it's about pericardities inflammation of pericardium and Myocarditis (inflammation of myocardium tissue) heart diseases

1. PERICARDITIS AND
MYOCARDITIS
Prepared by : Arpana Bhusal
Level : BNS

2. CONTENT
1) Pericarditis
 definition
 Incidents
 Causes
 Pathophysiology
 Sign and symptoms
 Treatment
 Complication

3. .3. Myocarditis
 Definition
 Incidents
 Causes
 pathophysiology
 Sign and symptoms
 Treatment
 Complication
 Nursing management

4. PERICARDITIS
Definition
 Pericarditis refers to an inflammatory process
of the visceral and parietal pericardium as a
result of bacterial, and viral infection
 Pericarditis may be acute or chronic in nature
and may spread to the myocardium.

6. CONT…
The cause of pericarditis in most individuals is unknown
but is likely due to viral infection. Pericarditis may be an
associated complication of many diseases or may be due to
trauma .

7. INCIDENT
 Pericarditis affects people of all ages, but men 20
to 50 years old are more likely to develop
pericarditis than others.
 Among those treated for acute pericarditis, 15 to 30
percent may experience the condition again.

8. TYPES OF PERICARDITIS .
 Acute Pericarditis
 It may be dry or exudative
 The exudative pericarditis may be serous,
purulent or hemorrhagic..

9. CONT.
 The accumulated fluid in the pericardium blocks the
ventricular action. It is no diagnosed in time and it
may cause severe reduction of cardiac output
which result in cardiac shock or even death.

10. CONT.
 Chronic pericarditis
 Pericardium becomes hard due to constrictive
band around the heart, this prevent blood from
filling and emptying the ventricles, resulting in
cardiac failure.

11. ETIOLOGY
 Infection of heart structure may be
 Bacterial (especially by tuberculosis bacillus )
 Viral(especially by Coxsackievirus must
common)
 Fungal

12.  Or due to complication of systemic disease.
 Rheumatoid arthritis
 Scleroderma
 Systemic lupus erythematosus
 Myocardial infarction and
 Trauma(pucture resulting inflammation and
infection)

13. CONT.
 Side effect of some medication:
• Isoniazid
• Cyclosporine
• Hydralazine .

14. PATHOPHYSIOLOGY

15. SIGN AND SYMPTOMS
In acute Pericarditis
 Severe chest pain(sharp stabbing pain) due to
pericardial friction
 Radiating pain over the left shoulder, neck ,back
 Dyspnea
 High fever
 Distended neck vein
 Feeble pulse due to cardiac tamponade

16. In acute Pericarditis
 Heart sound very muffled
 Sitting up and leaning forward tends to ease the
pain, while lying down and breathing deep worsens
it

17. CONT..
In chronic Pericarditis
 Dyspnea(due to diminished ability of heart to
function as pump)
 Fatigue.

18. DIAGNOSIS
 Blood testing
 Biopsy
 Electrocardiogram
 Echocardiogram
 Chest x-ray
 Cardiac computerized tomography (CT) scan
 Cardiac magnetic resonance imaging (MRI)

19. TREATMENT
• corticosteroid therapy (to help reduce inflammation)
• cardiac medications, such as a beta-blocker, ACE
inhibitor
• behavioral changes, such as rest, fluid restriction,
and a low-salt diet
• diuretic therapy to treat fluid overload
• antibiotic therapy

20. SURGICAL MANAGEMENT
 Pericardiocentesis. procedure, where sterile needle or a
small tube (catheter) to remove and drain the excess fluid
from the pericardial cavity
 Pericardiectomy. This surgery removes the entire
pericardium. It may be done if the sac surrounding heart
has become permanently rigid due to constrictive
pericarditis

21. COMPLICATION
 Pericardial effusion
 Chronic constrictive pericarditis
 Cardiac tamponade
 Bacterial complications
 Chronic heart failure
 Recurrent Pericarditis

22. MYOCARDITIS
Definition
 Myocarditis refers to an refers inflammation of
the heart muscle (myocardium)usually caused by
infection, drugs, chemicals, radiation and metabolic
disorder.
 The inflammation of the heart muscle causes
degeneration or death of heart muscle cells
 This disease is also occur quite often due to
Pericarditis or endocarditis .

