HEART INFECTIONS

Mr. Ryan Caoile Ricaña BSN RN

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Endocarditis • inflammation of the inside lining of the heart

chambers and heart valves (endocardium).

• can involve the heart muscle, heart valves, or lining of the heart.

• Most people who develop endocarditis have heart disease of the valves.

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Risk factors

• Injection drug use • Permanent central venous access lines • Prior valve surgery • Recent dental surgery • Weakened valves • Bacteriak infection• Fungi

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Symptoms  • Abnormal urine color • Blood in the urine • Chills • Excessive sweating • Fatigue • Fever • Heart murmur

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• Joint pain • Muscle aches and pains • Night sweats • Nail abnormalities (splinter hemorrhages under

the nails) • Paleness • Red, painless skin spots on the palms and

soles (Janeway lesions)

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Jane lesion

• Red, painful nodes in the pads of the fingers and toes (Osler's nodes)

• Shortness of breath with activity • Swelling of feet, legs, abdomen • Weakness • Weight loss

Note: Endocarditis symptoms can develop slowly (subacute) or suddenly (acute).

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Exams and Tests    • CBC anemia • Chest x-ray • Echocardiogram • ECG • Erythrocyte sedimentation rate (ESR) • Repeated blood culture and sensitivity • Serology • Transesophageal echocardiogram

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Treatment 

• Long-term antibiotic therapy is needed to get the bacteria out of the heart chambers and valves.

• usually have therapy for 6 weeks

• must be specific for the organism

• blood culture and the sensitivity tests

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Surgery to replace the heart valve is usually needed when:

• The infection is breaking off in little pieces, resulting in a series of strokes

• The person develops heart failure as a result of damaged heart valves

• There is evidence of organ damage

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Possible Complications    • Arrhythmias, such as atrial fibrillation • Blood clots or an infected clot from the

endocarditis that travels to the brain, kidneys, lungs, or abdomen, causing severe damage to, and infection of, these organs

• Brain abscess • Brain or nervous system changes

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• Congestive heart failure

• Glomerulonephritis

• Jaundice

• Severe heart valve damage

• Stroke

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Prevention  • People with certain heart conditions often

take preventive antibiotics before dental procedures or surgeries involving the respiratory, urinary, or intestinal tract.

• Those with a history of endocarditis should have continued medical follow-up.

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Myocarditis

• an inflammation of the heart muscle

• an uncommon disorder that is usually caused by viral infections such as coxsackie virus, adenovirus, and echovirus

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• may also occur during or after various viral, bacterial, or parasitic infections (such as polio, influenza, or rubella).

• exposure to chemicals or allergic reactions to certain medications

• associated with autoimmune diseases.

• muscle becomes inflamed and weakened

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Symptoms   • History of preceding viral illness

• Fever

• Chest pain that may resemble a heart attack

• Joint pain or swelling

• Abnormal heart beats

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• Fatigue

• Shortness of breath

• Leg swelling

• Inability to lie flat

*total absence of symptoms is common

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Additional symptoms • Fainting, often related to arrhythmias

• Low urine output

• Other symptoms consistent with a viral infection -- headache, muscle aches, diarrhea, sore throat, rashes

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Exams and Tests

• Electrocardiogram (ECG) • Chest x-ray • Ultrasound of the heart (echocardiogram)

-- may show weak heart muscle, an enlarged heart, or fluid surrounding the heart.

• White blood cell count

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• Red blood cell count

• Blood cultures for infection

• Blood tests for antibodies against the heart muscle and the body itself

• Heart muscle biopsy - rarely performed

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Treatment  • Antibiotics

• reduced level of activity, and

• low-salt diet.

• Steroids and other medications may be used to reduce inflammation.

• Diuretics

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• If the heart muscle is very weak, standard medicines to treat heart failure are also used.

• Abnormal heart rhythm may require the use of additional medications, a pacemaker or even a defibrillator.

• If a blood clot is present in the heart chamber, blood thinning medicine is given as well.

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Possible Complications  

• Heart failure

• Pericarditis

• Cardiomyopathy

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Prevention 

• Prompt treatment of causative disorders may reduce the risk of myocarditis.

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Pericarditis

• a disorder caused by inflammation of the pericardium, which is the sac-like covering around the heart.

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Causes • usually a complication of viral infections, most

commonly echovirus or coxsackie virus.

• less frequently, it is caused by influenza or HIV infection.

• Infections with bacteria can lead to bacterial pericarditis (also called purulent pericarditis).

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• Some fungal infections can also produce pericarditis.

• can be associated with systemic diseases such as autoimmune disorders, rheumatic fever, tuberculosis, cancer, leukemia, kidney failure, HIV infection, AIDS, and hypothyroidism

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• Heart attack and myocarditis

• radiation therapy to the chest

• medications that suppress the immune system.

