Pericarditis Overview and Causes

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Questions and Answers

What is the primary inflammation location in pericarditis?

Epicardium

Myocardium

Pericardium (correct)

Endocardium

Which of the following is a common viral cause of pericarditis?

Staphylococcus

Fungal infection

Influenza (correct)

Streptococcus

Which symptom is most characteristic of pericarditis?

Chest pain (correct)

Shortness of breath

Lower back pain

Palpitations

What is one possible management strategy for patients with pericarditis?

Using NSAIDs for pain relief Signup and view all the answers

Which procedure may be performed to help confirm the diagnosis of pericarditis?

Pericardiocentesis Signup and view all the answers

In which situation may corticosteroids be prescribed for pericarditis?

If the patient is resistant to NSAIDs Signup and view all the answers

What is a potential complication of pericarditis that may require immediate attention?

Cardiac tamponade Signup and view all the answers

What type of medical assessment is commonly used to detect inflammation in pericarditis?

Echocardiogram Signup and view all the answers

What is the primary purpose of performing a pericardial window?

To allow continuous drainage into the chest cavity Signup and view all the answers

Which nursing intervention is essential to manage a patient with acute pericarditis?

Providing analgesics for pain management Signup and view all the answers

What can indicate the development of myocarditis in a patient?

Dysrhythmias without any prior heart structure abnormalities Signup and view all the answers

Which of the following is NOT a known cause of myocarditis?

Chronic heart failure Signup and view all the answers

Which clinical manifestation would most likely indicate mild to moderate myocarditis?

Occasional chest discomfort and fatigue Signup and view all the answers

What key information should the nurse provide to a patient recovering from acute pericarditis?

Monitor for signs of cardiac tamponade Signup and view all the answers

How might myocarditis impact the heart muscle?

It causes heart dilation and degeneration of muscle fibers Signup and view all the answers

What is a common clinical finding in patients with systolic dysfunction?

Cardiac enlargement Signup and view all the answers

In which scenario might a patient with myocarditis present as asymptomatic?

If the infection resolves on its own Signup and view all the answers

What is the primary medication used if the underlying cause of myocarditis is identified?

Antibiotics like penicillin Signup and view all the answers

Why should NSAIDs be avoided in the acute phase of myocarditis?

They may cause further myocardial damage. Signup and view all the answers

What is a recommended activity level for patients recovering from myocarditis?

Increasing activity slowly after heart size normalizes Signup and view all the answers

What percentage of patients with rheumatic fever may develop rheumatic heart disease?

39% Signup and view all the answers

What clinical manifestation is associated with rheumatic endocarditis?

Translucent vegetation on valve flaps Signup and view all the answers

What condition often precedes the onset of acute rheumatic fever?

Group A beta-hemolytic streptococcal pharyngitis Signup and view all the answers

Which of the following is NOT a predisposing factor for rheumatic fever?

Regular exercise Signup and view all the answers

What is the most common type of valvular regurgitation?

Mitral regurgitation Signup and view all the answers

Which condition results from narrowed or stenotic valvular orifice?

Valvular stenosis Signup and view all the answers

What immediate risk is associated with valvular regurgitation?

Pulmonary abscesses Signup and view all the answers

What sign indicates streptococcal pharyngitis?

Fever and chills Signup and view all the answers

What is the recommended prophylactic treatment before dental procedures at risk of inducing gingival bleeding?

Penicillin Signup and view all the answers

Which procedure is NOT directly related to prophylaxis of penicillin in at-risk patients?

Cosmetic surgery Signup and view all the answers

Which of the following is part of the medical management for rheumatic endocarditis?

Corticosteroid therapy Signup and view all the answers

What is the main purpose of blood culture in the management of rheumatic endocarditis?

To monitor the course of therapy Signup and view all the answers

Study Notes

Pericarditis

Inflammation of the pericardium (sac surrounding the heart).
Can be a primary illness or develop as a complication of other health issues.
Occurs after pericardectomy (opening of the pericardium) in 5% to 30% of patients after cardiac surgery.
Pericarditis developing within 10 days to 2 months after acute myocardial infarction accounts for 1% to 3% of all pericarditis cases.
Common causes
- Idiopathic (unknown)
- Infections: Usually viral (influenza), rarely bacterial (streptococci, staphylococci), and fungal.
- Connective tissue disorders: Rheumatic fever, rheumatoid arthritis, polyarteritis.
- Hypersensitivity states: Immune reactions, medication reactions.
- Neoplastic disease (cancer)
- Radiation therapy
- Trauma: Chest injury, cardiac surgery, cardiac catheterization, pacemaker implantation.
- Renal failure and uremia
Clinical manifestations
- Chest pain: Located beneath the clavicle, in the neck, or left scapula region; worsens with deep inspiration and lying down, relieved by sitting forward.
- Mild fever
- Increased white blood cell count
- Increased erythrocyte sedimentation rate (ESR)
- Dyspnea (shortness of breath)
- Signs of heart failure (due to cardiac tamponade, where fluid compresses the heart)
Assessment and diagnostic findings:
- Diagnosis based on history, signs, and symptoms.
- Echocardiogram to detect inflammation, fluid build-up, and heart failure.
- ECG (electrocardiogram)
Medical management:
- Determine the cause.
- Administer therapy.
- Monitor for cardiac tamponade.
- Bed rest until fever and chest pain subside.
- Analgesics and NSAIDs (aspirin or ibuprofen) for pain relief.
- Corticosteroids for severe pericarditis or if NSAIDs are ineffective.
- Pericardiocentesis (removing pericardial fluid) to identify the causative agent.
- Pericardial window (opening in the pericardium) for continuous drainage into the chest cavity.
Nursing management
- Monitor for cardiac tamponade.
- Pain management with analgesics, positioning, and psychological support.
- Educate and reassure patients about chest pain, clarifying that it is not a heart attack.
- Educate and assist with activity restrictions until pain and fever subside, and encourage gradual increases in activity.
- Monitor for heart failure.
- Educate the patient and family about a healthy lifestyle to enhance the immune system.

