PERICARDITIS

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ENDOCARDITIS
PERICARDITIS
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PERICARDITIS
Pericarditis is the inflammation of the
membranous sac surrounding the heart. It may be
manifested as an acute or chronic condition.
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ACUTE PERICARDITIS
Infectious forms of acute pericarditis
include. -bacterial -viral -fungal -tubercular
Noninfectious forms of acute pericarditis are.

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• -azotemia-presence or increase of nitrogenous
  waste products, especially urea, in the blood.
• -acute MI
• -lung cancer
• -breast cancer
• -leukemia
• -Hodgkins disease
• -lymphoma
• -scleroderma
• -trauma after thoracic surgery
• -systemic lupus erythematosus
• -radiation
• -drug reactions

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BACTERIAL PERICARDITIS
The pericardial sac has been opened to reveal an
abundant amount of fibrin that is coating the
hearts surface.
Pericardial sac
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VIRAL PERICARDITIS
This is an example of severe viral pericarditis.
Here, the pericardial sac surrounding the heart
has been opened to show the amount of pus and
fibrin that has accumulated around the heart.
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FUNGAL PERICARDITIS
This is an example of purulent fungal
pericarditis. Note the yellowish exudate that
has pooled in the lower pericardial sac.
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• Fibrosis of the pericardial sac develops in the
  chronic form causing.
• -fibrous constriction of the pericardium
• -thickening of the pericardium
• -severe compression of the pericardium due to the
  fibrous growth
• -prevents normal filling during diastole-because
  of the fibrous constriction, the heart is not
  about to fill and pump effectively

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A window of adherent pericardium has been opened
to reveal the surface of the heart. There are
thin strands of fibrous exudate that extend from
the epicardial surface to the pericardial sac.
This is typical for a fibrous pericarditis.
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This is an example of a fibrous pericarditis. The
surface appears roughened from the normal
glistening appearance by the stands of pink and
tan firbin.
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The pericarditis here not only has fibrin, but
also hemorrhage. Thus, this is called a
hemorrhagic pericarditis. Without inflammation,
blood in the pericardial sac would be called
hemopericardium.
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Surgical removal of the pericardium may be
necessary to restore normal cardiac output
The white stuff that you see on the pericardium
is calcified, scar tissue that is filled with
fibrous material. The cause of why its there is
unknown. In this specific case they think that
it was caused by a childhood virus.
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• Pericarditis differs clinically from other
  inflammatory conditions of the heart in that the
  presentation of debilitating pain-much like that
  of an MI-is common.
• The pain is aggravated by
• -lying supine
• -deep breathing
• -coughing
• -swallowing
• -moving the trunk of the body
• The pain is alleviated by
• -sitting up
• -leaning forward

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The hallmark finding in acute pericarditis is a
pericardial friction rub due to an accumulation
of fluid in the pericardial space, this
produces. -grating -scratching -leathery sounds
on auscultation -dysrhythmias
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• Other findings in pericarditis include.
• -dypnea -nonproductive cough
• -fever -anxiety
• -chills -rapid pulse
• -diaphoresis -shallow breaths
• -leukocytosis
• -muscle aches
• -fatigue
• -excruciating chest pain
• radiating to the neck and
• shoulders with severe and
• sudden onset.

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• The most serious complication of pericarditis
  is a cardiac tamponade
• This is when a pericardial effusion is so large
  that it restricts heart movement and pumping

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Electrocardiogram obtained in 17-year-old
adolescent with chest pain caused by acute
pericarditis. The ST segments are elevated in
multiple leads. This represents the first stage
of acute pericarditis.
An EKG will note changes or dysrhythmias
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Visualization of the heart with an
echocardiography device. The pericarditis is
signaled by the arrow and corresponds to a
removal of the two leaflets of the pericardium
that is the heart envelope.
Echocardiography will show the presence of a
pericardial effusion or a cardiac tamponade by
ultrasound.
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Chest radiographic findings are generally normal
or nonspecific in acute pericarditis unless the
patient has a large pericardial effusion .
This chest x-ray shows viral pericarditis with a
massive pericardial effusion.
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A CT scan gives you a picture of the body in a
cross-section and it is as if you are looking
down at the section. The red arrow in the picture
is showing pericarditis.
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• Some medical management includes.
• -analgesics for pain
• -oxygen
• -parenteral fluids
• -antibiotics if bacterial
• -salicylates for an elevated temperature
• -corticosteroids for the inflammatory process
• Some surgical interventions are.
• -pericardial fenestration (pericardial window)-a
  surgical drainage portal through the pericardium
  into the peritoneum to drain fluid from the
  pericardial space.
• -pericardiocentesis

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• A pericardiocentesis is an invasive procedure in
  which the physician removes fluid from the
  pericardial sac. The procedure involves the
  insertion of a needle into the pericardium to
  withdraw fluid. A catheter may be inserted to
  allow further drainage. If necessary, the
  catheter will remain in place for several days
  for continuous drainage.
• Complications of a pericardiocentesis include.
• -atelectasis
• -introduction to infectious agents

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Pericardiocentesis
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• Nursing interventions.
• -carefully evaluate vitals every two to four
  hours
• -auscultate lungs and heart sounds
• -administer meds as ordered
• -provide physical and emotional support
• -observe for further complications
• -bed rest
• -HOB elevated 45 degrees to decrease dyspnea
• -hypothermia therapy may be necessary
• -explain all procedures thoroughly
• -monitor IO and restrict sodium intake

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• Some nursing diagnoses.
• -decreased cardiac output, related to
  inflammatory process
• -pain, related to inflammatory process
• -excess fluid volume, related to ineffective
  myocardial pumping action.

