OM VERMA ASSISTANT PROFESSOR MEDICAL-SURGICAL NURSING GRACIOUS COLLEGE OF INSTITUTE

1. TOPIC
ENDOCARDITIS,PERICARDITIC
,MYOCARDITIS
PRESENTED BY-
MR.OM VERMA
ASSISTANT PROFESSOR
GRACIOUS COLLEGE OF INSTITUTE

4. INFECTION AND
INFLAMMATION OF
HEART

5. INTRODUCTION:
• World Heart Day iscelebrated everyyear on
29th Septemberwith theintentof raising
awarenessaboutcardiovascular disease. Every
year has a different themewhich tackles
different aspectsof heartdisease. Thisyear, the
themeon World Heart Day iscreating heart-
healthy environments.Thisyear the theme is
“Power your life”

6. TERMINOLOGIES:
• Infection:
• Inflammation:
• Dysrhythmias
• Endocarditis
• Myocarditis
• Pericarditis
• The process of infecting or the
state of being infected
• A localized physical condition in which part of thebody
becomes reddened, swollen, hot, and often painful,
especially as a reaction to injury or infection
• Abnormality in a physiological rhythm, especially in the
activity of the brain or heart.
• Inflammation of the Endocardium
• Inflammation of the Myocardium
• Inflammation of the Pericardium

7. REVIEW OF ANATOMYAND
PHYSIOLOGY OF HEART:
Thewall of theheart is composedof three
distinct layers. Fromsuperficial todeepthey
are:
 The pericardium
 The myocardium
 The endocardium

8. PERICARDIUM:
• The pericardium is the outer most
layer made up of two membranes.
• The outer layer is the parietal
pericardium. The inner layer is the
visceral pericardium.
• It is made up of loose and dense
connective tissue.

9. • The myocardium is composed of
specialized cardiac muscle found
only in the heart. It is not under
voluntary control.
• It is made up of muscle fibres.
• The myocardium is thickest at the
apex and thins out towards the
base.
MYOCARDIUM:

10. • This is the inner layer.
• It is a thin, smooth membrane that
permits smooth flow of blood inside
the heart. It is made up of muscle
fibres.
• . It consists of flattened epithelial
cells and it is continuous with the
endothelium lining the blood vessels.
ENDOCARDIUM:

13. INFECTIVE DISORDERS OF HEART
There are 3 conditions under the
infective disorders of heart
namely,
• ENDOCARDITIS
• PERICARDITIS
• MYOCARDITIS

14. STATISTICALREPORT
• 30 million heart patients in India, 14 million reside
in urban areas and 16 million in rural areas.
• "Ifthe current trend continues, bythe year 2020,
the burden of atherothrombotic cardiovascular
diseasesin India will surpassthat of any other
country in the world."
• Today, cardiac hospitals in India perform over
2,00,000 openheart surgeries peryear, one of the
highest, worldwide.

15. ENDOCARDITIS:

16. ENDOCARDITIS:
infection of the
endocarditis, is an
endocardial surface of the heart. The
endocardium, the innermost layer of the
heart. Inflammation from endocarditis
affects the cardiac valves.

17. Endocarditis is a define as life-threatening
inflammation of the inner lining of your heart's
chambers and valves (endocardium). And caused by an
infection. Bacteria, fungi or other germs from another
part of body, such as mouth, spread through
bloodstream and attach to damaged areas in heart. It
is called endocarditis If it's not treated quickly,
endocarditis can damage or destroy heart valves.
According to lippen cott

20. CLASSIFICATION:

21. CLASSIFICATION:
• Acute form: healthy valves + endocarditis
mostly caused by S. aureus
• Subacute form: pre-existing valve disease +
endocarditis mostly caused by S.enterococci
•

23. ETIOLOGICAL FACTORS:
Cardiac Conditions:
• Prosthetic heart valves
• Acquired valve disease (mitral valve prolapse)
• Cardiac lesions (e.g., ventricular septal defect)
• Rheumatic heart disease (e.g., mitral valve regurgitation)
• Congenital heart disease
• Pacemakers
•Marfan’s syndrome ( genetic disorder that affects the
body’s connective tissue)
• Cardiomyopathy

24. NONCARDIAC CONDITIONS:
• Hospital-acquired bacteremia
• hospital-acquired heart valve infections are
being caused by staphylococcus bacteria—
which is very common in hospitals and
can lead to heart failure or stroke in
endocarditis patients.

