INFECTIOUS DISEASES of the Heart Carditis (severe heart inflammation)

↓
Rheumatic Heart Disease
Decreased contractility
- Also called as Rheumatic Endocarditis
Decreased cardiac output
or Myocarditis
Embolic events
- Usually a complication of rheumatic
fever which may occur days or weeks Chronic valvular disease
after an untreated Group A beta-
hemolytic streptococcal (GABHS)
infection of the upper respiratory tract Signs and Symptoms:

Classic signs of rheumatic fever

Risk Factors of Streptococcal Infection:
Major Criteria:
• May be transmitted via oral and
respiratory secretions  Carditis

• Malnutrition  Erythema marginatum

• Overcrowding  Syndenham’s chorea

• Low socioeconomic status  Migratory polyarthritis

• Family history of rheumatic fever  Subcutaneous nodules

Pathophysiology Minor Criteria:

Acquired streptococcal infection  Fever

↓  Arthralgia

Development of rheumatic fever  Leukocytosis/↑ESR (Normal is

0-22 mm/hr in males and 0-29
↓ mm/hr in females/ ↑C-Reactive
Inflammatory/Immunologic process in Protein – N is below 10 mg/L
response to infection  ECG: Prolonged P-R interval
↓

Autoimmune response  Small translucent vegetations or

(Immune complex deposits into the growths in the valve flaps
endocardium)  Valvular regurgitation or stenosis
↓  s/sx of heart failure
Classic Signs and Symptoms of
Rheumatic fever
Diagnostic:
Pericarditis (during acute phase)
 Throat culture
Myocarditis (lesions called ASCHOFF’S
BODIES in the interstitial tissue as well  Increased WBC and ESR levels
as swelling and fragmentation leads to  Increased cardiac enzyme levels
formation of fibrotic nodules and
scars);  (+) Antistreptolysin (ASO) Titer

Endocarditis (causes valve leaflet

swelling, erosion along the lines of
Treatment:
valves, blood platelet and fibrin
deposits)
Goals: to stop or prevent streptococcal ↓
infection
Deformity of the valves
Control of the infectious process and prevent
Rupture of the chordae tendineae
development of autoimmune response which
may lead to cardiac damage Blood flow obstruction
1. Penicillin parenteral (IM,IV) – drug of Heart failure
choice; erythromycin for patients who
are allergic to penicillin or as part of Signs and Symptoms:
long term therapy. • s/sx of infection (malaise,
anorexia, wt. loss, cough, back
2. Treatment of heart failure
and joint pain)
3. Cardiac valve surgeries
• Influenza-like signs and
 Valvuloplasty symptoms

 Valve replacement • Intermittent fever

Infective Endocarditis: (Bacterial • Splinter hemorrhages – blood

clots that run vertically under
Endocarditis)pp.818-820
the nails
- Infection of the valves and endothelial • Osler’s nodes - painful, red,
surface of the heart raised lesions found on the
Risk Factors: hands and feet.
• Roth’s spots – retinal
• Patients with cardiac structural
hemorrhages
defects
• Heart murmurs
• Older people
• S/sx of embolism
• IV injection drug users
• Janeway’s lesion
• Patients who undergoes
invasive procedures Diagnostics:
• Patients who have implants or • Blood culture
invasive equipment
• Echocardiogram
• Patients who are receiving
immunosuppressive drugs or Management:
corticosteroids
Goal:
Pathophysiology
• Infection prevention
Once in the bloodstream,
• If prevention fails: eradication of
bacteria travel through the heart invading microorganism
↓  Antibiotic Therapy – administered
parenterally for 4-6 weeks
Invasion of the endocardium by a
microbe  Valvular surgeries
(streptococci, enterococci,
staphylococci,

fungi and rickettsiae)

