INFECTIOUS DISEASES OF

THE HEART
 RHEUMATIC ENDOCARDITIS
ACUTE RHEUMATIC FEVER
- May develop after an episode of group A
beta-Hemolytic streptococcal pharyngitis
Predisposing factors:

• School-aged children (5-15 years old)

• Family history of the disorder
• Overcrowding
• Low socioeconomic status
• Malnutrition
• Poor hygiene
• Previous history of the infection
Most serious complication: Rheumatic
heart disease
As evidenced by:
• Valvular disorders
• Cardiomegaly
• Pericarditis
• Heart failure
• Heart murmur
ACUTE RHEUMATIC FEVER
Jones Criteria: 2 major criteria or 1 major and 2 minor
criteria
Major Criteria:
1. Carditis – inflammation of the three layers of the heart
✔ Heart murmur
✔ Pericarditis with a rub
✔ Cardiomegaly
✔ Heart failure
2. Migratory polyarthritis – inflammation of more than one
joint and moves from joint to joint (classic presenting
manifestation of RF)
3. Sydenham’s chorea (St. Vitus Dance) – disorder of the CNS
- sudden, aimless, erratic, jerky, uncoordinated involuntary
movements
- Onset: gradual, insiduous (starts with personality changes
and clumsiness)
- Duration: 1-3 months

4. Subcutaneous nodules – round, firm, free moving nodules

over bony surfaces and tendons
5. Erythema marginatum
- Transient, non-pruritic rash starting with central red
patches that expand
- Results in series of irregular patches with red, raised
margin and pale centers (giraffe spots)
ACUTE RHEUMATIC FEVER

Minor Criteria:
1. Fever
2. Recent history of strep infection
3. Arthralgia
4. Abdominal pain
5. Malaise, anorexia
ACUTE RHEUMATIC FEVER

Diagnostic Tests:
a. Elevated ESR (inflammation & infection)
b. Elevated C-reactive protein (inflammation;
necrosis)
c. Antistreptolysin O (ASO) titer increased (N⁰=
0-200 iu)
d. Positive throat culture
e. Leukocytosis
 ACUTE RHEUMATIC FEVER
Medical Management
Goals:
1. Identify and eradicate the causative organism and prevent
complications
2. Maximize cardiac output
3. Promote comfort
4. Prevent complications
a. Drug therapy
• Penicillin
• Erythromycin
• Salicylates
ACUTE RHEUMATIC FEVER
b. Steroids + cardiac glycosides and diuretics
c. Bed rest until lab studies return to normal
d. Prophylaxis for valvular heart disease, bacterial endocarditis (esp.
before surgery and dental work)

Nursing Diagnoses
1. Pain related to swelling of joints and liver enlargement
2. Risk for non-compliance with drug therapy related to lack of
knowledge about importance of long term therapy
3. Activity intolerance related to reduced cardiac reserve and fatigue
4. Imbalanced nutrition: less than body requirements related to loss of
appetite
ACUTE RHEUMATIC FEVER
Nursing Interventions
1. Carditis
a.Penicillin
b.Bed rest until ESR is normal
2. Arthritis
a.Aspirin
b.Position child slowly
3. Chorea
a.Decrease stimulation
b.Safe environment
c.Small, frequent meals
d.Sedatives
ACUTE RHEUMATIC FEVER
4. Nodules and rash : none
5. Alleviate child’s anxiety
6. Provide age appropriate sedentary play
7. Provide client teaching and discharge planning:
a. Adaptation of home environment to promote bedrest
b. Importance of prophylactic medication regimen
c. Diet modification in relation to decreased activity/
cardiac demands
• High CHON, high CHO
• Vitamin & mineral supplements
maintain hydration
ACUTE RHEUMATIC FEVER
d. Avoid reinfection
- prompt dental care
- prophylaxis before dental procedures
-avoid people with URTI or strep infection
- notify AP if the ff occurs:
✔Fever
✔Chills
✔Sore throat
✔Enlarged, painful lymph nodes
e. Monitor for s/s of complications
INFECTIVE ENDOCARDITIS
- A microbial infection of the endothelial surface of the
heart
- Usually develops in people with prosthetic heart valves
or structural heart defects
- Characterized by: Formation of vegetations on the heart
valves
2 Types
1. Acute bacterial endocarditis
2. Sub-acute endocarditis

