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Inflammatory diseases of heart

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The inflammation of the heart muscles, such as myocarditis, the membrane sac which surrounds the heart called as pericarditis, and the inner lining of the heart or the myocardium, heart muscle as endocarditis are known as the inflammatory heart diseases.

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Inflammatory diseases of heart

  1. 1. BY RAJEE RAVINDRAN
  2. 2. WELCOME
  3. 3. INFLAMMATORY DISEASES OF HEART The inflammation of the heart muscles, the membrane sac which surrounds the heart, or the inner lining of the heart are known as the inflammatory heart diseases.
  4. 4. PERICARDITIS TYPES ACUTE PERICARDITIS CHRONIC PERICARDITIS CAUSES INFECTION NON INFECTION VIRAL BACTERIAL FUNGAL TB HIV UREMIA RADIATION INDUCED CANCER TRAUMA TO HEART MEDICATION SIDE EFFECTS
  5. 5. PATHOPHYSIOLOGY OF PERICARDITIS INFECTION ETIOLOGY NON INFECTION ETIOLOGY INFLAMMATORY RESPONSE INFLUX OF NEUTROPHILS + OTHER CHEMICAL MEDIATORS CHANGE IN THE PERMEABILITY OF PERICARDIAL VASCULARITY PERICARDIAL INFLAMMATION AND EDEMA RESTRICTION OF HEART MOVEMENT CHEST PAIN
  6. 6. CLINICAL MANIFESTATIONS ACUTE PERICARDITIS CHRONIC PERICARDITIS
  7. 7. DIAGNOSIS OF PERICARDITIS • MEDICAL HISTORY AND PHYSICAL EXAM • ECG • ECHO • CARDIAC CT/ MRI • DOPPLER IMAGING • BLOOD TEST – CRP, BUN, TROPONIN-I, CK-MB, MYOGLOBIN, ESR
  8. 8. MANAGEMENT MEDICAL NON- PHARMACOLOGICAL SURGICAL ANTIBIOTIC ANTIFUNGAL NSAID DIURETICS ANTIPYRETICS ANALGESICS PERICARDIOCENTESIS HAEMODIALYSIS PERICARDIECTOMY
  9. 9. COMPLICATIONS OF PERICARDITIS
  10. 10. MYOCARDITIS TYPES LIEBERMAN’S CLINICOPATHOLOGICAL PATHOLOGICAL ETIOLOGICAL  FULMINANT MYOCARDITIS  ACUTE MYOCARDITIS  CHRONIC ACTIVE MYOCARDITIS  CHRONIC PERSISTENT MYOCARDITIS  LYMPHOCYTIC  EOSINOPHILIC  GRANULOMATOUS  NEUTROPHILIC  REPERFUSION  INFECTIOUS  POST VIRAL AUTOIMMUNE MEDIATED  AUTOIMMUNE MEDIATED  DRUG ASSOCIATED
  11. 11. CAUSES OF MYOCARDITIS INFECTIONS TOXINS IMMUNOLOGIC VIRAL PROTOZOAN BACTERIAL FUNGAL PARASITIC ALCOHOL CARBON MONOXIDE SNAKE VENOM DRUGS (ANTIPSYCHOTIC SUCH AS CLOZAPINE) ALLERGIC REJECTION AFTER A HEART TRANSPLANT AUTOANTIGENS HEAVY METALS PHYSICAL AGENTS
  12. 12. PATHOPHYSIOLOGY OF MYOCARDITIS CLINICAL MANIFESTATIONS OF MYOCARDITIS CHEST PAIN PALPITATIONS FEVER SHORTNESS OF BREATH
  13. 13. DIAGNOSIS OF MYOCARDITIS • ECG – • Elevated C-reactive protein (CRP) • Elevated erythrocyte sedimentation rate (ESR), • Increased IgM (serology) against viruses known to affect the myocardium. • Markers of myocardial damage (troponin or creatine kinase cardiac isoenzymes) are elevated. • Biopsy Focal destruction of myocytes explains the myocardial pump failure. • Cardiac magnetic resonance imaging (cMRI or CMR) in diagnosing myocarditis by visualizing markers for inflammation of the myocardium
  14. 14. MANAGEMENT OF MYOCARDITIS MEDICAL SURGICAL DIGOXIN DIURETICS INOTROPES INTRAVENOUS IMMUNOGLOBULINS SYSTEMIC CORTICOSTEROIDS HEART TRANSPLANTATION EXTRA CORPOREAL MEMBRANE OXYGENATION
  15. 15. COMPLICATIONS OF MYOCARDITIS
  16. 16. ENDOCARDITIS TYPES INFECTIVE ENDOCARDITIS NON INFECTIVE ENDOCARDITIS ACUTE INFECTIVE ENDOCARDITIS SUBACUTE ENDOCARDITIS
  17. 17. CAUSES OF ENDOCARDITIS • BACTERIA • FUNGI • VIRUSES • CARDIAC CONDITIONS(PROSTHETIC VALVES, CARDIAC LESIONS) • NON CARDIAC CONDITIONS (NOSOCOMIAL BACTEREMIA) • PROCEDURE ASSOCIATED RISKS(DENTAL PROCEDURES,RECENT HEART SURGERIES) • INTRAVASCULAR DEVICES(CVC,HEMODYNAMIC MONITORING)
  18. 18. PATHOPHYSIOLOGY OF ENDOCARDITIS ANATOMIC OR TRAUMATIC CHANGES DAMAGE TO ENDOTHELIAL SURFACE ADHERENCE OF CAUSATIVE FACTOR TO VALVE SURFACE FORMATION OF VEGETATIONS ON VALVE SURFACE LEFT SIDE HEART EMBOLIZATIONS LOCAL VALVE DAMAGE RIGHT SIDE HEART EMBOLIZATIONS BRAIN, LIMB KIDNEY, LIVER SPLEEN SEPSIS HEART FAILURE HEART BLOCK LUNGS
