Inflammatory Heart Diseases PDF

Inflammatory Heart Diseasesy  PERICARDITIS Pericarditis refers to an inflammation of the pericardium, the membranous sac enveloping the heart. It may be a primary illness, or it may develop in the course of a variety of medical and surgical disorders. Pericarditis occurs aft...

Inflammatory Heart Diseasesy  PERICARDITIS Pericarditis refers to an inflammation of the pericardium, the membranous sac enveloping the heart. It may be a primary illness, or it may develop in the course of a variety of medical and surgical disorders. Pericarditis occurs after pericardectomy (opening of the pericardium) in 5% to 30% of patients after cardiac surgery. Pericarditis that occurs within 10 days to 2 months after acute myocardial infarction causes 1% to 3% of all cases of pericarditis. Causes Idiopathic or nonspecific causes Infection: usually viral (eg, influenza); rarely bacterial (eg, streptococci, staphylococci), and mycotic (fungal) Disorders of connective tissue: rheumatic fever, rheumatoid arthritis, polyarteritis Hypersensitivity states: immune reactions, medication reactions Neoplastic disease Radiation therapy Trauma: chest injury, cardiac surgery, cardiac catheterization, pacemaker implantation Renal failure and uremia  Clinical Manifestations The most characteristic symptom of pericarditis is chest pain. Pain may be located beneath the clavicle, in the neck, or in the left scapula region. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning. It may be relieved with a forward sitting position. Mild fever, Increased white blood cell count, Increased erythrocyte sedimentation rate (ESR). Dyspnea and other signs and symptoms of heart failure may occur as the result of pericardial compression due to cardiac tamponade.  Assessment and Diagnostic Findings Diagnosis is most often made on the basis of the patient’s history, signs, and symptoms. An echocardiogram may detect inflammation and fluid build-up, as well as indications of heart failure, and help to confirm the diagnosis. ECG. Medical Management The objectives of management are to determine the cause, administer therapy, and be alert for cardiac tamponade. When cardiac output is impaired, the patient is placed on bed rest until the fever, and chest pain have subsided. Analgesics and NSAIDs such as aspirin or ibuprofen may be prescribed for pain relief during the acute phase. Corticosteroids may be prescribed if the pericarditis is severe or if the patient does not respond to NSAIDs. Pericardiocentesis, a procedure in which some of the pericardial fluid is removed, may be performed to assist in the identification of the causative agent. A pericardial window, a small opening made in the pericardium, may be performed to allow continuous drainage into the chest cavity.  Nursing Management Alert to the possibility of cardiac tamponade. Patients with acute pericarditis require pain management with analgesics, positioning, and psychological support. Patients experiencing chest pain often benefit from education and reassurance that the pain is not a heart attack. To minimize complications, the nurse educates and assists the patient with activity restrictions until the pain and fever subside. As the patient’s condition improves, the nurse encourages gradual increases of activity. If pain, fever reappear, however, activity restrictions must be resumed. The nurse educates the patient and family about a healthy lifestyle to enhance the patient’s immune system. The nurse monitors the patient for heart failure  MYOCARDITIS Myocarditis is an inflammatory process involving the myocardium. Myocarditis can cause heart dilation, thrombi on the heart wall (mural thrombi), infiltration of circulating blood cells around the coronary vessels and between the muscle fibers, and degeneration of the muscle fibers themselves.  Causes Viral, bacterial, , parasitic, mycotic, or protozoal infection. After acute systemic infections such as rheumatic fever, in those receiving immunosuppressive therapy, or in those with infective endocarditis. Allergic reaction to pharmacologic agents used in the treatment of other diseases. It may begin in one small area and then spread throughout the myocardium. Clinical Manifestations The symptoms of acute myocarditis depend on; 1- The type of infection, 2- The degree of myocardial damage, 3- The capacity of the myocardium to recover. - The patient may be asymptomatic, and the infection resolves on its own. - The patient may develop mild to moderate symptoms and seek medical attention. - The patient may also sustain sudden cardiac death or quickly develop severe congestive heart failure. Mild to moderate symptoms Fatigue Dyspnea Palpitations Occasional discomfort in the chest and upper abdomen. Assessment and Diagnostic Findings Assessment of the patient may reveal no abnormalities; as a result, the entire illness goes unrecognized The patient may complain of chest pain (with a subsequent cardiac catheterization demonstrating normal coronary arteries). The patient without any abnormal heart structure (at least initially) may suddenly develop dysrhythmias. If the patient has developed structural abnormalities (eg, systolic dysfunction), the clinical assessment may disclose cardiac enlargement, faint heart sounds, gallop rhythm, and a systolic murmur.  