Endocarditis Pericarditis myocarditis

1. By: Touqeer Zainab Endocarditis Pericarditis myocarditis

2. Objectives • By the end of my presentation the learner will be able tolabel the normal and altered anatomy and physiology of CVS • Define the pericarditis, Myocarditis,andEndocarditis. • Discuss the disease process of pt with pericarditis,Myocarditis,and endocarditis. • Discuss the S/S of pericarditis,Myocarditis,and endocarditis • Discuss the treatment option of patient with pericarditis,Myocarditis,endocarditis. • Utilize nursing process in providing care to pt with Endocarditis,myocarditis and pericarditis . • Incorporate relevent research findings in designing a plan of care. • Provide comprihensive Discharge teaching to pt with endocarditis,Myocarditis,and pericarditis

3. Normal Anatomy of CVS

5. EndocarditisDefi:Infectious EndocarditisDefinitionEndocarditis is an infection of the lining of the heart chambers and heart valves that is caused by bacteria, fungi, or other infectious substances.

7. Causes of Endocarditis • Bacteria • Staphylococcus aureus • Streptococcus viridians • Enterococcus • Fungi • Medical procedures

8. Risk factor • Artificial Heart Valves • Congenital Heart disease • Artial Septal Defect • Heart valve problems • Such as mitral insufficiency • History of rheumatic heart disease

9. Symptoms Symptoms of Endocarditis may develop slowly in (sub acute) or suddenly (acute). Fever • Other symptoms may include: • Abnormal urine color • Blood in the urine • Chills • Excessive sweating • Fatigue • Joint pain • Muscle aches and pains • Nail abnormalities (splinter hemorrhages under the nails) • Night sweats (may be severe) • Paleness • Red, painless skin spots on the palms and soles (Laneway lesions) • Red, painful nodes (Osler's nodes) in the pads of the fingers and toes • Shortness of breath with activity • Swelling of feet, legs, abdomen • Weakness • Weight loss

10. Exams and Tests • The health care provider may hear abnormal sounds, called murmurs, when listening to your heart with a stethoscope. • A physical exam may also reveal: • Physical Exam • Splinter hemorrhages in the fingernails. • An eye exam may show bleeding in the retina a central area of clearing. • This is known as Roth's spots

11. Blood culture • Chest x-ray • Complete blood count • CT scan of the chest • Echocardiogram (ultrasound of the heart) • Erythrocyte sedimentation rate (ESR) • Tran esophageal echocardiogram

12. Treatment Admitted to the hospital high-dose antibiotic treatment is needed to get rid of the bacteria. Treatment is usually given for 4 - 6 weeks, depending on the specific type of bacteria. Surgery may be needed to replace damaged heart valves

13. prognosis Early treatment of bacterial endocarditis generally has a good outcome. Heart valves may be damaged if diagnosis and treatment are delayed

14. Complication • Blood clots or emboli that travel to brain, kidneys, lungs, or abdomen • Brain abscess • Congestive heart failure • Glomerulonephritis • Jaundice • Neurological changes • Rapid or irregular heartbeats, including atrial fibrillation • Severe valve damage • Stroke

15. Prevention • The American Heart Association recommends preventive antibiotics for people at risk for infectious endocarditis before: • Certain dental procedures • Surgeries on respiratory tract or infected skin, skin structures, or musculoskeletal tissue • Antibiotics are more likely to be recommended those with the following risk factors: • Artificial heart valves • Certain congenital heart defects. • History of infective Endocarditis • Valve problems a heart transplant • Continued medical follow-up is recommended for people with a previous history of infectious Endocarditis. • Persons who use intravenous drugs should seek treatment • for addiction. If this is not possible, use a new needle for each injection, avoid sharing any injection-related paraphernalia, and use alcohol pads before injecting to reduce risk

16. Cardiac infections: medical and surgical therapies. Source UCSF Stanford Health Care, School of Nursing, USA. Abstract Infections of the heart can be acute or subacute, depending on host susceptibility, the cause and associated virulence, early diagnosis, and effective therapy. The following review will discuss the causes, clinical manifestations, diagnosis, and medical or surgical management of infective endocarditis, prosthetic valve endocarditis, myocarditis, and pericarditis. Nursing considerations emphasize understanding the pathogenesis, early recognition of signs and symptoms, and appropriate prevention and intervention

18. Pericardium • Two layers: • Visceral: thin, inner serosal layer • Parietal: tough, fibrous outer layer • 15-50 ml pericardial fluid • Intrapericardial pressure: mmHg(insp) to +5 mmHg(exp)-5.

19. Pericarditis? Inflammation of the lining of the heart is called pericarditis (itis=inflammation The heart muscle has a tight covering that surrounds it, a lining sac called the pericardium (peri=around +cardium=heart).

20. idiopathic • Viruses • Bacteria • tuberculosis • HIV • Metabolic illnesses • Kidney failure uremia • Hypothyroidism

22. Symptomchest pain • Patients feel worse when lying flat • Other symptoms may include fevers and chills sweats • Shortness of breath • Difficulty swallowing

23. Nursing consideration History and physical examination Diagnostic testing EKG or ECG the EKG may be normal. chest X-ray is usually normal. However, if fluid accumulates in the pericardial sac, the heart can appear larger on the X-ray. echocardiography

24. Treatment for Pericarditis A viral infection and the treatment is aimed at decreasing inflammation and controlling pain. Non steroidal anti-inflammatory drugs (ibuprofen, naproxen Pericardiocentesis Pericardotomy Pericardectomy

25. Nursing Interventions: Watch for signs and symptoms of embolization . Monitor the patient’s renal status including blood urea nitrogen levels, creatinine clearance levels and urine output. Assess cardiovascular status frequently and watch for signs of left ventricular failure such as dyspnea, hypotension, tachycardia, tachypnea, crackles, neck vein distention, edema, and weight gain. Check for changes in cardiac rhythm or conduction. Evaluate arterial blood gas values as needed to ensure adequate oxygenation. Observe for signs of infiltration or inflammation at the venipuncture site. Stress the importance of taking the medication and restricting activities for as long as the doctor orders. Tell patient to watch closely for fever, anorexia, and signs of relapse for about 2 weeks after treatment stops. Teach the patient how to recognize symptoms of endocarditis,. Stress the importance of dental hygiene .

