Inflammation of the innermost layer of the heart.
The lining of the chambers.
Bacterial infection with Streptococcus or
Other possible organisms
Gram negative bacteria
Mortality about 25%.
Prosthetic heart valve.
Causes of Infection of the Endocardium.
Damage to cardiac structures.
Damage to the walls of the endocardium.
Symptoms of endocarditis.
Chills, night sweats, fatigue,
anorexia, weight loss, and pain in
the muscles, joints, and back.
Petechiae - palpebral conjunctivae (insides of the eyelids), neck,
anterior chest, abdomen, or oral mucosa.
Janeway lesions - (nontender maculae) on the patient's palms and soles.
Osler's nodes - tender, erythematous, raised nodules on the fingers and
Splinterhemorrhages under the fingernails.
Roth's spots - retinal hemorrhages with pale centers known.
Development of a new cardiac murmur.
Beth Israel criteria
Persistent bacteremia (positive blood cultures, found in 91% of
New regurgitant murmurs
Duke criteria - These criteria add echocardiographic changes.
evidence of vegetation
thrombus on valves
other endocardiac structures
disruption of a prosthetic valve.
Transthoracic echocardiography (TTE)
Accurate for identifying vegetations
accuracy can be reduced in obesity, chronic obstructive pulmonary
disease, or chest-wall deformities.
Transesophageal echocardiography (TEE)
More accurate than TTE.
Allows closer visualization of common sites for vegetations and other
Better visualization of prosthetic heart valves.
Other signs and symptoms.
Increased sedimentation rate.
Positive rheumatoid factor.
Support cardiac function.
Eradicating the infection
Systemic embolization occurs in up to 50% of patients.
Emboli may go to brain, lungs, coronary arteries, spleen, bowel,and
Embolic events are most common in the first 2 weeks.
Anticoagulation isn't recommended for patients with endocarditis.
Because of the risk of intracerebral
Anticoagulation should be continued on it
before developing endocarditis.
Must have frequent neurologic monitoring.
Related to valvular problems.
More common with aortic valve infections than with infections of the
mitral or tricuspid valve.
Valvular dysfunction can progress in spite of antibiotic therapy
May need valve replacement
High Risk Patients.
Presence of prosthetic heart valves.
Require antibiotic prophylaxis before certain invasive procedures,
including dental extractions.
Inflammation of the myocardium, the heart's muscular layer.
Usually mild it can be fatal.
Can lead to coronary artery thrombus, coronary ischemia, dilated
cardiomyopathy, cardiac arrhythmias,
and sudden death.
Should be considered if myocardial infarction (MI) has been ruled out
in a patient with dyspnea and chest discomfort, especially if he has a
history of recent viral illness.
Caused by the coxsackievirus type B
Inflammation and fibrosis
Reduce blood flow, causing necrotic areas of the
Necrosis maybe patchy or global.
Virus or another underlying cause
Leukocytes, lymphocytes, and macrophages infiltrate the myocardium -
interstitial fibrosis in the myocardium.
Reduction in cardiac output (CO).
May cause left
Up to 6 weeks before the patient has signs and symptoms
Upper respiratory symptoms: fever, chills, and
and nausea, vomiting, diarrhea, arthralgia, and myalgia.
Heart failure with
Enlarged heart with
evidence of heart
Prominent blood vessels or
fluid within the lungs.
ST-segment and T-wave
Decreased QRS amplitude
May notice a heart block.
ECG usually returns to
normal within 2 months.
Rule out pericardial effusion.
Valvular dysfunction and
Done via through cardiac
only about 65%
of the time.
Increase in creatine kinase
Increase in sedementation
Increase in white
blood cells (leukocytosis).
Most are mild and
Treatment is supportive.
and treating cardiac arrhythmias.
Preserving myocardial function.
Preventing heart failure
Limiting myocardial oxygen demand
Treat the heart failure.
Anticoagulation to reduce the risk
of thrombosis and pulmonary embolism.
Myocarditis appears to make patients sensitive to
Intravenous immunoglobulin may be given to improve
the immune system
and limit the disease
Pericardium is a double-walled fibroserous sac that
supports the heart.
Normally, 15 to 50 mi of fluid separates the two
Pericardium becomes inflamed.
Pericardial Effusion - Excess
may accumulate in this space eht pericardial sac.
Can Progress to chronic constrictive pericarditis
Cardiac tamponade - fluid compresses the heart and
obstructs blood flow into the ventricles.
Usually occurs with a rapid accumulation of
a small amount of fluid.
Slow the body has time to
compensate for the change and the patient may experience few or no
50% are idiopathic.
Viruses (most common known cause
Acute myocardial infarction
Autoimmune or hypersensitivity
Symptoms of Pericarditis.
Most common symptom.
Sharp and constant, retrosternal.
Leaning forward while sitting may alleviate
pain, this is considered a hallmark sign of pericarditis.
down can worsen the pain from pericarditis, radiate to the neck,
and back; radiating to the left side.
malaise, tachypnea, and tachycardia.
Pericardial rub, although this is present in about
50% of cases.
Rising venous pressure
Faint heart sounds.
Reciprocal depression in lead AVR and
sometimes lead V1
ST segments return to normal
and T waves invert after several days.
Premature atrial beats and atrial fibrillation
Echocardiogram is the preferred imaging method for diagnosing
pericardial effusion or tamponade.
Chest X-ray may be
ordered to rule out pulmonary pathology.
Water bottle shape) if more
than 250 mi of pericardial fluid is present.
Cardiac enzyme levels
(including troponin) to rule out MI
Complete blood cell count
Large effusions or Cardiac tamponade.
Reduce pressure around the heart.
Nonsteroidal anti-inflammatory drugs
Manage pain and reduce
If pericarditis recurs frequently.