• injury (including surgery) or trauma to the chest, esophagus, or heart

• unknown (idiopathic pericarditis)

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• most often affects men aged 20-50, usually following respiratory infections

• In children, it is most commonly caused by adenovirus or coxsackie virus.

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Symptoms    • Chest pain, caused by the inflamed pericardium

rubbing against the heart

• relieved by sitting up and leaning forward• Pleuritis type: a sharp, stabbing pain • radiate to the neck, shoulder, back or abdomen• increases with deep breathing and lying flat, and

may increase with coughing and swallowing

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• Breathing difficulty when lying down • Need to bend over or hold the chest while

breathing • Dry cough • Ankle, feet and leg swelling (occasionally) • Anxiety • Fatigue • Fever

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Exams and Tests    • pericardial rub• heart sounds may be muffled or distant• signs of fluid in the pericardium (pericardial

effusion).• If the disorder is severe, there may be crackles

in the lungs, decreased breath sounds, or other signs of fluid in the space around the lungs (pleural effusion).

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• Chest x-ray

• Echocardiogram

• Chest MRI scan

• Heart MRI or heart CT scan

• Radionuclide scanning

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• Blood culture

• CBC, may show increased WBC count

• C-reactive protein

• Erythrocyte sedimentation rate (ESR)

• Pericardiocentesis, with chemical analysis and pericardial fluid culture

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Treatment  • analgesics

• anti-inflammatory drugs(NSAIDS) such as aspirin and ibuprofen.

• Corticosteroids

• Diuretics

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• Pericardiocentesis - if the buildup of pericardial fluid makes the heart function poorly or produces cardiac tamponade may be done using an echocardiography-guided needle or surgically in a minor procedure.

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• If the pericarditis is chronic, recurrent, or causes constrictive pericarditis, cutting or removing part of the pericardium may be recommended.

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Possible Complications    • Arrhythmias, such as atrial fibrillation

• Cardiac tamponade

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• Constrictive pericarditis, where inflammation of the pericardial sac results in fibrosis and thickening of the pericardium with adhesions (sticky scars) between the pericardium and the heart.

• The pericardium creates a rigid "case" around the heart, which can severely limit the ability of the heart to fill with blood. Patients with constrictive pericarditis may develop heart failure, which responds poorly to treatment.

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Non-Hodgkin's lymphoma

• is cancer that starts in the lymphoid tissue. that makes up the lymph nodes, spleen, and other organs of the immune system.

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Causes  • White blood cells called lymphocytes are found

in lymph tissues. Most lymphomas start in a type of white blood cells called B lymphocytes.

• For most patients, the cause of the cancer is unknown. However, lymphomas may develop in people with weakened immune systems. For example, after an organ transplant.

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• Non-Hodgkin's lymphoma is grouped, or staged, according to how fast the cancer spreads - low grade, intermediate grade or high grade.

• Burkitt's tumor is an example of a high-grade lymphoma.

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• According to the American Cancer Society, a person has a 1 in 50 chance of developing non-Hodgkin's lymphoma.

• Most of the time affects adults

• High-risk groups - have received an organ transplant or with weakened immune system (immunosuppression).

• more common in men

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Symptoms • Swollen lymph nodes in the neck,

underarms, groin, or other areas (may occur as an armpit lump)

• Fever • Excessive sweating with night sweats • Unintentional weight loss • Severe itchiness

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• Coughing or shortness of breath may occur if the cancer affects the thymus gland or lymph nodes in the chest, which puts pressure on the windpipe.

• stomach pain or swelling, which may lead to a loss of appetite, constipation, nausea, and vomiting

• headache, concentration problems, personality changes, or seizures.

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Exams and Tests   

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• Lymph node biopsy • Bone marrow biopsy • CBC with differential • CT scans of the chest, abdomen and pelvis • Blood chemistry tests • X-rays • PET (positron emission tomography) scan

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Treatment   • Chemotherapy

• Rituximab (Rituxan) is often used to treat non-Hodgkin's lymphoma - a form of immunotherapy

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• Radioimmunotherapy - involves linking a radioactive substance with an antibody that helps the immune system fight infection, and injecting the substance into the body.

• In select cases, a stem cell transplant may be needed.

Possible Complications   

• Infection

• Autoimmune hemolytic anemia

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Hodgkin's vs. non-Hodgkin's lymphoma: What's the

difference?

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• Both are lymphomas, a type of cancer that originates in a subset of white blood cells called lymphocytes — an important component of immune system.

• The main difference is in the specific lymphocyte each involves.

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• If in examining the cells, the doctor detects the presence of a specific type of abnormal cell called a Reed-Sternberg cell, the lymphoma is classified as Hodgkin's. If the Reed-Sternberg cell is not present, the lymphoma is classified as non-Hodgkin's.

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