Inflam Heart Disease.txt

• Inflammation of the lining of the heart and valves
• Previously damaged valve surface seeded with bacteria released during invasive prodcedures
• Infection (through bloodstream) causes valve damage; can infect myocardium and/or result in sepsis
• Valve damage can lead to CHF

Clumps of bacteria, fibrin, platelets, and leukocytes that effects valvular function and can embolize to brain, kidneys, lungs, limbs, etc.

• Dental procedures
• Cystoscopy
• Endoscopy
• GYN procedures
• Surgery
• IV drug abuse
• Cardiac cath
• IV therapy

• Fever, chills, weakness (immune response)
• Myalgias, arthralgias (inflammatory cytokines released in reaction to infection)
• New onset murmur (caused by valvular damage from infection and bacteria)
• Splinter hemorrhage and petechiae (vegetations lodge in peripheral vessels)
• Osler's Nodes (painful tender red or purple pea sized lesions on finger tips or toes)
• Janeway's Lesions (bruising areas; flat painless small red spots on palms and soles)
• Embolic complications (strokes, embolism in kidneys)

• CBC (elevated WBCs)
• Blood cultures (want to know organism so know how to treat; usually strep, staph or enterococci)
• 2D echo or TEE (to visualize valves; TEE better visualize vegetation)

• IV antibiotics for weeks (usually PCN, cephalosporin, or vancomycin)
• May be discharged with PICC
• May require valve replacement (if damage is severe)

• Assessment (vitals, heart sounds, fever, lack of cardiac flow due to valve damage, skin lesions)
• Cardiac monitoring
• Draw labs and evaluate results (draw culture prior to 1st dose of antibiotics)
• IV antibiotics (maintain IV access, review allergy history, observe for response to therapy and adverse reactions)
• Acetaminophen for fever (control fever to decrease cardiac workload)
• Patient education (explain diagnosis and treatment)
• Psychosocial support
• Discharge planning (home health follow up; PICC line; teach patient to do treatment themselves, maintenance of PICC line, signs and symptoms of infection, and what to do if there is a problem)

• Patient's with pre-existing valve disease are more prone to endocarditis because they already have valves that are calcified
• Required for patients with prosthetic heart valves, pacemakers, ICDs, some heart murmurs (does not include functional murmurs or MVP without regurgitation), rheumatic fever and prior history of endocarditis
• Usually single dose of PCN or erythromycin 1 hour prior to procedure
• Educate patient (inform dentist and other healthcare providers)

• Inflammation of the pericardial sac
• Inflammation results from infection, autoimmune responses, mechanical or biochemical sources
• Results in chest pain and can cause increase in pericardial fluid which impedes cardiac function (normal is less than 50 ml)
• Chest pain tends to be pleuritic, positional and sharp; auscultate rub (MI ischemia chest pain is more heavy and diffuse)

• Cardiac tamponade (fluid accumulation due to inflammation)
• Chronic constrictive pericarditis
• Myocarditis

• Viral (treat by symptom management)
• MI (inflammatory response after infarction can produce pericarditis)
• Dressler's syndrome (2 weeks after MI; autoimmune pericarditis)
• Bacterial
• Trauma
• Neoplasm
• Radiation
• Tuberculosis
• Uremia

• Chest pain (sharp, pleuritic; worse with coughing, swallowing, movement or lying down; relieved by sitting up or leaning forward)
• Fever
• Pericardial friction rub
• EKG changes (diffuse ST segment elevation across all 12 leads; if is an MI, will correlate with leads that correspond to a certain artery and not across all 12 leads)

• EKG and cardiac enzymes (to rule out MI)
• Echo (to look for inflammation, effusion, or tamponade)
• Pericardiocentesis (pull fluid from sac) or pericardial biopsy (to determine etiology)

• NSAIDs or corticosteroids
• Treat underlying cause if not viral
• Rest

• Assess pain
• Observe for medication effects (NSAIDs: GI bleed, kidney problems; corticosteroids: incr risk for infection, catabolism, incr blood sugar)
• Observe for signs or symptoms of tamponade
• Assist to position of comfort
• Provide emotional support

• Rapid accumulation of fluid compresses the heart impeding its ability to fill
• Results in severely compromised cardiac output (impaired preload)
• Can occur from trauma
• Severity depends on how rapidly it develops
• Hypotension, tachycardia, tachypnea, dyspnea, anxiety, confusion, JVD, muffled heart sounds, poor perfusion peripherally (low voltage EKG)
• Pulsus paradoxus - inspiratory drop in SBP of >10mmHg (related to shifts in thoracic pressure)

• Emergent pericardiocentesis
• Risks of pericardiocentesis: arrhythmias, pneumomediastinum, pneumothorax, myocardial laceration, coronary artery laceration, puncture of ventricle
• Pericardial window: removal of part of pericardium in patient's who have chronic pericardial effusions (keep re-accumulating fluid)

• Impaired contractility due to inflammation of myocardium
• Etiology: viral, SLE, idiopathic
• Clinical manifestations: similar to pericarditis with CHF, crackles, S3, JVD, edema
• Contraindication to perform any type of exertion (can go into a lethal arrhythmia)

• No specific treament
• Rest and treat underlying CHF
• Most will resolve
• Some will progress to dilated cardiomyopathy

• Inflammation of the heart resulting from an immune reaction to an infection with group A beta hemolytic strep
• Occurs 2 to 3 weeks after infection
• Inflammation can occur throughout the heart but primarily affects the valves
• Complications: permanent valve damage (usually mitral or aortic), stenosis, regurgitation

• Fever (immune response)
• Cardiac effects (new onset murmur, CHF, pericardial effusion, pericarditis)
• Migratory polyarthritis (inflammatory arthritis; joints are red, swollen, tender)
• Subcutaneous nodules (Firm, small, round, painless swellings over bony prominences)
• Sydenham's chorea (nervous system inflammation; spastic movements that worsen with voluntary activity; delayed sign; weakness, ataxia)
• Erythema marginatum (less common; bright red macular lesions on trunk, upper arms, and thighs)

• History and exam (recent infections, sore throat, assess pharynx, lymph nodes, CV exam)
• ASO titer (indicates immune response to strep; tests for antibodies)
• Throat culture (identify strep source)
• Echo (assess heart valves)

• Antibiotics (treat with PCN or macrolide to eradicate underlying strep infection; will require antibiotic prophylaxis for 5 years to life because attacks will recur if re-infected with strep)
• Anti-inflammatiories (salicylates or corticosteroids)
• Course (95% resolve in 6 months)
• Valve damage (may require on-going evaluation and treatment)
• Prevention

• The bacteria that cause them (endocarditis: usually staph)
• Different antibodies (rheumatic rever: antibodies are causing problem, not bacteria; endocarditis: bacteria causes problem, bacteria is attacking the heart)
• Etiology (endocarditis: bacteria gets into blood stream; can get rheumatic fever without septicemia)