myocarditis ppt new.ppt

8/10/2019 MYOCARDITIS ppt new.ppt

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INFLAMATION

By : Sari Fatimah


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MYOCARDITIS

PERICARDITIS

ENDOCARDITIS


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MYOCARDITIS

myocarditisis inflammationof the

myocardium, the muscular part of the

heart. It is generally due to infection(viral

or bacterial). It may present with chest

pain, rapid signs of heart failure, or sudden

death.
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Bacteriumhttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Bacteriumhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Inflammation


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Signs and symptoms of myocarditis

Chest pain(often described as "stabbing" incharacter)

Congestive heart failure(leading to edema,breathlessnessand hepaticcongestion)

Palpitations(due to arrhythmias)

Sudden death (in young adults, myocarditiscauses up to 20% of all cases of sudden

death)[2] Fever (especially when infectious, e.g. in

rheumatic fever
http://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Breathlessnesshttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Palpitationhttp://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Rheumatic_feverhttp://en.wikipedia.org/wiki/Rheumatic_feverhttp://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Palpitationhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Breathlessnesshttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Chest_pain


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Elevated CRPand/or ESRand increased IgM(serology) againstviruses known to affect the myocardium. Markers of myocardialdamage (troponinor creatine kinasecardiac isoenzymes) are

elevated.[1] The ECGfindings most commonly seen in myocarditis are diffuse Twaveinversions; saddle-shaped ST-segment elevations may bepresent (these are also seen in pericarditis).[1]

The gold standardis still biopsyof the myocardium, generally done inthe setting of angiography. A small tissue sample of the endocardiumand myocardiumis taken, and investigated by a pathologistby lightmicroscopyandif necessaryimmunochemistryand special stainingmethods. Histopathological features are: myocardial interstitium withabundant edema and inflammatory infiltrate, rich in lymphocytesandmacrophages. Focal destruction of myocytes explains the myocardialpump failure.[1]

Recently, cardiac magnetic resonance imaging(cMRI or CMR) has

been shown to be very useful in diagnosing myocarditis by visualizingmarkers for inflammationof the myocardium.[3]
http://en.wikipedia.org/wiki/C-reactive_proteinhttp://en.wikipedia.org/wiki/Erythrocyte_sedimentation_ratehttp://en.wikipedia.org/wiki/IgMhttp://en.wikipedia.org/wiki/Serologyhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Troponinhttp://en.wikipedia.org/wiki/Creatine_kinasehttp://en.wikipedia.org/wiki/Electrocardiogramhttp://en.wikipedia.org/wiki/T_wavehttp://en.wikipedia.org/wiki/T_wavehttp://en.wikipedia.org/wiki/Gold_standard_%28test%29http://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/Angiographyhttp://en.wikipedia.org/wiki/Endocardiumhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Pathological_anatomyhttp://en.wikipedia.org/wiki/Light_microscopyhttp://en.wikipedia.org/wiki/Light_microscopyhttp://en.wikipedia.org/wiki/Immunochemistryhttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Immunochemistryhttp://en.wikipedia.org/wiki/Light_microscopyhttp://en.wikipedia.org/wiki/Light_microscopyhttp://en.wikipedia.org/wiki/Pathological_anatomyhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Endocardiumhttp://en.wikipedia.org/wiki/Angiographyhttp://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/Gold_standard_%28test%29http://en.wikipedia.org/wiki/T_wavehttp://en.wikipedia.org/wiki/T_wavehttp://en.wikipedia.org/wiki/Electrocardiogramhttp://en.wikipedia.org/wiki/Creatine_kinasehttp://en.wikipedia.org/wiki/Troponinhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Serologyhttp://en.wikipedia.org/wiki/IgMhttp://en.wikipedia.org/wiki/Erythrocyte_sedimentation_ratehttp://en.wikipedia.org/wiki/C-reactive_protein


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Etiology Infectious:

Viral(e.g. enterovirus, Coxsackie virus, rubella virus, polio virus, cytomegalovirus, possibly

hepatitis C) Bacterial(e.g. brucella, Corynebacterium diphtheriae, gonococcus, Haemophilus influenzae,

Actinomyces, Tropheryma whipplei, and Vibrio cholerae).