24. CAUSES
 Viral infection is the most common cause of
myocarditis.
 Some organisms that can cause myocarditis
include:
 Epstein-Barr virus (EBV)
 Cytomegalovirus (CMV)
 Hepatitis

25. CONT.
 Herpes
 HIV
 Chlamydia Streptococcal (strep) bacteria
 Staphylococcal (staph) bacteria

26. CONT…
Fungal and parasitic infections can also cause it.
 Other causes include certain chemicals or allergic
reactions to medications or toxins like:
 Alcohol
 Drugs
 Lead
.

27. CONT.
 An autoimmune disease
 Spider bites
 Wasp stings
 Snakebites
 Chemotherapy and radiation therapy

28.  LVEDV: left ventrical end diastolic volume
 LAP : Left arterial pressure.

29. SIGN AND SYMPTOMS
 Myocarditis often has no symptoms. In fact, most
people recover and never even know they had it.
 symptoms may include:
 Shortness of breath
 Abnormal heartbeat, which causes fainting in rare
cases
 Light-headedness

30. CONT..
 A sharp or stabbing chest pain or pressure, which
may spread to your neck and shoulders
 Fatigue
 Painful joints
 Swollen joint, legs, or neck veins
 Small amounts of urine

31. CONT…
 Signs of infection, such as
 Fever
 Muscle aches
 Sore throat
 Headache
 Diarrhea

32. TREATMENT
• Corticosteroid therapy (to help reduce
inflammation)
• Cardiac medications, such as a beta-blocker, ACE
inhibitor, or ARB
• Behavioral changes, such as rest, fluid restriction,
and a low-salt diet
• Diuretic therapy to treat fluid overload
• Antibiotic therapy

33. COMPLICATION
 Heart failure
 Heart attack or stroke
 Rapid or abnormal heart rhythms (arrhythmias).
 Sudden cardiac death
 Sudden cardiac death

34. NURSING MANAGEMENT
Nursing assessment :
It includes history taking like ;
Subjective Data
 Past medical history ; asked for sign of the
disease and the onset of the disease and review
with patients history of risk factor like cardiac failure
, shock

35. CONT..
 Medication history
 Family history
 Social history
 Surgical history

36. CONT..
Objective data
 Assess for temperature elevation , heart murmur,
evidence of cough, peripheral edema an embolism,
, auscultate for heart sound dyspnea, restlessness,
and manifestation of heart failure .

37. NURSING DIAGNOSIS
 Ineffective breathing pattern related to inflammation
of heart muscles as evidenced by use of accessory
muscle , dyspnea
 Impaired gas exchange related to fluid
accumulation in the lungs as evidenced by
shortness of breath

38.  Decreased cardiac output related to valvular
dysfunction as evidenced by poor tissue perfusion
 Impaired physical mobility related to fatigue
 Altered thermoregulation related to infection as
evidenced by increased body temperature

39. Pain and comfort management
 Complete bed rest to reduce oxygen demand
 Place the patient in upright position to relieve
dyspnea and chest pain.
 Provide analgesics to relieve pain and oxygen to
prevent tissue hypoxia.
 Assess the patient’s cardiovascular status
frequently.

40. CONT..
 Monitor the patient’s pain level and the
effectiveness of analgesics
 Limiting activities
 Providing calm and quiet environment
 Offering support to reduce anxiety

41. Administering medications & IV fluids:
 Monitor vitals before and after administering
medications & IV fluids.
 Give drugs as indicated (Aspirin, Steroids).
 Give antipyretic drug if fever present.

42. CONT..
 Administer prescribed medications & fluids
accurately (Follow10 Rights).
 Assess IV infusion site for bleeding or any allergic
response.

43. Nutrition
 Ensure high protein, high carbohydrate,
 Low sodium diet.
 Serve attractive meals that stimulate appetite

44. Prevent complication
 Check vital sign and record it carefully.
 Carefully monitor intake output.
 Closely monitor sign for cardiac tamponade

46. CONT..
 MandalG.N.,“Text book of adult nursing” Makalu
publication house (P) Ltd, Dili bazar, Kathmandu
 R.N. Wilma J. phipps “Shafer’s Medical Surgical
Nursing”B.I. Publications PVT LTD, New Delhi
 Datta BN, (1992). “Text book of Pathology” 2nd
edition, Jaypee brothers (p). Ltd, New Delhi
 Mosby,( 2009 ),Medical surgical Nursing (5th edition)