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PRESENTED TO :
Pericarditis Myocarditis & Endocarditis
MADAM SHUMAILA TARIQ
PRESENTED BY :
 ALI RAZA KHAN
 HASNAIN AHMAD
 MUHAMMAD BILAL

PRESENTATION ON HEART BSN 1st PROFE.pptx

OBJECTIVES
After attending this session students will be able to :
 Understand the anatomy and physiology
 Define pericarditis myocarditis endocarditis
 Explain the types
 Identify the causes and risk factors
 Explain the pathophysiology
 Know the clinical manifestations
 Know how to asses and diagnosis
 Know the Medical Management
 Know the Nursing Management
 Complications
 Make NANDA nursing diagnosis

Anatomy and Physiology of Heart Walls
PERICARDIUM:
It is a outermost membrane of the heart. Which is double membranous sac
The outer sac is fibrous pericardium and inner sac is serous pericardium.
MYOCARDIUM:
Myocardium is composed of cardiac muscles found only in heart
The ends of cells are closed contact with adjacent cells.
These joints or Intercalated discs are thicker darker lines.
When an impulse is initiated it spread from cell to cell via these discs.
ENDOCARDIUM:
It is the inner most layer of the heart.it surrounds the chambers of the
heart.

INTRODUCTION
PERICARDITIS:
It is the swelling and irritation of thin sac like tissues surrounding the
heart. It often causes sharp chest pain occurred by the layers of
pericardium rub against each other.
MYOCARDITIS:
It is an inflammatory process involving the myocardium, can cause
heart dilation, thrombi on the heart wall, Infiltration of circulating
blood cells around the coronary vessels and between the muscle
fibres.
ENDOCARDITIS:
It is the inflammation of the inner lining of the heart chambers and walls, and
usually caused by the infection from blood stream and attach to damage area of the
heart.

TYPES
PERICARDITIS MYOCARDITIS ENDOCARDITIS
ACUTE PERICARDITIS ACUTE MYOCARDITIS INFECTIVE ENDOCARDITIS
RECURRENT PERICARDITIS CHRONIC MYOCARDITIS RHEUMATIC ENDOCARDITIS
CHRONIC CONSTRICTIVE
PERICARDITIS
LYMPHOCYTIC MYOCARDITIS ACUTE ENDOCARDITIS
CHRONIC ENDOCARDITIS

VIRAL INFECTION: Coxasackie virus A&B strands , Poliomyelitis, influenza virus, Rubella, Odeno virus, HIV,
Covid-19
BACTERIAL INFECTION: Diphtheria, Tuberculosis, Typhoid Fever, Tetanus, Staphylococcal, Pneumococcal,
streptococcus, E coli
PARASITIC AND FUNGAL: Trapanosome, Candida
CONNECTIVE TISSUE DISEASE: Lupus rheumatoid arthritis
DRUG & CHEMICAL POISONING: Penicillin, sulphonamides, anti-seizures, cocaine
RADIATION THERAPY: Large doses of radiation to chest
AUTOIMMUNE DISORDERS: Rheumatoid arthritis
TUMOR OR CANCER: Metastasis from breast
CAUSES OF INFLAMATION

PATHOPHYSIOLOGY
Loss of consciousness and sudden death
Too little O2 reaches the tissues, faster
heart beat
Less blood leaves heart
Pressure prevents the heart from
expanding and filling completely
Puts pressure on heart
Fluid within the pericardium & hardening
Due to etiological factors
Heart Failure and sudden death
Decreased cardiac output
LV & DP and LAP increased
Heart Enlarges
Decreased Myocardial contractility
Myocardium damaged
Inflammation and in jury to myocardium

Sudden death may occur
Heart failure
Valve destruction
Fibrin and platelet deposition over clusters of
bacteria
Vegetation and activation of clotting cascade
Bacteria adhere to damage endothelium
Inflammation and in jury to endocardium

CLINICAL MANIFESTATIONS
 Chest pain
 Fever, Chills
 Tachycardia
 Fatigue
 Dyspnea
 Syncope
 Palpitations
 Discomfort in chest and upper abdomen
 Flue like symptoms like headache ,body aches ,joint pain
ENDOCARDIUM:
 Valvular damage
 Rapture of cordhae tandinae
 Pulmonary Embolism
 Heart Block