Spirochetal(Borrelia burgdorferiand leptospirosis)

Protozoal(Toxoplasma gondiiand Trypanosoma cruzi)

Fungal(e.g. aspergillus)

Parasitic: ascaris, Echinococcus granulosus, Paragonimus westermani, schistosoma, Taeniasolium, Trichinella spiralis, visceral larva migrans, and Wuchereria bancrofti

Rickettsial Immunological:

Allergic(e.g. acetazolamide, amitriptyline)

Rejection after a heart transplant

Autoantigens(e.g. systemic vasculitissuch as Churg-Strauss syndrome, Wegener'sgranulomatosis)

Toxic:

Drugs(e.g. anthracyclinesand some other forms of chemotherapy, ethanol, and antipsychotics,e.g. clozapine)

Toxins(e.g. arsenic, carbon monoxide, snake venom)

Heavy metals(e.g. copper, iron)

Physical agents (electric shock, hyperpyrexia, and radiation)
http://en.wikipedia.org/wiki/Infectious_diseasehttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Enterovirushttp://en.wikipedia.org/wiki/Coxsackie_virushttp://en.wikipedia.org/wiki/Rubella_virushttp://en.wikipedia.org/wiki/Polio_virushttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Hepatitis_Chttp://en.wikipedia.org/wiki/Bacteriumhttp://en.wikipedia.org/wiki/Brucellosishttp://en.wikipedia.org/wiki/Corynebacterium_diphtheriaehttp://en.wikipedia.org/wiki/Gonococcushttp://en.wikipedia.org/wiki/Haemophilus_influenzaehttp://en.wikipedia.org/wiki/Actinomyceshttp://en.wikipedia.org/wiki/Whipple%27s_diseasehttp://en.wikipedia.org/wiki/Vibrio_choleraehttp://en.wikipedia.org/wiki/Spirochetehttp://en.wikipedia.org/wiki/Borrelia_burgdorferihttp://en.wikipedia.org/wiki/Leptospirosishttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/Toxoplasma_gondiihttp://en.wikipedia.org/wiki/Trypanosoma_cruzihttp://en.wikipedia.org/wiki/Fungushttp://en.wikipedia.org/wiki/Aspergillushttp://en.wikipedia.org/wiki/Parasitehttp://en.wikipedia.org/wiki/Ascarishttp://en.wikipedia.org/wiki/Echinococcus_granulosushttp://en.wikipedia.org/wiki/Paragonimus_westermanihttp://en.wikipedia.org/wiki/Schistosomahttp://en.wikipedia.org/wiki/Taenia_soliumhttp://en.wikipedia.org/wiki/Taenia_soliumhttp://en.wikipedia.org/wiki/Trichinella_spiralishttp://en.wikipedia.org/wiki/Visceral_larva_migranshttp://en.wikipedia.org/wiki/Wuchereria_bancroftihttp://en.wikipedia.org/wiki/Rickettsiahttp://en.wikipedia.org/wiki/Immunologyhttp://en.wikipedia.org/wiki/Allergyhttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Amitriptylinehttp://en.wikipedia.org/wiki/Heart_transplanthttp://en.wikipedia.org/wiki/Autoimmune_disorderhttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Churg-Strauss_syndromehttp://en.wikipedia.org/wiki/Wegener%27s_granulomatosishttp://en.wikipedia.org/wiki/Wegener%27s_granulomatosishttp://en.wikipedia.org/wiki/Toxicologyhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Anthracyclinehttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Ethanolhttp://en.wikipedia.org/wiki/Antipsychotichttp://en.wikipedia.org/wiki/Clozapinehttp://en.wikipedia.org/wiki/Toxinhttp://