25. • IV drug abuse
• Endocarditis is often associated
with heart defects or abnormal
valves, but can also be formed by
using unsanitary needles to
inject drugs. This causes bacteria
from the needle to be released
directly into the bloodstream.

26. PROCEDURE-ASSOCIATED RISKS
•Intravascular devices (pulmonary
artery catheters)
•Intravascular catheter-related infections are
a major cause of morbidity and ...
valvular heart disease or
an intravascular prosthetic device, should
receive ... bacterial endocarditis,
septic pulmonary emboli, and septic
thrombosis Removal of vascular
catheters that are infected with S. aureus.

27. PATHOPHYSIOLOGY

28. .
PATHOPHYSIOLOGY

30. CLINICAL
MANIFESTATIONS

31. The onset of symptoms is usually ~2 weeks or less from the initiating
bacteremia is the presence of bacteria in the bloodstream
Symptoms are -
High grade fever and chills
Arthralgias/ myalgias
Arthralgia Is joint pain. Myalgia is muscle pain.
Abdominal pain
Pleuritic chest pain
Back pain
Anorexia An eating disorder characterized by markedly reduced appetite
Weight loss
Fatigue

32. Signs are –
Fever
Heart murmur – if no murmur with other
signs and symptoms may indicate right-
sided heart infection
Nonspecific signs – petechiae, "splinter"
hemorrhages, clubbing, splenomegaly,
neurologic changes
More specific signs - Osler's Nodes,
Janeway lesions, and Roth's Spots

33. Nonspecific signs –
Petechiae—conjunctiva, mucous membranes
Splinter hemorrhages in nail-beds
Clubbing of fingers and toes—primarily occurs in
patients who have an extended course of
untreated infective endocarditis.
Neurological changes - Localized headaches,
Transient cerebral ischemia, Altered mental
status, aphasia
Splenomegaly, Enlargement of spleen

34. More specific signs –
Osler's nodes—painful red nodes on palmds of
fingers and toes; usually late sign of endocardial
infection
Janeway's lesions— flat painless and small red sport
in palm and sole several days 1 to 2 weeks; usually
an early sign of endocardial infection.
Roth's spots (retinal hemorrhages)

36. splinter hemorrhage is a small amount of bleeding underneath a nail.
You may notice a dark red or brown line along your nail

37. Petechiae— bleeding conjunctiva, mucous membranes ,bucal
mucosa ,lips ankle and feet

47. COLLABORATIVE MANGEMENT:
DRUGS:
• IV antibiotic therapy, based on blood cultures, is
started.
• Fever may persist for several days after
treatment has been started and can be treated
with aspirin, acetaminophen
• Iv fluids

49. COMPLICATION
As a result, endocarditis can cause several
major complications, including
Heart failure.
Abscesses in the heart.
Heart rhythm problems.
Heart attack.
Stroke.
Infections in other organs such as the lungs, brain, or kidneys.

50. PERICARDITIS

53. PERICARDITIS:
Pericarditis isa condition caused byinflammation of
thepericardial sac (the pericardium)
According to Lewis

54. CAUSES OF PERICARDITIS
Infectious pericarditis: Pericarditis that develops as
the result of a viral, bacterial, fungal or parasitic
infection.
adenovirus, mumps, hepatitis, varicella zoster,human
immunodeficiency virus
Pneumococci, staphylococci, streptococci,
gonorrhoeae, Legionella pneumophila,
Mycobacterium tuberculosis
Histoplasma, Candida species
Idiopathic pericarditis: Pericarditis that does
not have a known cause.

55. Viral pericarditis is caused by a complication of a
viral infection, most often a gastrointestinal virus.
Bacterial pericarditis is caused by a bacterial
infection, including tuberculosis.
Fungal pericarditis is caused by a fungal infection.
Parasitic pericarditis is caused by an infection from a
parasite.
Some autoimmune diseases, such as lupus,
rheumatoid arthritis and scleroderma can cause
pericarditis.