Assessment and Diagnostic Findings
 Patient history
 Physical examination
 Heart sounds
 WBC count
 C Reactive Protein test
 Leucocyte count
 Erythrocyte Sedimentation Rate ( ESR )
 Ct Scan
 Magnetic Resonance Imaging ( MRI )
 Endo Myocardial Biopsy
 Stool and Throat culture
 Blood test for Heart muscle enzymes(Troponin and CK levels)

PREVENTION
 Avoid close contact with people
 Avoid Alcohol
 Quit Smoking
 Reduce Sodium Diet
 Reduce Stress
 Do not eat unhealthy food
 Do not awake more ( have proper sleep )

MEDICAL MANAGEMENT
 Antibiotics(Penicillin)
 Analgesics and anti inflammatory
 Angiotensin Converting Enzymes Inhibiters ( ACEIs ) captopril , enalapril ,lisinopril
 Angiotensin 2 Receptor blockers : Losartan , Valsartan
 Beta Blockers : metaprolol , carvadelol
 Diuretics : Furosemide
 Corticosteroids : Prednisone.

SURGICAL MANAGMENT
 Pericardialcentesis
 Extra Carporal Membrane Oxygenation ( ECMO )
 Heart Transplant
 Open Heart Surgery

NURSING MANAGEMENT
NURSING INTERVENTION RATIONALS
Assess the vital signs and characteristics of heart beat,
every
2-hours.
To assist in creating accurate diagnosis.
Assess the breath sounds via auscultation Breath sounds are important sign of fluid overload and
myocarditis
Administer the antibiotics and other medication as per
order
To alleviate the symptoms of infectious disease.
Provide bed rest to patient It reduces the myocardial oxygen demand
Administer supplemental oxygen as prescribed To increase oxygen level and achieve an SPO2 as in
target rang

Elevate the head of the bed to semi-fowlers position Head elevation help improve the expansion of lungs.
Prepare the patient for ventricular assist device by
consent
This help the ventricles of heart to pump more blood
supply
In ineffective breathing situation check the ABG level. It helps to identify the level of O2 and CO2
Evaluate the patients response to pharmacological
treatment
In order to compare the response with patients therapy
goal
Encourage to take adequate oral fluids as prescribed In order to prevent from dehydration

COMPLICATIONS
 Pericardial Effusion
 Cardiac Temponade
 Cardiomyopathy
 Heart Failure
 Irregular Rhythms
 Pulmonary Embolism
 Cerebral Hemorrhage

NURSING DIAGNOSIS
 Acute pain related to inflammation as evidence by hyperthermia
 Decrease cardiac output related to impaired cardiac contractility as
evidence by arrhythmia
 Activity intolerance related to oxygen imbalance as evidence by
fatigue and breathing difficulty
 Ineffective breathing pattern related to decrease expansion of lungs as
evidence by productive cough
 Deficient knowledge related to disease as evidence by patients
questions about the condition

1: Which of following test is criterion standard for diagnosis of Myocarditis?
a: ECHOCARDIOGRAPHY C: ENDOMYOCARDIAL BIOPSY
B: SCINTIGRAPHY D: ELECTROCARDIOGRAM
2: which of the following result in left ventricular hypertrophy except :
A: Aortic stenosis c : systemic hypertension
B: mitral stenosis d : coarctation of aorta
3: Which of these is most commonly responsible for myocardial infarction :
A : Aneurysm c : heart failure
B : coronary artery thrombosis d : Renal failure
4 : The following commonly cause myocarditis :
A: dengue fever c: malaria
B: Trypanosome cruzi d : radiations
Post Activity Questions

REFERENCES
 BRUNNER & SUDDARTH
MEDICAL –SURGICAL NURSING 13th
Edition
 LAKHWINDER KAUR &SUKHWINDER KAUR
MEDICAL –SURGICAL NURSING 4th
Edition
 www.nclex.edu

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PRESENTATION ON HEART BSN 1st PROFE.pptx

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