INFEKSI

JANTUNG

Dr Elfiani,Sp.PD
FKIK- UNJA
April 2014
 INFEKSI
JANTUNG

ENDOKARDITIS

MIOKARDITIS

PERIKARDITIS
 Endocarditis
 Endocarditis is an inflammation of the inner
layer of the heart (endocardium)
 It usually involves the heart valves (native or
prosthetic valves)
 Other structures that may
be involved include :
- the interventricular septum
- the chordae tendineae
- the mural endocardium
- or even the surfaces of intracardiac devices
 Endocarditis
Endocarditis is characterized
by a prototypic lesion
(vegetation)  which is a
mass of platelets, fibrin,
microcolonies of
microorganisms, and scant
inflammatory cells
In the subacute form of
infective endocarditis, the
vegetation may also include a
center of granulomatous
tissue  which may fibrose or
calcify
 Classify Endocarditis

 The simplest classification is based on etiology :

- infective
- non-infective
 depending on whether a microorganism is the
source of the inflammation or not
 The diagnosis of endocarditis is based on :
- clinical features
- investigations  echocardiogram and
blood cultures demonstrating the
presence of endocarditis-causing
microorganisms
Etiologi

Endokarditis paling banyak disebabkan

oleh :
o streptokokus viridans yaitu
mikroorganisme yang hidup dalam
saluran napas bagian atas
o stapilokokus aureus yang menyebabkan
infeksi endokarditis subakut
o Penyebab lainnya adalah streptokokus
fekalis, stapilokokus, enterokokus,
bakteri gram negatif aerob/anaerob,
jamur/fungi, riketsia
 Non-infective endocarditis
Nonbacterial thrombic endocarditis (NBTE) or
marantic endocarditis
Usually occurs :
- during a hypercoagulable state system
wide bacterial infection or pregnancy
- it is also sometimes seen in patients with
venous catheters
- may also occur in patients with cancers 
particularly mucinous adenocarcinoma
The problems of NBTE: parts of thevegetations
may break off and embolize to the heart or
brain
 Diagnostics
 Careful cardiac auscultation  the degree of valvular
and violations of the pumping function of the
heart
Various blood tests :
- signs of inflammation (increased ESR,
leukocytosis)
- identify the specific pathogen blood
culture  it is necessary requires two
samples of blood
 ECG
 Cardiac ultrasound (echocardiography) the presence
of microbial vegetation, the degree of valvular
and violations of the pumping function of the heart
 Myocarditis

Myocarditis or inflammatory cardiomyopathy is

inflammation of heart muscle (myocardium)
Myocarditis is most often due to infection by
common viruses, such as parvovirus B19, less
commonly nonviral pathogens such as Borrelia
burgdorferi (Lyme disease) or Trypanosoma
cruzi, or as a hypersensitivity response to
drugs
 The definition of myocarditis :
- infection of the heart
- an inflammatory infiltrate
- and damage to the heart muscle
 Myocarditis may or may not include death
(necrosis) of heart tissue  dilated
cardiomyopathy
 Myocarditis is often an autoimmune reaction
 during and after the viral infection the
immune system may attack cardiac myosin
 Because a definitive diagnosis requires a heart
biopsy  invasive
 Signs and symptoms
Chest pain  often described as "stabbing" in character
 Congestive heart failur leading to edema,
breathlessness, hepatic congestion
 Palpitations  due toarrhythmias
 Sudden death (in young adults up to 20% of all cases)
 Fever (especially when infectious)

Symptoms in infants and toddlers tend to be more

nonspecific, with generalized malaise, poor appetite,
abdominal pain, and/or chronic cough. Later stages of the
illness will present with respiratory symptoms with
increased work of breathing, and is often mistaken for
asthma

Myocarditis is often associated with pericarditis

 Treatment
As most viral infections cannot be treated with directed
therapy
Symptomatic treatment is the only form of therapy for
those forms of myocarditis :
• In the acute phase  supportive therapy,
including bed rest is indicated
• For symptomatic patients  digoxin and diuretics
• For patients with moderate to severe dysfunction
 supported by use of inotropes such as Milrinone in
the acute phase  followed by oral therapy with
ACEI (Captopril, Lisinopril) when tolerated
• People who do not respond to conventional therapy are
candidates for bridge therapy with LVAD (Left
Ventricular Assist Devices)
• Heart transplantation  reserved for patients who
fail to improve with conventional therapy
 Pericarditis

An ECG showing pericarditis. Note the ST elevation in

multiple leads with slight reciprocal ST depression in aVR.
 Pericarditis
• Pericarditis is an inflammation of the
pericardium (the fibrous sac surrounding
the heart)
• A characteristic chest pain is often
present
• The causes of pericarditis are varied 
infections of the pericardium by viruses
or bacteria (Mycobacterium tuberculosis,
idiopathic causes, uremic pericarditis,
post-infarct pericarditis (within 24
hours of a heart attack), or Dressler's
syndrome (weeks to months after a
heart attack)
 Signs and symptoms
 Substernal or left pain with radiation to the
trapezius ridge which is relieved by sitting
up and worsened by lying down or
inspiration
 Other symptoms of pericarditis may include
dry cough, fever, fatigue, and anxiety
 The classic sign of pericarditis is a friction
rub on the cardiovascular examination
usually on the lower left sternal
 precardial tamponade causing pulsus
paradoxus, distant (muffled) heart sounds,
and distension of the jugular vein
 Diagnosis
Laboratory :
 increased urea (BUN), or increased blood
creatinine in cases of uremic pericarditis
 increased cardiac markers like Troponin (I,
T), CK-MB, Myoglobin, and LDH1

The EKG which will show a 12-lead  non

specific (ST segment-elevations all leads
except aVR and V1), sinus tachycardia, and
low-voltage QRS complexes
 Imaging

Ultrasounds showing a pericardial

effusion in someone with pericarditis
A pericardial effusion as seen on CXR in
someone with pericarditis
 Treatment
The treatment in viral or idiopathic pericarditis is with
aspirin or non-steroidal anti-inflammatory drugs
(NSAIDs such as ibuprofen)
Colchicine may be added to the above

Severe cases may require one or more of the following :

 pericardiocentesis to treat pericardial
effusion/tamponade
 antibiotics to treat tuberculosis or other bacterial
causes
 steroids are used in acute pericarditis but are not
favored because they increase the chance of
recurrent pericarditis.
 in rare cases, surgery
 in cases of constrictive pericarditis 
pericardiectomy
TERIMAKASIH