or infection.

98. PHARMACOLOGICAL MANAGEMENT
DRUGTHERAPY:
•Cardiac glycosides(Digoxin)
•Loop diuretics (Furosemide)
•Calcium channel blockers(Amlodipine)
•ACE (Angiotensin converting enzyme
inhibitors(Captopril)
•Vasodilators(Nitro-glycerine)

101. Ventricular assist devices.Ventricular assist devices (VADs)
are mechanical pumps that help pump blood from the lower
chambers of your heart (the ventricles) to the rest of your
body. VADs are used in people who have weakened hearts or
heart failure. This treatment may be used to allow the heart to
recover or while waiting for other treatments, such as a heart
transplant.
Intra-aortic balloon pump.Doctors insert a thin tube
(catheter) in a blood vessel in your leg and guide it to your
heart using X-ray imaging. Doctors place a balloon attached to
the end of the catheter in the main artery leading out to the
body from the heart (aorta). As the balloon inflates and
deflates, it helps to increase blood flow and decrease the
workload on the heart.

103. POSSIBLE COMPLICATIONS
If left untreated, myocarditismay lead
tosymptoms of heart failure, where your heart
has trouble pumping blood the way it should. In
rare cases, it leads to other problems, such as:
Cardiomyopathy: The heart muscle weakens or
the structure of the heart muscle changes.
Pericarditis: Inflammation of the sac covering the
heart (called the pericardium).