Inflammatory process (infection) along

the endocardium Nursing Management:
  Assess and monitor for signs and
symptoms of murmurs, embolism,
infection and heart failure
 Ensure appropriate infusion site and
tolerance to antibiotic therapy
Myocarditis p.820
- Inflammatory process involving the
myocardium
- May remain unrecognized throughout
the course of the illness (asymptomatic)
Risk Factors:
• Patients who has infections viral,
bacterial, protozoal or parasitic)
• Patients who are receiving
immunosuppressive drugs or
corticosteroids
• Patients who may develop sensitivity
reaction to long-term drug therapy
Pathophysiology
May begin as an inflammatory or
allergic reaction
↓ damage
May affect one part of the myocardium
↓
May spread to other parts of the
myocardium
↓ 
Heart dilation
Thrombi on the heart wall
Degeneration of muscle fibers
↓ -
Heart failure
Signs and Symptoms:
• May be asymptomatic
• Fever
• Fatigue
• Dyspnea
• Palpitations
• Chest or upper abdominal pain
• Auscultation: Heart mumurs
and irregular rhythm
• Congestive Heart Failure
• Sudden Cardiac Death
Diagnostics:
• Blood cultures
• Echocardiography
• Cardiac M.R.I.
Treatment:
Goals:
- Infection prevention
- If prevention fails: Treatment of the
causative factor, reduction of heart’s
workload and management of heart
failure
 Specific treatment for the underlying
infection
 Do not give NSAIDs if with heart failure
which may further cause myocardial
 Restriction of strenuous physical
activities
 Embolization precaution
 Elastic pressure stockings
ROM exercises
 Anticoagulants
 Cardiac monitoring
Pericarditis p.821
Inflammation of the pericardium
- May be acute or chronic
- Maybe classified according to what
accumulates in the pericardium
Types:
• Acute Dry Pericarditis
• Acute Pericarditis with Effusion
Pathophysiology
 Inflammation of the pericardium Goals:

↓ - Relieve symptoms;

Accumulation of fluid in the - Prevent or treat pericardial effusion or

pericardial sac cardiac tamponade (compression of the
heart from excessive fluid in the
↓
pericardial space)
Rise in the intrapericardial pressure
 Activity restriction
(cardiac tamponade)
 Drug therapy
↓
 Analgesics and NSAIDs
May become thickened and fibrotic
 Corticosteroids
Decreased elasticity
 Colchicines
Formation of scar
 Antibiotics
↓
 Surgeries
Decreased contractility
 Pericardiocentesis
Increased diastolic filling pressure
 Pericardial window or
Decreased cardiac output partial pericardiectomy

Heart failure  Pericardiectomy

Signs and Symptoms Nursing Management:

• Pleuritic chest pain  Prevention or management of infection

• Pericardial friction rub  Nursing responsibility with drug

administration
• Mild fever
 Analgesics
• S/sx of heart failure
 Antibiotics
• ↑R.R./↑H.R.
 Cardiac glycosides
• Pulsus paradoxus
 Activity restriction
• Beck triad (hypotension,
elevated jugular pressure,  Monitor for presence of heart failure
muffled heart sounds)
 Monitor for s/sx of infection
Diagnostics:
 Health teachings:
• CBC - ↑WBC & ↑ESR
 Surgeries
• Blood/Pericardial fluid culture
 Drug therapy
• Cardiac enzymes
 Assessment of s/sx of disease
Imaging Studies: and complications

• CXR, CT-Scan, MRI  Avoidance of complication

• Echocardiography

• ECG

Treatment: General Nursing Diagnoses for Patients with

Infectious Diseases of the Heart
  Activity intolerance related to
compromised oxygen transport
system secondary to heart
muscle dysfunction
 Risk for ineffective breathing
pattern related to decreased
respiratory depth secondary to
pain
 Pain related to friction rub and
inflammatory process
o Primarily supportive and
directed toward controlling
fever, preventing
dehydration, and minimizing
possible cardiac
complications
o Intravenous gamma globulin
o Large doses of aspirin
o Monitoring cardiac status

MUCOCUTANEOUS LYMPH NODE

SYNDROME (KAWASAKI DISEASE)
Description

Acute febrile illness of unknown cause;

principally involving the cardiovascular system,
with extensive perivasculitis of arterioles,
venules, capillaries, including the coronary
arteries; panvasculitis of the main coronary
arteries may cause stenosis or obstruction with
aneurysm formation, pericarditis, interstitial
myocarditis and endocarditis, and phlebitis of
the larger veins

Geographic and season outbreaks

Clinical findings
o Fever for 5 or more days
o Bilateral congestion of the
ocular conjunctiva without
exudation
o Changes of the mucous
membranes of the oral
cavity, such as erythema,
dryness, and fissuring of the
lips, oropharyngeal
reddening, or “strawberry
tongue”
o Changes in the extremities,
such as peripheral edema,
peripheral erythema and
desquamation of the palms
and soles, particularly
periungual peeling
o Polymorphous rash, primarily
of the trunk
o Cervical lymphadenopathy
Treatment