Critical Care

in
Cardiovascular
Diseases
 Cardiovascular System
The cardiovascular system comprises :

 The Blood,
 Heart
 Blood Vessels
 The lymph
 Lymph nodes
 Lymph Vessels
 Critical Care
 The specialized care of patients whose
conditions are life-threatening and who
require comprehensive care and constant
monitoring, usually in intensive care units.
Also known as intensive care.
 Critical Care is a term used to describe as
the care of patients who are extremely ill
and whose clinical condition is unstable or
potentially unstable.
 Cardiovascular Diseases
 Infective Endocarditis
 Myocarditis
 Pericarditis
 Rheumatic Fever
 Septicaemia
 Tularaemia
 Plague
 Brucellosis
 Anthrax
 Lyme Disease
 Human Granulocytic Ehrlichiosis (HGE)
 Atherosclerosis
 Treatment

Heart infections are generally treated with

one or more of the following methods:
 Antibiotics.
 Medications used to treat heart failure.
 Corticosteroids.
 Drugs that reduce inflammation in the
body.
 Occasionally, surgery.
 Antibiotics
 Antibiotics, also known as antibacterials,
are medications that destroy or slow down
the growth of bacteria.
 They include a range of powerful drugs and
are used to treat diseases caused by
bacteria.
 Route of Antibiotic Administration: The
choice between oral and parenteral
administration of drugs that are effective
by either route is usually made on the basis
of expediency.
Antibiotics Used in
Cardiovascular Disease
 Penicillin-
Piperacillin
 Cephalosporin: ceftriaxone, Cefipime,
cefuroxime
 Tetracycline: Doxycycline
 Glycopeptide: Vancomycin, Teicoplanin
 Lincosamide: Clindamycin
 Polymixins: Colistimethate
 Oxazolidinone: Linezolid
 Aminoglycoside: Netilmicin
 Carbapenem: Meropenem, Faropenem
Infective Endocarditis
Infective Endocarditis is an infection in the heart
valves or endocardium. The endocardium is the
lining of the interior surfaces of the chambers of the
heart.
This condition is usually caused by bacteria entering
the bloodstream and infecting the heart. Bacteria
may originate in the:
 mouth
 skin
 intestines
 respiratory system
 urinary tract
Infective endocarditis is a serious condition that requires
prompt medical treatment. If left untreated, the infection
can damage your heart valves. This can lead to problems
including:
 Stroke
 Damage to other organs
 Heart Failure
 Death

Symptoms may include:

 Fever
 Chest Pain
 Weakness
 Blood in Urine, Abnormal Urine Colour
 Sinus congestion and Headache
 Nausea or Vomiting
 Weight Loss
Causative Organism of Infective Endocarditis
 The most common bacterial pathogens implicated
in Infective Endocarditis are
Streptococcus and Staphylococcus species (80% to
90% ), while Enterococcus species are the third most
common bacterial etiology.

 Other causative organisms are Haemophilus

species, Actinobacillus,actinomycetem comitans,
Cardio bacterium hominis, Eikenella corrodens,
Kingella kingae, and Kingella denitrificans,
Enterobacteriaceae, Pseudomonas
species, Neisseria gonorrhoeae, and fungi.
Antibiotics in Infective Endocarditis

 Penicillinand Ceftriaxone are considered the drugs

of choice, and Gentamicin may be added for
synergy.
 Vancomycin can be considered in patients unable
to take a beta-lactam antibiotic.
 Linezolid, which is effective against both E faecium
and E faecalis, can be used to treat VRE that is not
susceptible to ampicillin/penicillin.
Septicemia
 Septicemia, is a serious bloodstream infection. It’s
also known as blood poisoning.
 Septicemia occurs when a bacterial infection
elsewhere in the body, such as the lungs or skin,
enters the bloodstream.
 If left untreated, septicemia can progress to sepsis
and quickly become life-threatening. It must be
treated in a hospital.
 Septicemia and sepsis aren’t the same. Sepsis is a
serious complication of septicemia. Sepsis causes
inflammation throughout the body. This
inflammation can cause blood clots and block
oxygen from reaching vital organs, resulting in organ
failure.
Symptoms of Septicemia
The symptoms of septicemia usually start very quickly.
Even in the first stages, a person can look very sick. They
may follow an injury, surgery, or another localized
infection, such as pneumonia. The most common
symptoms are:
 chills
 fever
 breathing very fast
 rapid heart rate
 confusion or inability to think clearly
 nausea and vomiting
 red dots that appear on the skin
 reduced urine volume
 inadequate blood flow
 shock
Causative Organism of Septicemia
The following is a short partial list of both organism and
organ system (and organ-related) terms that are seen in
both the lay and medical literature:
 MRSA sepsis: sepsis caused by methicillin-
resistant Staphylococcus aureus bacteria
 VRE sepsis: sepsis caused by vancomycin-
resistant Enterococcus species of bacteria
 Urosepsis: sepsis originating from a urinary tract
infection (UTI)
 Wound sepsis: sepsis originating from an infection of
a wound
 Neonatal sepsis or septicemia: sepsis seen in newborns,
usually in the first four weeks after birth; sepsis
neonatorum means the same as neonatal sepsis
 Septic abortion: an abortion due to infection with sepsis
in the mother
 Common bacterial causes of sepsis are gram-
negative bacilli e.g. E.coli, P.aeruginosa, E.
corrodens, and Haemophilus influenzae.
 Other bacteria also causing sepsis are Staph.
aureus, Streptococcus species,Enterococcus species
and Neisseria; however, there are large numbers of
bacterial genera that have been known to cause
sepsis.
Antibiotics in Septicemia
Appropriate antibiotics to treat sepsis are combinations of
two or three antibiotics given at the same time; most
combinations usually include vancomycin to treat
many MRSA and other antibiotic-resistant (drug-resistant)
infections. Some of the commonly used antibiotics used
are
 Ceftriaxone,
 Meropenem
 Ceftazidime,
 Cefotaxime,
 Cefepime
 Piperacillin and Tazobactam
 Ampicillin and Sulbactam
 Imipenem/Cilastatin
 Levofloxacin
 Clindamycin
Myocarditis
 Myocarditis is an inflammation of the heart muscle
(myocardium). Myocarditis can affect your heart
muscle and your heart's electrical system, reducing
your heart's ability to pump and causing rapid or
abnormal heart rhythms (arrhythmias)
 Severe myocarditis weakens your heart so that the
rest of your body doesn't get enough blood. Clots
can form in your heart, leading to a stroke or heart
attack.
 Numerous bacteria can cause myocarditis, including
staphylococcus, streptococcus, the bacterium that
causes diphtheria and the tick-borne bacterium
responsible for Lyme disease.
Symptoms
Common myocarditis signs and symptoms include:

 Chest pain
 Rapid or abnormal heart rhythms (arrhythmias)
 Shortness of breath, at rest or during physical
activity
 Fluid retention with swelling of your legs, ankles and
feet
 Fatigue
 Other signs and symptoms of a viral infection, such
as a headache, body aches, joint pain, fever, a
sore throat or diarrhea
Antibiotics in Myocarditis
 Doxycycline
 Ceftriaxone
 Erythromycin
 Clarithromycin

as well as losartan and furosemide

Pericarditis
 Pericarditis is swelling and irritation of the
pericardium, the thin saclike membrane
surrounding your heart.
 The condition can have a number of
causes, including bacterial or viral infection,
parasites, or fungus.
 Most commonly, pericarditis is due to a virus.
 Symptoms of pericarditis include
palpitations, a dry cough, and pain in the
shoulder.
 In rare cases, pericarditis can permanently
scar the pericardium.
Symptoms
The symptoms of pericarditis can include the
following:
 sharp pain in the chest, sometimes central, other
times to the left, that may decrease in intensity
when sitting up and leaning forward
 palpitations
 shortness of breath, especially when reclining
 minor fever
 general weakness
 swelling of the abdomen or legs
 a cough
 pain in the shoulder
Treatment
 Acute pericarditis (treatment). Aspirin (750-1000 mg
every 8 hours for 1-2 weeks) or NSAIDs (ibuprofen
600 mg every 8 hours for 1-2 weeks) with gastric
protection are recommended as first-line therapy
for acute pericarditis.
Rheumatic Fever
A rare but potentially life-threatening disease,
rheumatic fever is a complication of
untreated strep throat caused by bacteria called
group A streptococcus.
 In more than half of all cases, rheumatic fever scars
the valves of the heart, forcing this vital organ to
work harder to pump blood.
 Symptoms
The main symptoms –
 Fever,
 Muscle aches,
 Swollen and painful joints,
 and in some cases, a red-lattice-
like rash.
 Treatment

 Oral Penicillin
 Oral Cephalosporin
 Oral Macrolides
Plague
 Plague is caused by the Gram-negative rod Yersinia
pestis. This organism is similar to the agent of
tularemia and is transmitted by its rodent reservoir,
the rat flea.
 The organism enters the lymphatic system and
causes swelling of the lymph nodes
called buboes. This stage is called bubonic plague.
 When the bacteria enter the blood, the condition is
referred to as septicemic plague,
 and when the bacteria enter the lungs, the disease
is called pneumonic plague.
Symptoms of Septicemic Plague

 Abdominal pain.
 Diarrhea.
 Nausea and Vomiting.
 Fever and Chills.
 Extreme weakness.
 Bleeding (blood may not be able to clot)
 Shock
 Skin turning black (gangrene)
 Treatment
 Antibiotics
such as streptomycin, gentamicin,
doxycycline, or ciprofloxacin are used to treat
plague.
Anthrax
 Anthrax is due to the Gram-positive, aerobic, spore
forming rod Bacillus anthracis.
 Spores from this organism are inhaled from the air,
or they are acquired during contact with
contaminated soil or animals such as sheep and
cattle.
 In the bloodstream, B. anthracis causes severe
haemorrhaging, and the spleen, kidneys, and other
blood rich organs become engorged with blood.
 In the lungs, anthrax is called woolsorter's
disease and is accompanied by pneumonia.
 Treatment of Anthrax

 Antibiotics that may be prescribed include

penicillin, doxycycline, and ciprofloxacin.
 Inhalation anthrax is treated with a combination
of antibiotics such as ciprofloxacin plus another
medicine. They are given by IV (intravenously).
Tularemia
 Tularemia is due to a Gram-negative rod
called Francisella tularensis. The bacteria enter the
body by contact, inhalation, ingestion of
contaminated rabbit meat, and the bite of ticks
and other arthropods.

 Patients experience a blood disorder

accompanied by fever, malaise, and numerous
nonspecific symptoms.
 Treatment of Tularemia

 Streptomycin or Gentamicin, which are given by

injection directly into a muscle or vein.

 Oral antibiotics such as Doxycycline, Clindamycin.