26. MyocarditisDefi…..

27. Anatomy&PhysiologyofMyocardium Myocardium is the muscular middle layer of the wall of the heart . It is composed of spontaneously contracting cardiac muscle fibers which allow the heart to contract. Heart contraction is an autonomic (involuntary) function of the peripheral nervous system The myocardium is surrounded by the pericardium(outer layer of the wall of the heart) and the endocardium (inner layer of the heart).

28. Conti …. • Myocardium stimulates heart contractions to pump blood from the ventricles and relaxes the heart to allow the atria to receive blood. • These contractions produce what is known as a heart beat. • The beating of the heart drives the cardiac cycle

29. MyocarditisDefin…Myocarditis is an inflammatory disease of the myocardium.

30. MyocarditisDefi • Causes • Myocarditis is an uncommon disorder that is usually caused by viral, bacterial, or fungal infections that reach the heart. • Viral infections: • Coxsackie • Cytomegalovirus • Hepatitis C • Herpes • HIV • Parvovirus • Bacterial infections: • Chlamydia • Mycoplasma • Streptococcus • Treponema • Fungal infections: • Aspergillus • Candida • Coccidioides • Cryptococcus

31. Allergic reactions to certain medications or toxins (alcohol, cocaine, certain chemotherapy drugs, heavy metals. Being around certain chemicals Certain diseases that cause inflammation throughout the body (rheumatoid arthritis.

32. Symptoms • There may be no symptoms. Symptoms may be similar to the flu. If symptoms occur, they may include: • Abnormal heartbeat • Chest pain that may resemble a heart attack • Fatigue • Fever and other signs of infection including headache, muscle aches, sore throat, diarrhea, or rashes • Joint pain or swelling • Leg swelling • Shortness of breath • Other symptoms that may occur with this disease: • Fainting, often related to irregular heart rhythms • Low urine output

33. Exams and Tests • A physical examination may show no abnormalities, or may reveal the following: • Abnormal heartbeat or heart sounds (murmurs, extra heart sounds) • Fever • Fluid in the lungs • Rapid heartbeat (tachycardia) • Swelling (edema) in the legs • Tests used to diagnosis myocarditis include: • Blood cultures for infection • Blood tests for antibodies against the heart muscle and the body itself • Chest x-ray • Electrocardiogram (ECG) • Heart muscle biopsy (endomyocardial biopsy) • Red blood cell count • Ultrasound of the heart (echocardiogram) • White blood cell count

34. Treatment • Treatment is aimed at the cause of the problem, and may involve: • Antibiotics (Panicillin for hemolytic streptococci) • Anti-inflammatory medicines to reduce swelling • Diuretics to remove excess water from the body • Low-salt diet • Reduced activity

35. Prognosis How well you do depends on the cause of the problem and your overall health. The outlook varies. Some people may recover completely. Others may have permanent heart failure.

36. Complication • Cardiomyopathy • Heart failure • Pericarditis

37. Nursing DiagnosisPain R/t inflamation of pericardium secondary to disease process.

38. Watch for bleeding from gums or nose. • Be aware of what medicines you take. • Take this medicine exactly as primary healthcare provider tells . • Talk to primary healthcare provider about diet. This medicine works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and other foods, such as cooked peas Nursing management

39. Ask for information about where and when to go for follow-up visits: • For continuing care, treatments, or home services, ask for more information. • Activity: • Limit your physical activity: Caregivers may suggest that you avoid doing stressful and heavy physical activities. Ask your caregivers what activities you are allowed to do. • . • Lifestyle changes: • Do not drink alcohol: • Some people should not drink alcohol. These people include those with certain medical conditions or who take medicine that interacts with alcohol. Alcohol includes beer, wine, and liquor. Tell your caregiver if you drink alcohol. Ask him to help you stop drinking. • Exercise: • Exercise makes the heart stronger, lowers blood pressure, and helps keep you healthy. Begin to exercise slowly and do more as you get stronger. . • Do not smoke: • If you smoke, it is never too late to quit. Ask for information about how to stop smoking if you need help. • Manage your stress: • Stress may slow healing and lead to illness. Learn ways to control stress, such as relaxation, deep breathing, and music. Talk to someone about things that upset you.

40. Discharge plain Rest Rest when you feel it is needed. Slowly start to do more each day. Return to your daily activities as directed. Good nutrition for your heart: Get enough calories, protein, vitamins, and minerals to help prevent poor nutrition and muscle wasting. You may be told to eat foods low in cholesterol or sodium (salt). You also may be told to limit saturated and trans fats. Do eat foods that contain healthy fats, such as walnuts, salmon, and canola and soybean oils. Eat foods that help protect the heart, including plenty of fruits and vegetables, nuts, and sources of fiber. Ask what a healthy weight is for you. Set goals to reach and stay at that weight.

41. References McKenna W. Diseases of the myocardium and endocardium Bruner& sudahath 9th edition lson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association

42. Thank you