This chapter is from the book
This chapter is from the book
This chapter is from the book
Inflammatory Diseases of the Heart
Inflammatory and infectious diseases of the heart often are a result of systemic infections that affect the heart. Inflammation and infection might involve the endocardium, pericardium, valves, or the entire heart.
Infective Endocarditis
Infective endocarditis, also known as bacterial endocarditis, is usually the result of a bacterial infections, collagen diseases, or cancer metastasis. As a result, the heart is damaged and signs of cardiac decompensation results. The client commonly complains of shortness of breath, fatigue, and chest pain. On assessment, the nurse might note distended neck veins, a friction rub, or a cardiac murmur.
Treatment involves treating the underlying cause with antibiotics, anti-inflammatory drugs, and oxygen therapy. Bed rest is recommended until symptoms subside. If the valve is severely damaged by infection, a valve replacement might have to be performed. Replacement valves are xenograft (bovine [cow] or porcine [pig]), cadaver, or mechanical. If the client elects to have a mechanical valve replacement, he will have to take anticoagulants for life. Following surgery, the nurse must be alert for signs of complications. These include decreased cardiac output or heart failure, infection, and bleeding. The physician often will prescribe digoxin, anticoagulants, cortisone, and antibiotics postoperatively.
Pericarditis
Pericarditis is an inflammatory condition of the pericardium, which is the membrane sac around the heart. Symptoms include chest pain, difficulty breathing, fever, and orthopnea. Clients with chronic constrictive pericarditis show signs of right-sided congestive heart failure. During auscultation, the nurse will likely note a pericardial friction rub. Laboratory findings might show an elevated white cell count. ECG changes consist of an S-T segment and T wave elevation. The echocardiogram often shows pericardial effusion.
Treatment includes use of nonsteroidal anti-inflammatory drugs to relieve pain. The nurse should monitor the client for signs of pericardial effusion and cardiac tamponade that include jugular vein distention, paradoxical pulses (systolic blood pressure higher on expiration than on inspiration), decreased cardiac output, and muffled heart sounds. If fluid accumulates in an amount that causes cardiac constriction, the physician might decide to perform a pericardiocentesis to relieve the pressure around the heart. Using an echocardiogram or fluoroscopic monitor, the physician inserts a large-bore needle into the pericardial sac. After the procedure, the nurse should monitor the client’s vital signs and heart sounds. In severe cases, the pericardium might be removed.