en.wikipedia.org/wiki/Arsenichttp://en.wikipedia.org/wiki/Carbon_monoxidehttp://en.wikipedia.org/wiki/Snake_venomhttp://en.wikipedia.org/wiki/Heavy_metalshttp://en.wikipedia.org/wiki/Copperhttp://en.wikipedia.org/wiki/Ironhttp://en.wikipedia.org/wiki/Electric_shockhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Radiationhttp://en.wikipedia.org/wiki/Radiationhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Electric_shockhttp://en.wikipedia.org/wiki/Ironhttp://en.wikipedia.org/wiki/Copperhttp://en.wikipedia.org/wiki/Heavy_metalshttp://en.wikipedia.org/wiki/Snake_venomhttp://en.wikipedia.org/wiki/Carbon_monoxidehttp://en.wikipedia.org/wiki/Arsenichttp://en.wikipedia.org/wiki/Toxinhttp://en.wikipedia.org/wiki/Clozapinehttp://en.wikipedia.org/wiki/Antipsychotichttp://en.wikipedia.org/wiki/Ethanolhttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Anthracyclinehttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Toxicologyhttp://en.wikipedia.org/wiki/Wegener%27s_granulomatosishttp://en.wikipedia.org/wiki/Wegener%27s_granulomatosishttp://en.wikipedia.org/wiki/Churg-Strauss_syndromehttp://en.wikipedia.org/wiki/Churg-Strauss_syndromehttp://en.wikipedia.org/wiki/Churg-Strauss_syndromehttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Autoimmune_disorderhttp://en.wikipedia.org/wiki/Heart_transplanthttp://en.wikipedia.org/wiki/Amitriptylinehttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Allergyhttp://en.wikipedia.org/wiki/Immunologyhttp://en.wikipedia.org/wiki/Rickettsiahttp://en.wikipedia.org/wiki/Wuchereria_bancroftihttp://en.wikipedia.org/wiki/Visceral_larva_migranshttp://en.wikipedia.org/wiki/Trichinella_spiralishttp://en.wikipedia.org/wiki/Taenia_soliumhttp://en.wikipedia.org/wiki/Taenia_soliumhttp://en.wikipedia.org/wiki/Schistosomahttp://en.wikipedia.org/wiki/Paragonimus_westermanihttp://en.wikipedia.org/wiki/Echinococcus_granulosushttp://en.wikipedia.org/wiki/Ascarishttp://en.wikipedia.org/wiki/Parasitehttp://en.wikipedia.org/wiki/Aspergillushttp://en.wikipedia.org/wiki/Fungushttp://en.wikipedia.org/wiki/Trypanosoma_cruzihttp://en.wikipedia.org/wiki/Toxoplasma_gondiihttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/Leptospirosishttp://en.wikipedia.org/wiki/Borrelia_burgdorferihttp://en.wikipedia.org/wiki/Spirochetehttp://en.wikipedia.org/wiki/Vibrio_choleraehttp://en.wikipedia.org/wiki/Whipple%27s_diseasehttp://en.wikipedia.org/wiki/Actinomyceshttp://en.wikipedia.org/wiki/Haemophilus_influenzaehttp://en.wikipedia.org/wiki/Gonococcushttp://en.wikipedia.org/wiki/Corynebacterium_diphtheriaehttp://en.wikipedia.org/wiki/Brucellosishttp://en.wikipedia.org/wiki/Bacteriumhttp://en.wikipedia.org/wiki/Hepatitis_Chttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Polio_virushttp://en.wikipedia.org/wiki/Rubella_virushttp://en.wikipedia.org/wiki/Coxsackie_virushttp://en.wikipedia.org/wiki/Enterovirushttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Infectious_disease