56. Other causes
pericarditis include injury to the chest,
such as after a car accident (traumatic
pericarditis), other health problems such as
kidney failure (uremic pericarditis), tumors,
genetic diseases such as Family history, or
rarely, medications that suppress the
immune system.

57. Uremic pericarditis is thought to
result from inflammation of the
visceral and parietal layers of
the pericardium by metabolic
toxins that accumulate in the
body owing to kidney failure.

58. Pericardiocentesis: A procedure performed to drain
excess fluid from the pericardium with a catheter.
Pericardiectomy: Surgical treatment of pericarditis
that involves the removal of a portion of the
pericardium.
Pericardial window: A minimally invasive surgical
procedure performed to drain fluid that has
accumulated in the pericardium. This surgical
procedure involves a small chest incision through
which an opening is made in the pericardium.

59. Pericardial effusion: Excess fluid
build-up in the pericardium.
Cardiac tamponade: A severe compression
of the heart that impairs its ability to
function. Cardiac tamponade is a medical
emergency that requires prompt diagnosis
and treatment. Chronic pericarditis

60. SIGNS AND SYMPTOMS

65. DIAGNOSTIC STUDIES:
ECG
Echocardiogram (echo) to see how
well heart is working and check for fluid
or pericardial effusion around the heart.
Electrocardiogram (ECG ) to look for changes in heart rhythm. ..

66. COMPUTET-
TOMOGRAPHY
CHEST
X-RAY

67. Chest X-ray to see the size
of your heart and any fluid
in lungs.

69. COLLABORATIVE MANAGENMENT:
MEDICATION:
• Non-steroidal anti-
inflammatory drugs
Example: Ibuprofen
• Corticosteroids: Example:
Prednisolone

71. SURGICAL PROCEDURE:
PERICARDIOCENTESIS

72. Pericardiocentesis is a procedure done
to remove fluid that has built up in the
sac around the heart (pericardium). It's
done using a needle and small catheter
to drain excess fluid. A fibrous sac
known as the pericardium surrounds
the heart.

76. MYOCARDITIS
• Myocarditis is an inflammation of
the myocardium, the middle layer
of the heartwall.
• Myocarditis can affect boththe
heart'smuscle cells and the heart's
electrical system,leading to
reduction in theheart'spumping
function and toirregular heart
rhythms.

77. Myocarditis it is a define as disease marked by the
inflammation of the heart muscle known as the
myocardium — the muscular layer of the heart wall.
This muscle is responsible for contracting and
relaxing to pump blood in and out of the heart and to
the rest of the body.
According to lippen cott

80. ETIOLOGICAL FACTORS:
VIRUSES: Coxsackie virus, Parvovirus B19,
Herpes simplex virus
BACTERIA: Staphylococcus, streptococcus
PARASITES: Toxoplasma
FUNGI: Aspergillus

81. Viral infection
is the most common cause of myocarditis. When you have one,
your body produces cells to fight it. These cells release
chemicals. If the disease-fighting cells enter your heart, some
chemicals they release can inflamation heart muscle.
Some things that can cause myocarditis include:
Coxsackie B viruses
Epstein-Barr virus (EBV)
Cytomegalovirus (CMV)
Hepatitis C
Herpes
HIV
Parvovirus

82. Chlamydia (a common sexually transmitted
disease)
Mycoplasma (bacteria that cause
a lung infection)
Streptococcal (strep) bacteria
Staphylococcal (staph) bacteria
Treponema (the cause of syphilis)
Borrelia (the cause of Lyme disease)

83. Alcohol
Drugs
Lead
Spider bites
Wasp stings
Snakebites
Chemotherapy and radiation therapy
An autoimmune disease that
causes inflammation throughout your body,
like lupus or rheumatoid arthritis, may also lead to
myocarditis.