Myocarditis

Inflammation of the myocardium (heart muscle).
Can cause heart dilation, blood clots on the heart wall (mural thrombi), infiltration of blood cells around coronary vessels and muscle fibers, and muscle fiber degeneration.
Causes:
- Viral, bacterial, parasitic, fungal, or protozoal infections.
- After acute systemic infections (rheumatic fever).
- Immunosuppressive therapy
- Infective endocarditis
- Allergic reaction to medications.
Clinical manifestations
- Severity depends on: Type of infection, degree of myocardial damage, and the myocardium's ability to recover.
- May be asymptomatic and resolve on its own.
- Mild to moderate symptoms:
  - Fatigue
  - Dyspnea
  - Palpitations
  - Chest and upper abdominal discomfort.
- Sudden cardiac death or severe congestive heart failure.
Assessment and diagnostic findings:
- May be no abnormalities initially.
- Chest pain (cardiac catheterization may show normal coronary arteries).
- Sudden dysrhythmias without any initial structural heart abnormalities.
- If structural abnormalities develop (e.g., systolic dysfunction), clinical assessment may reveal cardiac enlargement, faint heart sounds, gallop rhythm, and a systolic murmur.
Medical management:
- Specific treatment for the underlying cause if known (e.g., penicillin for streptococci).
- Bed rest to reduce cardiac workload and complications.
- Activity restriction (especially sports, young patients) for 6 months or until heart size and function normalize.
- Gradual increase in physical activity, with monitoring for symptoms.
- Corticosteroids are controversial.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are not to be used during the acute phase or with heart failure, as they can cause further myocardial damage.
Nursing management
- Assess temperature to determine if the disease is subsiding.
- Cardiovascular monitoring for heart failure and dysrhythmias.
- Continuous cardiac monitoring with personnel and equipment readily available for life-threatening dysrhythmias.
- Elastic compression stockings and passive and active exercises to prevent venous thrombosis (blood clots) and potential emboli.

Rheumatic Endocarditis

Inflammation of the heart valves, typically occurring after group A beta-hemolytic streptococcal pharyngitis (strep throat).
Affects 0.3% to 3% of strep throat cases.
Prompt antibiotic treatment for strep throat prevents rheumatic fever.
39% of rheumatic fever patients develop rheumatic heart disease, leading to valve insufficiency, heart failure, and death.
Affects joints, causing polyarthritis.
Predisposing factors:
- Bacteria
- Malnutrition
- Overcrowding
- Lower socioeconomic status.
Clinical manifestations
- Small, translucent vegetations (tiny bead-like growths) on valve flaps, causing valve dysfunction.
- Valvular regurgitation (leakage), most commonly mitral regurgitation.
- Valvular stenosis (narrowed valve opening).
Assessment and diagnostic findings
- Dyspnea (shortness of breath), with crackles and wheezes in the lungs.
- New heart murmur
- Risk for embolic phenomena (blood clots) affecting the lungs, kidneys, spleen, heart, brain, or peripheral vessels.
Prevention:
- Early and adequate treatment of streptococcal infections.
- Penicillin therapy for streptococcal infections prevents rheumatic fever.
- Throat culture for accurate diagnosis.
- Signs and symptoms of streptococcal pharyngitis:
  - Fever (38.9° to 40°C)
  - Chills
  - Sore throat (sudden onset)
  - Red throat with exudate (pus)
  - Enlarged and tender lymph nodes
  - Abdominal pain (common in children)
  - Acute sinusitis and otitis media (if caused by streptococci)
Prophylaxis (prevention) of rheumatic endocarditis:
- Penicillin is recommended for at-risk individuals undergoing procedures such as:
  - All dental procedures likely to cause bleeding.
  - Tonsillectomy, Bronchoscopy
  - Surgeries involving respiratory mucosa.
  - Genitourinary and gastrointestinal procedures.
Medical management:
- Bed rest during fever.
- Salicylates (e.g., aspirin) to reduce inflammation.
- Corticosteroids.
- Antibiotics based on sensitivity testing (penicillin is usually the drug of choice).
- Blood cultures to monitor therapy.
- Monitor temperature.
- Psychological support.
Nursing Management:
- Educate patients about the disease, its treatment, and preventive measures.
- Teach patients about the need for prophylactic antibiotics before invasive procedures.

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Description

This quiz covers the inflammation of the pericardium, known as pericarditis. It explores the various causes, clinical manifestations, and complications associated with this condition. Test your knowledge on the impact of infections, autoimmune disorders, and trauma related to pericarditis.