2. INFECTIOUS DISEASES OF THE
HEART
• Any of the herat‘s three layers may be affected by an
infectious process.
• The diseases are named for the layer of the heart most
involved in the infectious process:
• (Myocarditis (inflammation of the myocardium),
Endocarditis(inflammation of the endocardium) and
pericardium(inflammation of the pericardium)
• The usual management for all infectious diseases
prevention. IV antibiotics are usually necessary once an
infection in the heart has developed.
3. COMMON INFLAMMATORY
DISEASES OF THE HEART
• Infective Endocarditis
• Acute pericarditis
• Myocarditis
• Rheumatic fever and Herat disease
4. INEFFECTIVE ENDOCARDITIS
• Endocarditis is inflammatory process of the
endocardium, especially the valves.
• This disorders carriers high morbidity and mortality
rates,but outcomes can be improved greatly with
early diagnosis and effective treatment.
5. ETIOPATHOPHYSILOGY
• Common injecting organisms include
1. Staphylococci (s. aureus, S.faecalis, S.epidermidis)
2. Streptococci
3. Escherichia coli
4. Gram negative organisms
(klebsiella,pseudomonas,)
5. Fungai (Candida,aspergillus) and HACEK
organisms
6. CONTI.....
• These organisms enter the body through the oral
cavity after dental procedures, mouth or tooth
abscesses, oral irrigations, or irritations from dental
floss or bridge work.
7. CONTI...
• the upper respiratory tract is another port of entry
following surgery, intubations, or infections.
•Direct exposure of the bloodstream to organisms
can occur with prolonged IB
catheters,hemodialysis catheters and IB drug use.
8. CONTI..
• procedures involving the gastrointestinal and
geneto urinary tract(barium enemas
sigmoidoscopy,clonoscopy,liver biopsy and
prostatectomy) have been associated with infective
endocarditis
9. RISK FACTORS
• Previous heart damage
• Dental procedures which lead into the introduction of bacterias
• Heart surgery
• Intubations
• Procedures involving gastrol intestinal and genitourinaly tracts
e.g. barium, enemas, sigmoidoscopy, catheterisation and
cytoscopy
• Reproductive conditions like delivery of new babies, abortions
and pelvic inflammatory disease
10. PATHOPHYSIOLOGY
• Usually in this case the bacterias or any other causing
agents enter the blood stream through invasive procedures
like dental procedures, surgery , urinary catherisation.
• Then they accumulate on the valves of the heart or
endocardium
• Finally they form vegetations or crusters
• These vegetation they lead into damage heart valves by
perforating and deforming the valves leaflets
• This at the end leads to tearing which means there is poor
flow of blood and lead into accumulation of blood in
11. CLINICAL MANIFESTATIONS
• The primary presenting symptoms of infective
endocarditis are fever and a heart murmur.
• Clinical manifestations related to the infection include
• Fever ,chills, alternating with sweats, malaise,weakness,
anorexia,weigt loss, pallor, backache and spleeno megaly
12. CLINICAL MANIFESTATIONS RELATED
TO EMBOLIZATION OCCURS IN ANY
PART OF THE BODY
• Stroke, TIA, aphasia
• Loss of vision form embolization to the brain or retinal
artery
• Roth’s spots
• Myocardial infarction
• Pulmonary embolism
• Splinter haemorrhage
• Clubbing of the fingers
13. ASSESSMENT AND DIAGNOSTIC
TESTS
• History collection
• Physical examination
• Based on parenting symptoms
• WBC
• Eco cardiography
• ESR
• Blood culture
15. PREVENTION
• Antibiotics prophylaxis is recommended for moderate and high risk patients
is recommended before and sometimes after the following procedures
1. Dental procedures
2. Tonsillectomy and adenoidectomy
3. Surgical procedures that mainly intstinaland respiratory
4. Bronchoscopy
5. Fall bladder surgery
6. Urethral cacatheterisation
7. Urinary tract and prostatic surgery
16. MEDICAL MANAGEMENT
• The objective of management to eradicate the infecting
organisms through adequate doses of an appropriate
antimicrobial therapyand to tret complications
17. CONTI...
• The choice of antibiotics therapy depends on the types of
organisms involved.
• Penicillin and gentamicin commonly used
• Therapy should administer at least 4 to 6 weeks
18. NURSING ASSESSMENT
• It includes history taking like;
• Subjective data:
• past medical history: patient asked of signs of the disease
and the onset of the disease and review with patient
history of risk factors like cardiac failure, shock
• Medication history: has the pt ever taken any medication,
what happened afterwards
• Family history:asked of any case at home of the similar
conditions
19. • Social history: social behaviours that can trigger
the problem
• Surgical history: if ever operated on
• Objective data: assess for temperature elevations,
heart mummer, evidence of cough , peripheral
edema and embolism, alscultate for heart sound,
monitor arterial blood gas, rapid purse
rate,dyspnea, restlessness and manifestation of
heart failure
20. NURSING DIAGNOSES
• Infective breathing pattern related to inflammation of heart muscle
as evidenced by use of accessory muscle, dyspnea.
• Impaired gaseous exchange related to fluid accumulation in the
lungs as evidenced by shortness of breath
• Decreased cardiac output related to valvular dysfunction as
evidenced by poor tissue perfusion
• Imbalanced nutrition less than body requirement related to
anorexia as evidenced by loss of weight.
21. NURSING MANAGEMENT
• Position the patient at semi fowlers position to help in
infective breathing through providing enough room for
lung expansion as abdominal contents goes down
• Administer oxygen therapy 4-6 l/min to help pt in
breathing effectively through supplementing oxygen
22. • Monitor arterial blood gas , carbon dioxide, oxygen
saturation hourly and document to monitor signs of
respiratory acidosis
• Encourage and provide small frequent meals reach in
proteins helping in repairing worn-out tissues
• Monitor vital signs , heart and lung sound, level of
consciousness to evaluate how effectively the organs like
the heart and the lungs are working
23. • Schedule nursing activities to allow rest
• Encourage and assist pt to cough and deep breath to promote chest
expansion
• provide tepid sponging to reduce raised body temperature by
evaporation and conduction
• Encourage patient on exercises in order to improve patients mobility
through making the body physically fit
• Make yourself available to the patient and nurse with love and respond
well to his/her questions to array pain and anxiety
• Educate the patient on disease process to make pt cope up with
therapy and the condition