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PERICARDITIS

an inflammation(-itis) of the pericardium(the fibrous sac surrounding the heart).Pericarditis is further classified accordingto the composition of the inflammatoryexudate: serous, purulent, fibrinous, andhemorrhagic types are distinguished.[1]

Acute pericarditisis more common than

chronic pericarditis, and can occur as acomplication of infections, immunologicconditions, or heart attack.
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Pericardiumhttp://en.wikipedia.org/wiki/Exudatehttp://en.wikipedia.org/wiki/Acute_pericarditishttp://en.wikipedia.org/wiki/Acute_pericarditishttp://en.wikipedia.org/wiki/Acute_pericarditishttp://en.wikipedia.org/wiki/Acute_pericarditishttp://en.wikipedia.org/wiki/Exudatehttp://en.wikipedia.org/wiki/Pericardiumhttp://en.wikipedia.org/wiki/Inflammation


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Causes Idiopathic No identifiable etiology found after routine testing.

Viralinfection, especially by Coxsackie virus(most common cause) Bacterial infection, especially by the Tuberculosisbacillus

Fungal

Immunologicconditions including Lupus erythematosus(more commonamong women)

Myocardial Infarction(Dressler's syndrome) Traumato the heart, e.g. puncture, resulting in infection orinflammation

Uremia

Malignancy(as a paraneoplastic phenomenon)

Side effectof some medications, e.g. isoniazid, cyclosporine,

hydralazine Radiation induced

Aortic dissection

Tetracyclines
http://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Coxsackie_virushttp://en.wikipedia.org/wiki/Tuberculosishttp://en.wikipedia.org/wiki/Immune_mediated_inflammatory_diseaseshttp://en.wikipedia.org/wiki/Lupus_erythematosushttp://en.wikipedia.org/wiki/Myocardial_Infarctionhttp://en.wikipedia.org/wiki/Dressler%27s_syndromehttp://en.wikipedia.org/wiki/Physical_traumahttp://en.wikipedia.org/wiki/Uremiahttp://en.wikipedia.org/wiki/Malignancyhttp://en.wikipedia.org/wiki/Paraneoplastic_phenomenonhttp://en.wikipedia.org/wiki/Adverse_drug_reactionhttp://en.wikipedia.org/wiki/Medicationshttp://en.wikipedia.org/wiki/Aortic_dissectionhttp://en.wikipedia.org/wiki/Tetracycline_antibioticshttp://en.wikipedia.org/wiki/Tetracycline_antibioticshttp://en.wikipedia.org/wiki/Aortic_dissectionhttp://en.wikipedia.org/wiki/Medicationshttp://en.wikipedia.org/wiki/Adverse_drug_reactionhttp://en.wikipedia.org/wiki/Paraneoplastic_phenomenonhttp://en.wikipedia.org/wiki/Malignancyhttp://en.wikipedia.org/wiki/Uremiahttp://en.wikipedia.org/wiki/Physical_traumahttp://en.wikipedia.org/wiki/Dressler%27s_syndromehttp://en.wikipedia.org/wiki/Myocardial_Infarctionhttp://en.wikipedia.org/wiki/Lupus_erythematosushttp://en.wikipedia.org/wiki/Immune_mediated_inflammatory_diseaseshttp://en.wikipedia.org/wiki/Tuberculosishttp://en.wikipedia.org/wiki/Coxsackie_virushttp://en.wikipedia.org/wiki/Virus


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Complications

Complications may include:

Pericardial effusion

Constrictive pericarditis

Cardiac tamponade[1]
http://en.wikipedia.org/wiki/Pericardial_effusionhttp://en.wikipedia.org/wiki/Constrictive_pericarditishttp://en.wikipedia.org/wiki/Cardiac_tamponadehttp://www.mayoclinic.com/invoke.cfm?objectid=CE3BC2CF-B4C1-4401-8F0F9E0B7C284538&dsection=6http://www.mayoclinic.com/invoke.cfm?objectid=CE3BC2CF-B4C1-4401-8F0F9E0B7C284538&dsection=6http://en.wikipedia.org/wiki/Cardiac_tamponadehttp://en.wikipedia.org/wiki/Constrictive_pericarditishttp://en.wikipedia.org/wiki/Pericardial_effusion


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Pericarditis due to Tuberculosis

is difficult to diagnose, because definitive diagnosis requiresculturing Mycobacterium tuberculosisfrom aspirated pericardialfluidor pericardial biopsy, which requires high technical skill and is oftennot diagnostic (the yield from culture is low even with optimumspecimens).

The Tygerberg scoring systemhelps the clinician to decide whether

pericarditis is due to tuberculosis or whether it is due to anothercause: night sweats (1 point), weight loss (1 point), fever (2 point),serum globulin > 40g/l (3 points), blood total leucocyte count


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Treatment

The treatment in viral or idiopathicpericarditis is with non-steroidal anti-inflammatory drugs. Severe cases mayrequire:

pericardiocentesis antibiotics

steroids

colchicine surgery
http://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drughttp://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drughttp://en.wikipedia.org/wiki/Pericardiocentesishttp://en.wikipedia.org/wiki/Antibiotichttp://en.wikipedia.org/wiki/Steroidhttp://en.wikipedia.org/wiki/Colchicinehttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Colchicinehttp://en.wikipedia.org/wiki/Steroidhttp://en.wikipedia.org/wiki/Antibiotichttp://en.wikipedia.org/wiki/Pericardiocentesishttp://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drughttp://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drughttp://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drughttp://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drughttp://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drug


