INFECTIVE DISEASES

OF HEART

Wella karolina
 INFECTIVE DISEASES OF
HEART
The infections are named for the layer
of heart most involved in the infectious
process:
Pericarditis (pericardium)
Myocarditis (myocardium)
Endocarditis (endocardium)
PERICARDITIS
Pericarditis refers to the inflammation
of the pericardium, the membraneous
sac enveloping the heart.

Incidence varies with the cause.

 Pericarditis

Acute Chronic
Pericarditis Pericarditis
 Acute Chronic
pericarditis pericarditis

Adhesive
Serous mediastino
pericarditis pericarditis

Fiberous Constrictive
pericarditis pericarditis

Purulent
pericarditis

Hemorrhagic
pericarditis
Acute pericarditis

Serous pericarditis is usually caused

by noninfectious inflammation such as
occurs in rheumatoid arthritis and
systemic lupus erythematosus .
Fibrous and serofibrinous
pericarditis represent the same basic
process and are the most frequent
type of pericarditis. Common causes
include acute myocardial infarction
(MI), postinfarction (Dressler
syndrome), uremia, radiation and
trauma
 Purulent or suppurative pericarditis
due to causative organisms may arise
from direct extension, hematogenous
seeding, or lymphatic extension, or by
direct introduction during cardiotomy.
 Immunosuppression facilitates this
condition.
 Clinical features include fever, chills, and
spiking temperatures.
 Constrictive pericarditis is a serious
potential complication.
 Hemorrhagic pericarditis involves
blood mixed with a fibrinous or
suppurative effusion, and it is most
commonly caused by tuberculosis or
direct neoplastic invasion.
 This condition can also occur in severe
bacterial infections.
 Hemorrhagic pericarditis is common after
cardiac surgery and may cause
tamponade.
 The clinical significance is similar to
suppurative pericarditis
Chronic pericarditis
Adhesive mediastino pericarditis is
a reaction that usually follows
suppurative pericarditis, cardiac
surgery, or irradiation.
This condition is rarely caused by a
simple fibrinous exudate.
The pericardial potential space is
obliterated, and adhesion of the
external surface of the parietal layer to
surrounding structures occurs.
Clinically, systolic contraction of the
ribcage and diaphragm and pulsus
paradoxus may be observed.
The increased workload may cause
massive cardiac hypertrophy and
dilatation, which can mimic an
idiopathic cardiomyopathy.
 Constrictive pericarditis is usually
caused by suppurative, caseous,
or hemorrhagic pericarditis.
 The heart may become encased in a
0.5-cm–thick to 1-cm–thick layer of
scar or calcification.
 Etiology
INFECTION
 Viral infection :
 Accounts for 1-10% of cases.
 The disease is usually a short self-limited
disease that lasts 1-3 weeks and can occur
as seasonal epidemics, especially
coxsackievirus B and influenza.
 Bacterial infections
Accounts for 1-8% of pericarditis
cases
Result from direct pulmonary
extension, hematogenous spread,
myocardial abscess or endocarditis,
penetrating injury to chest wall from
either trauma or surgery, or a
subdiaphragmatic suppurative lesion.
 Parasitic
: Parasitic organisms include
Entamoeba, Echinococcus, and
Toxoplasma.

 Fungal: Fungal organisms that may

cause acute pericarditis include
Histoplasma, Blastomyces,
Coccidioides, Aspergillus, and
Candida. Myocardial injury
Cont...
Myocardial injury

 Myocardial infarction
 Cardiac trauma
 Post cardiac surgery
 Hypersensitivity
Cont...
Collagen diseases
Drug reaction
Radiation therapy
Uremia
Neoplasm
 Clinical Manifestations
PHYSICAL EXAMINATION FINDING
Dyspnea/tachypnea, particularly in patients with
sizable effusions
Pericardial friction rub
Ewart Sign
Fever
◦ Tachycardia and cardiac arrhythmias, such
as premature atrial and ventricular
contractions, are occasionally present
◦ Pulsus paradoxus occurs in 70-80% of
patients with pericardial tamponade and is
measured by careful auscultation with a
blood pressure cuff.
Complications of Pericarditis
Pericardial Effusion

Cardiac Tamponade
 Collaborative Care
-Pericarditis, Pericardial Effusion,
Cardiac Tamponde

Diagnostic Tests
Medications
Surgical/Therapeutic Intervention
 Diagnostic Tests- to R/O
Laboratorium
EKG- diffuse St elevation *important to different
from MI changes (acute pericarditis)
CXR
Echo- for wall movement
Pericardiocentesis fluid- determine cause; treat
cardiac tamponade
Medications-
NSAIDS : Drug-induced pericarditis
treatment includes stopping the
administration of the offending agent
and anti-inflammatory therapy as
needed.
Treatment is with aspirin or NSAIDs
Corticosteroids
 Surgical/invasive Interventions
(remove fluid-treat tamponade)

Pericardiocentesis
Myocarditis

Myocarditis-uncommon inflammation of
heart muscle
Etiology
Virus
Bacterial infection
HIV infection
Other agents are also able to provoke
myocarditis, such as alcohol,
radiation, chemicals, and drugs
Myocarditis- infection in muscles of heart; most commonly caused by Coxsackie B virus that
follows a respiratory or viral illness, bacteria and other infectiousagents
Risk factor-myocarditis
Treatment of URI
Toxic or chemical effects
Autoimmune disorders
Post pericarditis
Metabolic-lupus
Heat stroke or hypothermia
Clinical Findings
In severe cases - symptoms of
progressive heart failure like CHF,
pulmonary rales, pedal edema
Frequent manifestation are fatigue,
dyspnea, palpitation and chest pain
Diagnostic Tests

A physical examination may show no

abnormalities, or may reveal the
following:
Abnormal heartbeat
Fever
Tachycardia
Edema in the legs
Electrocardiogram
Chest X-Ray
Echo
MRI
Biopsy
Medications

In the acute phase, supportive therapy

For symptomatic patients, digoxin and
diuretics.
For patients with moderate to severe
dysfunction, cardiac function can be
supported use of :
Antibiotics
Oral therapy with ACE inhibitors (Captopril,
Lisinopril)
Inotropes
Antiviral with interferon-a
Corticosteroid
HF drugs-
 Diuretic
 Beta blockers
 Antiarrhythmics
 Anticoagulants
Heart transplantation
COMPLICATION
Atrial fibrillation
Ventricular tachyarrhythmias
Dilated cardiomyopathy
Sudden cardiac death
Multisystem organ failure
Endocarditis
Endocarditis is an inflammation of
the inner layer of the heart , the
endocardium.
Types of Endocarditis

Sub acute bacterial endocarditis

Acute bacterial endocarditis
Native wall endocarditis
Prosthetic wall endocarditis
Diagnostic test

History
Laboratory tests
Echocardiography
Chest x-ray
Treatment
Prophylactic treatment for patients
Antibiotic administration
Surgical
◦ Early valve replacement.
Complications
Emboli (50% incidence)
◦ Right side- pulmonary emboli
◦ Left side-brain, spleen, heart, limbs,etc
CHF-check edema, rales
Arrhythmias
Death