  19. 19. CLINICAL MANIFESTATIONS OF ENDOCARDITIS ACUTE INFECTIVE ENDOCARDITIS SUBACUTE INFECTIVE ENDOCARDITIS ONSET sudden gradual USUAL ORGANISM Staphylococcus aureus Streptococcus viridans, enterococci, gram- negative and gram-positive bacilli, fungi, yeasts RISK FACTORS Usually occurs in previously normal heart; intravenous drug use, infected intravenous sites Usually occurs in damaged or deformed dental work, invasive procedures, and infections PATHOLOGICAL PROCESS Rapid valve destruction Valve destruction leading to regurgitation; embolization of friable vegetations PRESENTATION Abrupt onset with spiking fever and chills, manifestations of heart failure Gradual onset of febrile illness with cough, dyspnea, arthralgias, abdominal pain
  20. 20. CLINICAL MANIFESTATIONS OF ENDOCARDITIS PERIPHERAL MANIFESTATIONS INCLUDE PETECHIAE SPLINTER HEMORRHAGE OSLER’S NODES JANEWAY LESIONS ROTH’S SPOTS
  21. 21. DIAGNOSIS OF ENDOCARDITIS BLOOD CULTURES ECG ECHO SEROLOGIC IMMUNE TESTING CBC,ESR CHEST XRAY
  22. 22. MANAGEMENT OF ENDOCARDITIS MEDICAL SURGICAL ANTIBIOTICS REPLACE SEVERLY DAMAGED VALVES REMOVE LARGE VEGETATIONS
  23. 23. NURSING MANAGEMENT OF ENDOCARDITIS Interventions • Auscultate apical pulse, assess heart rate, rhythm. • Inspect skin for pallor, cyanosis • Palpate peripheral pulses and monitor BP • Encourage rest, semi recumbent in bed or chair. Assist with physical care as indicated. • Provide quiet environment: explain therapeutic management, help patient avoid stressful situations, listen and respond to expressions of feelings. • Elevate legs, avoiding pressure under knee. • Encourage active and passive exercises. Increase activity as tolerated. • Check for calf tenderness, diminished pedal pulses, swelling, local redness, or pallor of extremity. Decreased cardiac output related to structural changes evidenced by tachycardia, dysrhythmias, ECG changes, chest Pain.
  24. 24. NURSING MANAGEMENT OF ENDOCARDITIS Interventions • Check vital signs before and immediately after activity • Document cardiopulmonary response to activity. Note tachycardia, dysrhythmias, dyspnea, diaphoresis, pallor. • Evaluate accelerating activity intolerance. • Provide assistance with self-care activities as indicated. • Assist patient with ROM exercises. Check regularly for calf pain and tenderness. Activity intolerance related to imbalance between oxygen supply/demand evidenced by Weakness, fatigue, changes in vital signs, presence of dysrhythmias dyspnea, pallor, diaphoresis
  25. 25. NURSING MANAGEMENT OF ENDOCARDITIS Interventions • Assess patient pain for intensity using a pain rating scale, for location and for precipitating factor Administer or assist with self-administration of vasodilators, as ordered. • Assess the response to medications every 5 minutes. • Establish a quiet environment. • Elevate head of bed. • Monitor vital signs, especially pulse and blood pressure, every 5 minutes until pain subsides. • Provide oxygen and monitor oxygen saturation via pulse oximetry, as ordered. • Teach patient relaxation techniques and how to use them to reduce stress. • Instruct patient on eating a small frequent feeding Ineffective tissue perfusion related to decreased cardiac output.
  26. 26. SUMMARY AND CONCLUSION
  27. 27. BIBLIOGRAPHY Polaski L A, Tatra E S: Luckmann’s Core Principles and Practice of Medical Surgical Nursing, Elsevier (2010), p 736-744 Smeltzer C S, Bare G B, Hinkle L J, Cheever H K : Brunner and Suddarth’s Textbook of Medical Surgical Nursing: 11th edition, vol 1 (2009), p933-942 Lewis L S, Heitkemper M M et al: Chintamani- Lewis’s Medical Surgical Nursing. Mosby. 7th edition(2011), p 860-869 Lemane P, Burke K, Medical Surgical Nursing, 4th edition, p1045-1051
  28. 28. EVALUATION

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