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ENDOCARDITIS

is an inflammationof the inner layer of theheart, the endocardium. The most

common structures involved are the heart

valves. Endocarditis can be classified by etiology

as either infectiveor non-infective,

depending on whether a microorganismisthe source of the problem
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Endocardiumhttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Microorganismhttp://en.wikipedia.org/wiki/Microorganismhttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Heart_valvehttp://en.wikipedia.org/wiki/Endocardiumhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Inflammation


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Classification infective endocarditis has been clinically divided into acuteand subacute

(because the patients tend to live longer in subacute as opposed to acute)endocarditis. This classifies both the rate of progression and severity ofdisease. Thus subacute bacterial endocarditis (SBE) is often due tostreptococciof low virulence and mild to moderate illness which progressesslowly over weeks and months, while acute bacterial endocarditis (ABE) is afulminant illness over days to weeks, and is more likely due toStaphylococcus aureuswhich has much greater virulence, or disease-producing capacity.

This terminology is now discouraged. The terms short incubation(meaningless than about six weeks), and long incubation(greater than about sixweeks) are preferred.[citation needed]

Infective endocarditis may also be classified as culture-positiveor culture-negative. Culture-negative endocarditis is due to micro-organisms thatrequire a longer period of time to be identified in the laboratory. Suchorganisms are said to be 'fastidious' because they have demanding growthrequirements. Some pathogens responsible for culture-negativeendocarditis includeAspergillusspecies, Brucellaspecies, Coxiella burnetii,Chlamydiaspecies, and HACEK bacteria.
http://en.wikipedia.org/wiki/Streptococcihttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Growth_mediumhttp://en.wikipedia.org/wiki/Aspergillushttp://en.wikipedia.org/wiki/Brucellahttp://en.wikipedia.org/wiki/Coxiella_burnetiihttp://en.wikipedia.org/wiki/Chlamydiahttp://en.wikipedia.org/wiki/HACEK_organismhttp://en.wikipedia.org/wiki/HACEK_organismhttp://en.wikipedia.org/wiki/Chlamydiahttp://en.wikipedia.org/wiki/Coxiella_burnetiihttp://en.wikipedia.org/wiki/Brucellahttp://en.wikipedia.org/wiki/Aspergillushttp://en.wikipedia.org/wiki/Growth_mediumhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Streptococci


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Etiology

As previously mentioned, altered blood flow around thevalves is a risk factor in obtaining endocarditis. Thevalves may be damaged congenitally, from surgery, byauto-immunemechanisms, or simply as a consequenceof old age. The damaged part of a heart valve becomes

covered with a blood clot, a condition known as non-bacterial thrombotic endocarditis (NBTE).

In a healthy individual, a bacteremia(where bacteria getinto the blood stream through a minor cut or wound)would normally be cleared quickly with no adverse

consequences. If a heart valve is damaged and coveredwith a piece of a blood clot, the valve provides a placefor the bacteria to attach themselves and an infectioncan be established.
http://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Auto-immunehttp://en.wikipedia.org/wiki/Bacteremiahttp://en.wikipedia.org/wiki/Bacteremiahttp://en.wikipedia.org/wiki/Auto-immunehttp://en.wikipedia.org/wiki/Auto-immunehttp://en.wikipedia.org/wiki/Auto-immunehttp://en.wikipedia.org/wiki/Surgery


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The bacteremia is often caused by dentalprocedures, suchas a cleaning or extractionof a tooth. It is important that adentistor a dental hygienistis told of any heart problemsbefore commencing.Antibioticsare administered to patientswith certain heart conditions as a precaution.

Another group of causes result from a high number ofbacteria getting into the bloodstream. Colorectal cancer,serious urinary tract infections, and IV druguse can all

introduce large numbers of bacteria. With a large number ofbacteria, even a normal heart valve may be infected. A morevirulent organism (such as Staphylococcus aureus, but seebelowfor others) is usually responsible for infecting a normalvalve.

