INFLAMMATORY

CONDITIONS OF
HEART
Dr. Jayesh Patidar
www.drjayeshpatidar.blogspot.com
LAYERS OF THE HEART
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MYOCARDITIS
It is inflammation of heart muscle.
CAUSES
Commonest cause a virus.
Other infections sarcoidosis,
immune disease, pregnancy
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PATHOPHYSIOLOGY
Virus invades the muscle local
inflammation.
After infection subsides, the
bodys immune system continues
to inflict inflammatory
damage to the heart muscle.
This immune response prolongs
the myocarditis.
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MYOCARDITIS
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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.
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Treatment
Corticosteroids.
No proven medications
Treatment -Salt restriction, ACE
inhibitors, beta blockers treating as
well as monitoring heart rhythm
abnormalities.
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Prognosis
After initial phase of myocarditis -
complete recovery
Chronic Heart Failure due to injured
heart muscle.
Sudden unexpected, potentially fatal heart
rhythm abnormalities.
Prevented with implantable defibrillators
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ENDOCARDITIS
It is a serious infection of one of the four
heart valves.
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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).
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Endocarditis
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ENDOCARDITIS
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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
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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.
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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.
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Etiology
Idiopathic cause of illness is not
identified
Mechanical injury to the heart
Heart attack (MI) and Dresslers
syndrome
Heart surgery and post
pericardiotomy syndrome
Trauma
Infection
Bacterial, viral, fungal, HIV
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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.
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Sign & Symptoms
Chest pain
SOB
Fever, chills, muscle aches, malaise
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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).
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Treatment
Medicines that reduce inflammation
NSAIDs to decrease inflammation and
fluid accumulation in the pericardial
sac.
Narcotic pain medication for pain
Corticosteroids for immunologically
mediated causes.
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Complications
Cardiac tamponade
Constrictive pericarditis
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Nursing management
Psychological support
Assess heart sounds for new or
worsening murmur.
If pt received surgical treatment,
provide postsurgical care.
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After surgery, monitor patients
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.
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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.
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