Medical Management Specific treatment for the underlying cause if it is known (eg, penicillin for hemolytic streptococci). Bed rest to decrease the cardiac workload, decrease myocardial damage and the complications of myocarditis. Activities, especially sports in young patients with myocarditis, should be limited for a 6- month period or at least until heart size and function have returned to normal. Physical activity is increased slowly, and the patient is instructed to report any symptoms that occur with increasing activity, such as a rapidly beating heart. The use of corticosteroids in treating myocarditis remains controversial. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are not to be used during the acute phase or if the patient develops heart failure, because these medications can cause further myocardial damage. Nursing Management Assesses the patient’s temperature to determine whether the disease is subsiding. The cardiovascular assessment focuses on signs and symptoms of heart failure and dysrhythmia. The patient experiencing dysrhythmias should receive continuous cardiac monitoring with personnel and equipment readily available to treat life threatening dysrhythmias. Elastic compression stockings and passive and active exercises should be used, because embolization from venous thrombosis can occur.  Rheumatic endocarditis Acute rheumatic fever, which occurs most often in school-age children, follows 0.3% to 3% of cases of group A beta-hemolytic streptococcal pharyngitis. Prompt treatment of strep throat with antibiotics can prevent the development of rheumatic fever. As many as 39% of patients with rheumatic fever develop various degrees of rheumatic heart disease associated with valvular insufficiency, heart failure, and death. The disease also affects all bony joints, producing polyarthritis.  Predisposing Factors:- Bacteria are the causative agents, Malnutrition, Overcrowding, Lower socioeconomic status Clinical Manifestations:- Anatomically manifest itself by tiny translucent vegetation, which resemble beads about the size of the head of a pin. These tiny beads more often have serious effect on valve flaps. They are starting points of a process that gradually thickness the flaps, rendering them from closing the orifice of the valve perfectly. The result is leakage a condition called valvular regurgitation. The most common type of valvular regurgitation is mitral regurgitation. " In other clients, the inflamed margins of the valve flaps become adherent, resulting in valvular stenosis, a narrowed or stenotic valvular orifice. Assessment and Diagnostic Findings:- Shortness of breath with crackles and wheezes in the lungs. New murmur. The patient is also at risk for embolic phenomena of the lung (eg, recurrent pneumonia, pulmonary abscesses), kidney (eg, hematuria, renal failure), spleen (eg, left upper quadrant pain), heart (eg, myocardial infarction), brain (eg, stroke), or peripheral vessels. Prevention:- Rheumatic endocarditis is prevented through early and adequate treatment of streptococcal infections. Penicillin therapy in patients with streptococcal infections can prevent almost all primary attacks of rheumatic fever. A throat culture is the only method by which an accurate diagnosis can be determined. The signs and symptoms of streptococcal pharyngitis are the following: Fever (38.9° to 40°C) Chills Sore throat (sudden in onset) Diffuse redness of throat with exudate on oropharynx (may not appear until after the first day) Enlarged and tender lymph nodes Abdominal pain (more common in children) Acute sinusitis and acute otitis media (if due to streptococci) Prophylaxis of penicillin is recommended for persons at risk who undergoing the following procedures; ** All dental procedures likely to induce gingival bleeding. ** Tonsillectomy, Bronchoscopy ** Surgical procedures involving respiratory mucosa. ** Genitourinary and gastrointestinal procedures.  Medical Management: Bed rest as long they are febrile. Give salicylate to suppress Rh. activity. Corticosteroid therapy. Antibiotic according to sensitivity test to the causative agent. Penicillin usually the drug of choice. Blood culture is taken periodically to monitor the course of therapy. Monitor client's temperature at regular intervals. Psychological support.  Nursing Management Teaching patients about the disease, its treatment, and the preventive steps needed to avoid potential complications. After acute treatment with antibiotics, patients need to learn about the need to take prophylactic antibiotics before invasive procedures.