Intravenous drug users tend to get their right heart valvesinfected because the veinsthat are injected enter the rightside of the heart. The injured valve is most commonlyaffected when there is a pre-existing disease. (In rheumaticheart disease this is the aortic and the mitral valves, on theleft side of the heart.)
http://en.wikipedia.org/wiki/Dentistryhttp://en.wikipedia.org/wiki/Extraction_%28dental%29http://en.wikipedia.org/wiki/Toothhttp://en.wikipedia.org/wiki/Dentisthttp://en.wikipedia.org/wiki/Dental_hygienisthttp://en.wikipedia.org/wiki/Antibioticshttp://en.wikipedia.org/wiki/Colorectal_cancerhttp://en.wikipedia.org/wiki/Urinary_tract_infectionhttp://en.wikipedia.org/wiki/IV_drughttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/IV_drughttp://en.wikipedia.org/wiki/Urinary_tract_infectionhttp://en.wikipedia.org/wiki/Colorectal_cancerhttp://en.wikipedia.org/wiki/Antibioticshttp://en.wikipedia.org/wiki/Dental_hygienisthttp://en.wikipedia.org/wiki/Dentisthttp://en.wikipedia.org/wiki/Toothhttp://en.wikipedia.org/wiki/Extraction_%28dental%29http://en.wikipedia.org/wiki/Dentistry


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Clinical and pathological features

Fever, i.e. fever of unknown origin(often spiking caused byseptic emboli)

Continuous presence of micro-organisms in the bloodstreamdetermined by serial collection of blood cultures

Vegetations on valves on echocardiography, which sometimescan cause a new or changing heart murmur, particularlymurmurs suggestive of valvular regurgitation

Vascular phenomena: (causing thromboembolic problems suchas strokein the parietal lobeof the brainor gangreneof

fingers), Janeway lesions(painless hemorrhagic cutaneouslesions on the palms and soles), intracranial hemorrhage, ,

Immunologic phenomena: Glomerulonephritis, Osler's nodes(painful subcutaneous lesionsin the distal fingers), Roth's spotson the retina, positive serum rheumatoid factor
http://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Fever_of_unknown_originhttp://en.wikipedia.org/wiki/Echocardiographyhttp://en.wikipedia.org/wiki/Heart_murmurhttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Parietal_lobehttp://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Gangrenehttp://en.wikipedia.org/wiki/Janeway_lesionhttp://en.wikipedia.org/wiki/Glomerulonephritishttp://en.wikipedia.org/wiki/Osler%27s_nodehttp://en.wikipedia.org/wiki/Lesionshttp://en.wikipedia.org/wiki/Roth%27s_spothttp://en.wikipedia.org/wiki/Retinahttp://en.wikipedia.org/wiki/Rheumatoid_factorhttp://en.wikipedia.org/wiki/Rheumatoid_factorhttp://en.wikipedia.org/wiki/Retinahttp://en.wikipedia.org/wiki/Roth%27s_spothttp://en.wikipedia.org/wiki/Lesionshttp://en.wikipedia.org/wiki/Osler%27s_nodehttp://en.wikipedia.org/wiki/Glomerulonephritishttp://en.wikipedia.org/wiki/Janeway_lesionhttp://en.wikipedia.org/wiki/Gangrenehttp://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Parietal_lobehttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Heart_murmurhttp://en.wikipedia.org/wiki/Echocardiographyhttp://en.wikipedia.org/wiki/Fever_of_unknown_originhttp://en.wikipedia.org/wiki/Fever


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Diagnosis The most important investigation is Blood

culture. In general, a patient should fulfill theDuke Criteria[1]in order to establish the

diagnosis of endocarditis

EchocardiographyThe transthoracic echocardiogram has a

sensitivity and specificity of approximately 65%

and 95% if the echocardiographer believes there

is 'probabable' or 'almost certain' evidence ofendocarditis
http://www.medcalc.com/endocarditis.htmlhttp://www.medcalc.com/endocarditis.html


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BACTERIAL ENDOCARDITIS also called infective endocarditis) is an infection of

the heart valves or the hearts inner lining(endocardium).