Risk Factors
✔ Prosthetic heart valves
✔ Sructural cardiac defects
✔ Hx of bacterial endocarditis
✔ Reduced immunologic response
✔ Immunosuppressive therapy (fungal endocarditis)
✔ Older people
INFECTIVE ENDOCARDITIS
Clinical Manifestations
1. Fever
2. Heart murmur (1⁰)
3. Petechiae
INFECTIVE ENDOCARDITIS
4. Oslers nodes (small, painful nodules in the pads of
fingers or toes)
INFECTIVE ENDOCARDITIS
5. Janeway lesions (irregular, red or purple, painless flat
macules in the palms, fingers, hands, soles and toes)
INFECTIVE ENDOCARDITIS
6. Roth spots (hemorrhages with pale centers in the fundi
of the eyes – caused by emboli)
INFECTIVE ENDOCARDITIS
7. Splinter hemorrhages (reddish-brown lines and streaks
under the fingernails and toenails)
INFECTIVE ENDOCARDITIS
8. Cardiomegaly
9. Heart failure
10. Tachycardia

CNS manifestations: headache, transient cerebral

ischemia, and strokes
INFECTIVE ENDOCARDITIS
Assessment and Diagnostic Findings
Definitive diagnosis: when a microorganism is found in 2
separate blood cultures, in a vegetation, or in an abscess
• Leukocytosis
• Anemia
• Positive rheumatoid factor - antiglobulin antibodies often
found in the serum of patients with a clinical dx of RA
• Increased ESR or C-reactive protein
• Microscopic hematuria
• Doppler echocardiography – mass on the valve,
or supporting structures; identifies vegetations,
abscesses, new prosthetic valve dehiscence, or
new regurgitation
 INFECTIVE ENDOCARDITIS
Prevention:
1. Antibiotic prophylaxis (surgery & dental work)
- Amoxillin (Amoxil) 2g orally 1 hour before procedure (dental, surgical, invasive
dx, delivery)
- Clindamycin (Cleocin)
- Cephalexin (Keflex)
- Cefazolin (Ancef, Kefzol)
- Ceftriaxone (Rocephin)
- Azithromycin (Zithromax)
- Clarithromycin (Biaxin)
2. Good oral hygiene
3. Avoid nail biting
4. Avoid IUDs and body piercing and branding
INFECTIVE ENDOCARDITIS
5. Ensure meticulous hand hygiene, site preparation and
aseptic technique with IV catheters and invasive
procedures

Medical Management:
1. Antibiotic therapy – IV infusion for 2-6 wks
DOC: Penicillin
2. Monitor temperature regularly
INFECTIVE ENDOCARDITIS
Surgical Management
Indications:
a. Unresponsive to medications
b. Prosthetic heart valve endocarditis
c. Vegetation larger than 1 cm
d. Onset of complications (i.e. septal perforation)

1. Valve debridement or excision

2. Debridement of vegetations
3. Debridement and closure of abscess
4. Aortic or mitral valve debridement, excision or replacement
INFECTIVE ENDOCARDITIS
Nursing Diagnoses
1. Decreased cardiac output related to cardiac valve dysfunction
2. Ineffective individual coping related to the chronic nature of the
disease

Nursing Management
1. Monitor temperature
2. Assess heart sounds
3. Monitor signs and symptoms of systemic embolization or
pulmonary infarction; organ damage (i.e. stroke), meningitis, HF,
MI, glomerulonephritis and splenomegaly
4. Assess daily invasive lines and wounds
5. Discharge teachings:
• Activity restrictions
• Continue medications as directed
• The need for antibiotic prophylaxis for invasive
procedures
MYOCARDITIS
• The inflammation of the myocardial wall

• Frequently, the inflammation is not limited to the

myocardium but extends to the pericardium
(pericarditis)
MYOCARDITIS
• Etiology and Risk Factors
❖ in most cases, it is caused by viral infections
• Coxsackie virus (most common)
• Mumps
• Influenza
• Rubella
• Measles
• Bacterial, fungal, helmintic, protozoal infections
• Alcohol
• Large doses of radiation therapy to the chest
MYOCARDITIS
Clinical Manifestations
history of recent upper respiratory or GIT infection
Most frequent manifestations are:
• Fatigue
• Dyspnea
• Palpitations
• Chest pain (sharp, stabbing precordial pain)
ECG abnormalities
Elevated serum levels of cardiac enzymes
Chest X-ray may show an enlarged cardiac silhouette
Elevated WBC and ESR
MYOCARDITIS
Prevention:
1. Immunizations (influenza, hepatitis)
2. Early treatment

Medical Management:
1. Antibiotic therapy specific to the cause
2. Bed rest
3. Limit physical activities for 6 months
4. Avoid beta blockers – decrease the strength of ventricular
contraction
THANK
YOU!