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• Prognosis.
• The prognosis is fair in early stages but
  extremely poor if purulent and fibrous stages
  develop. Also, depending on the underlying
  cause, pericarditis usually subsides in one month
  or less. However, if pericarditis is caused by a
  disease like lupus or rheumatoid arthritis, it
  can persist for longer periods of time.

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ENDOCARDITIS
Endocarditis is an infection or inflammation of
the inner lining of the heart, particularly the
heart valves.
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• It is termed infective endocarditis, causative
  organisms include.
• -fungi
• -chlamydiae
• -rickettsiae
• -viruses
• -bacteria
• Most common organisms.
• -streptococcus viridans
• -streptococcus pyogenes
• -staphylococcus aureus
• -staphylococcus epidermidis

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• Endocarditis may result from.
• -invasion of an organism into the endocardium
• -injury to the lining of the endocardium
• -after cardiac surgery
• Whos at risk?
• -rheumatic heart disease
• -congestive heart disease
• -degenerative heart disease
• -street drugs-due to the possibility of bacterium
  from contaminated needles
• -following intrusive procedures
• -dental procedure
• -minor surgery
• -gynecological exams
• -insertion of indwelling urinary catheters

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• As organisms embed into the tissues, a vegetative
  (morbid outgrowth, wart-like projections made of
  fibrin, RBCs, and WBCs) growth perforates the
  chambers or valve leaflets. Fibrin and
  calciferous growths may ulcerate and scar the
  valves.

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• If the vegetations break away from the valves
  they could cause an embolus, which it turn could
  cause an infection or abscess in the organs where
  they lodge.
• Systemic embolization
• -occurs from left side heart vegetation that
  breaks loose and travels to the peripheral
  circulation
• -progresses to organs
• -brain
• -kidneys
• -spleen
• -limb infarction
• Lung embolization
• -occurs from right side heart vegetation that
  break off and travels to the lungs

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• Some signs and symptoms of endocarditis.
• -flu like symptoms -splinter hemorrhages in
  nailbed
• -fatigue -weight loss
• -chest pain -rapid pulse
• -headaches -onset of a murmur
• -joint pain -aortic and mitral valves most
• -chills commonly affected
• -petechiae
• -conjuntiva
• -oral mucosa
• -neck
• -anterior chest
• -abdomen
• -legs

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Roth spots-small white spots in the retina close
to the optic disk, often surrounded by a systemic
infection. Osler nodes-small, tender cutaneous
nodes, usually present in the fingers and toes.
They are due to infected emboli from the heart.
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DIAGNOSTICS.
-EKG-will show changes and dysrhythmias -Chest
x-ray -TEE-transesophageal echocardiography (An
ultrasonographic transducer is introduced into
the esophagus. This test detects cardiac sources
of emboli, prosthetic heart valve malfunction,
endocarditis, aortic dissection, cardiac tumors,
and valvular and congenital heart disease.
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• Labs would indicate.
• -leukocytosis-elevated WBC count
• -increased erythrocyte sedimentation rate
  (ESR)-test of the speed at which RBCs settle out
  of un-clotted blood
• -anemia-reduction in the amount of circulating
  red blood cells
• -hyperglobulinemia-excess amount of globin (a
  plasma protein) in the blood.
• -sensitivity tests for antibiotics

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• Medical management may include.
• -rest to decrease cardiac output
• -massive doses of antibiotics-usually
  parenterally-to kill the organism
• -supporting cardiac function
• -prevention of complications, such as emboli and
  heart failure
• -prophylactic antibiotics for individuals who at
  high risk for developing infective endocarditis
• -previous valve surgery
• -preexisting valvular heart disease
• -congenital abnormalities
• -surgical repair of valves
• -surgical replacement of valves

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Gross anatomy of aortic valve endocarditis. The
left-sided image displays a quadricuspid aortic
valve with prominent nodules of Arantii (arrow).
The right-sided image displays a vegetation on
the aortic valve (arrow). The pulmonary valve is
on the left side of this image and is bicuspid.
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• Nursing interventions.
• -based on the signs and symptoms
• -observe for petechiae
• -location of pain
• -vomiting
• -fever
• -decreased activity
• -calm, quiet environment
• -vitals every 4 hours, including apical pulse
• -adequate nutrition
• -give attractive meals to stimulate appetite and
  supplements in between meals
• -promote rest and comfort
• -preventing further inflammation and infection

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• Prognosis.
• Before the advent of antibiotics, patients with
  infective endocarditis could be expected to live
  approximately one year prompt treatment with
  intensive antibiotic therapy will now cure about
  90 of patients with this condition.