Bacterial endocarditis occurs when germs(especially bacteria but occasionally fungi andother microbes) enter the blood stream and attackthe lining of the heart or the heart valves. Bacterialendocarditis causes growths or holes on the valvesor scarring of the valve tissue, most often resultingin a leaky heart valve. Without treatment, bacterial

endocarditis can be a fatal disease. Normally, bacteria can be found in the mouth, on

the skin, in the intestines


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Who is at risk for developing bacterial

endocarditis

Patients most at risk of developing bacterial endocarditisinclude those who have:

An artificial (prosthetic) heart valve, including bioprostheticand homograft valves

Previous bacterial endocarditis Certain congenital heart diseases

Acquired valve disease (for example, rheumatic heartdisease)

Heart valve disease that develops after heart transplantation Hypertrophic cardiomyopathy (HCM)

Mitral valve prolapse with valve regurgitation (leaking) and/orthickened valve leaflets


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How is bacterial endocarditis diagnosed?

The diagnosis of bacterial endocarditis is based on the presence of symptoms :

Symptomsof infection (see the next page), particularly a fever over 100F(38.4C)

Blood culturesshow bacteria or microorganisms commonly found withendocarditis. Blood cultures are blood tests taken over time that allow thelaboratory to isolate the specific bacteria that is causing your infection. Theymust be taken before antibiotics are started to determine if you haveendocarditis.

Echocardiogram (ultrasound of the heart) may show growths, abscesses(holes), new regurgitation (leaking) or stenosis (narrowing), or an artificial heartvalve that has begun to pull away from the heart tissue. Sometimes doctorsinsert an ultrasound probe into the esophagus or food pipe (transesophagealecho) to obtain a very detailed look at the heart.

Other signs and symptoms of bacterial endocarditis include: Emboli (small blood clots), hemorrhages (internal bleeding), or stroke

Shortness of breath

Night sweats

Poor appetite or weight loss

Muscle and joint ache


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Signs of infection:

Fever over 100F(38.4C) Sweats or chills, particularly night sweats

Skin rash

Pain, tenderness, redness or swelling

Wound or cut that won't heal

Red, warm or draining sore Sore throat, scratchy throat or pain when swallowing

Sinus drainage, nasal congestion, headaches or tenderness alongupper cheekbones

Persistent dry or moist cough that lasts more than two days

White patches in your mouth or on your tongue

Nausea, vomiting or diarrhea


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How is bacterial endocarditis treated?

After the specific bacteria causing the endocarditis areidentified from blood culture tests, a course of intravenous(IV) antibiotic therapy is started. IV antibiotics may begiven for as long as 6 weeks to control the infection.Symptoms are monitored throughout therapy and blood

tests are performed to determine the effectiveness oftreatment.

If heart valve damage has occurred, surgerymay berequired to fix the heart valve and improve heart function.

Bacterial endocarditis treatment starts withprevention. Once endocarditis occurs, quick treatment isnecessary to prevent damage to the heart valves andmore serious complications, such as death
http://www.clevelandclinic.org/heartcenter/pub/guide/disease/valve/sbesurgery.htmhttp://www.clevelandclinic.org/heartcenter/pub/guide/disease/valve/sbesurgery.htm


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Rheumatic Heart Disease

is a condition in which the heart valves aredamaged by rheumatic fever.

Rheumatic fever begins with a strep throat from

streptococcal infection. Rheumatic fever is an inflammatory disease. Itcan affect many of the body's connective tissuesespecially those of the heart, joints, brain or skin.

Anyone can get acute rheumatic fever, but itusually occurs in children five to 15 years old.The rheumatic heart disease that results can lastfor life.


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What are the symptoms of rheumatic heart

disease?

Symptoms vary greatly. Often the damage toheart valves isn't immediately noticeable. A

damaged heart valve either doesn't fully close or

doesn't fully open.

Eventually, damaged heart valves can causeserious, even disabling, problems. These

problems depend on how bad the damage is and

which heart valve is affected. The most advanced

condition is congestive heart failure. This is a

heart disease in which the heart enlarges and

can't pump out all its blood.


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Some of the most common symptoms ofrheumatic heart disease are:

breathlessness, fatigue, palpitations,

chest pain, and fainting attacks.


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myocarditis ppt new.ppt

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