84. Autoimmune diseases
Autoimmune diseases that cause
inflammation in other parts of the
body, like rheumatoid arthritis or
SLE, can also sometimes cause
myocarditis

85. PATHOPHYSIOLOGY
Due to the risk etiological factors the
inflammatory process causes an infiltrate to
build up in the cardiac myocytes, resulting
in injury to myocardial cells.
That infective agents forming abscess and
an autoimmune injury may occur when the
immune system destroys both invading
organism and myocardial cells
Heart Enlarges:  LVEDV

86.  Cardiac Output
Damage of the long term effect on
heart function

87. SIGNS AND SYMPTOMS
• Chest pain (often described as "stabbing"
in character).
• CHF
• Palpitations (due to arrhythmias).
• Sudden death
• Fever (especially when infectious)

90. Signs and Symptoms
Myocarditis often has no symptoms. In fact, most people
recover and never even know they had it.
If you do have symptoms, they may include:
Shortness of breath during exercise at first, then at night
while lying down
Abnormal heartbeat, which causes fainting in rare cases
Light-headedness
A sharp or stabbing chest pain or pressure, which may
spread to your neck and shoulders
Fatigue

91. Signs of infection, such as
Fever
Muscle aches
Sore throat
Headache
Diarrhea
Painful joints
Swollen joints, legs, or neck veins
Small amounts of urine

92. DIAGNOSTIC EVALUATION:
• ECG: Diffuse ST segment changes
• LABORATORY FINDINGS: Increased ESR
erythrocyte sedimentation rate and CRP c-reactive
protein levels, elevated levels of myocardial markers
such as troponin
• CHEST RADIOGRAPHY:Cardiomegaly
• MRI: localization of inflammation

95. Electrocardiogram (ECG). This noninvasive test shows your
heart's electrical patterns and can detect abnormal rhythms.
Chest X-ray. An X-ray image shows the size and shape of your
heart, as well as whether you have fluid in or around the
heart that might indicate heart failure.
MRI. Cardiac MRI will show your heart's size, shape and
structure. This test can show signs of inflammation of the
heart muscle.
Echocardiogram. Sound waves create moving images of the
beating heart. An echocardiogram might detect enlargement
of your heart, poor pumping function, valve problems, a clot
within the heart or fluid around your heart.

96. Blood tests. These measure white and red blood
cell counts, as well as levels of certain enzymes
that indicate damage to your heart muscle. Blood
tests can also detect antibodies against viruses
and other organisms that might indicate a
myocarditis-related infection.
Cardiac catheterization and endomyocardial
biopsy. A small tube (catheter) is inserted into a
vein in your leg or neck and threaded into your
heart. In some cases, doctors use a special
instrument to remove a tiny sample of heart
muscle tissue (biopsy) for analysis in the lab to
check for inflammation or infection.

98. PHARMACOLOGICAL MANAGEMENT
DRUG THERAPY:
• Cardiac glycosides (Digoxin)
• Loop diuretics (Furosemide)
• Calcium channel blockers (Amlodipine)
• ACE (Angiotensin converting enzyme
inhibitors (Captopril)
• Vasodilators (Nitro-glycerine)

101. Ventricular assist devices. Ventricular assist devices (VADs)
are mechanical pumps that help pump blood from the lower
chambers of your heart (the ventricles) to the rest of your
body. VADs are used in people who have weakened hearts or
heart failure. This treatment may be used to allow the heart to
recover or while waiting for other treatments, such as a heart
transplant.
Intra-aortic balloon pump. Doctors insert a thin tube
(catheter) in a blood vessel in your leg and guide it to your
heart using X-ray imaging. Doctors place a balloon attached to
the end of the catheter in the main artery leading out to the
body from the heart (aorta). As the balloon inflates and
deflates, it helps to increase blood flow and decrease the
workload on the heart.

103. POSSIBLE COMPLICATIONS
If left untreated, myocarditis may lead
to symptoms of heart failure, where your heart
has trouble pumping blood the way it should. In
rare cases, it leads to other problems, such as:
Cardiomyopathy : The heart muscle weakens or
the structure of the heart muscle changes.
Pericarditis : Inflammation of the sac covering the
heart (called the pericardium).