Table of Contents:

1. Inflammatory Heart Disorders 3. Acute Pericarditis

2. Infective Endocarditis 4. Cardiac Tamponade

Endocarditis, Pericarditis, & Cardiac Tamponade

1. Inflammatory Heart Disorders

Cardiovascular
FIGURE 1. INFECTIVE ENDOCARDITIS PATHOPHYSIOLOGY
Cardiac conditions involving
inflammation or compression
of the heart include:
y Infective endocarditis =
infection of the heart’s inner
lining or valves (endocardium).
y Myocarditis = inflammation of
the heart muscle (myocardium).
y Pericarditis = inflammation
of the sac around the heart
(pericardium).
y Cardiac tamponade = life-
threatening fluid accumulation
in the pericardial sac, which
compresses the heart.
FIGURE 2. ENDOCARDITIS FINDINGS
2. Infective Endocarditis
Infective endocarditis: Infection of the endocardium
(inner lining of the heart and valves) from bacteria, fungi,
or viruses entering the bloodstream
y Prevents heart valves from fully closing 
Backward flow of blood
Risk factors include anything that can introduce
bacteria into the bloodstream.

IV drug use

Poor dental hygiene, recent dental procedures
y Prosthetic heart valves, valve surgery
Pathophysiology
y Pathogens enter bloodstream and stick to endocardial
lining  Damages endocardial lining  Causes
vegetations (growths of clots and microorganisms) on
the endocardial lining and valves (FIGURE 1). TABLE 1. ENDOCARDITIS FINDINGS “FROM JANE”
y Complications
y Vegetations break off (septic emboli)  F: Fever, chills, malaise
Can obstruct blood flow to organs (stroke, R: Roth spots (retinal hemorrhages)
pulmonary embolism) O: Osler nodes (painful red/purple nodules on fingers/toes)
y Valve damage cardiac output + Heart failure M: Murmur
Assessment findings J: Janeway lesions (flat spots on palms/soles)
y Findings of infection and embolization A: Anorexia
(“FROM JANE”) (FIGURE 2 & TABLE 1) N: Nailbed “splinter” hemorrhages
E: Emboli to other organs (stroke, pulmonary embolism),
microemboli (petechiae)

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2. Infective Endocarditis, Continued 3. Acute Pericarditis
Interventions
1. Diagnostics: FIGURE 3. PERICARDITIS

Collect blood cultures, which are crucial to
identify the infectious organism for antibiotic
selection.

Monitor blood culture sensitivity results and
notify HCP if the cultured organism is antibiotic-

Cardiovascular
resistant (MRSA).
y Prepare client for an echocardiogram to identify
vegetations or abscesses.
2. Antibiotic therapy:
y Anticipate long-term IV antibiotic therapy
(4-6 weeks).
y Prepare client for discharge home with home
nursing care and/or a peripherally inserted central
catheter (PICC) for ongoing IV antibiotic therapy.
y Teach client aseptic technique for home
PICC care as needed.
Pericarditis: Inflammation of the pericardium (the sac
3. Monitoring complications: around the heart) (FIGURE 3)

Immediately report signs of embolism. y It can be idiopathic (spontaneous) or caused by:
y Stroke symptoms (brain emboli) y Myocardial infarction (MI)
y Dyspnea, chest pain (pulmonary emboli) y Infections (bacterial, viral, fungal)
y Sharp epigastric pain radiating to left y Autoimmune conditions (Lupus)
shoulder (splenic emboli) Pathophysiology
y Flank pain, hematuria (renal emboli) y Inflammatory response that targets the pericardial
y Cool, pale extremity (peripheral emboli) lining of the heart  Fluid accumulates in the
y Monitor for signs of heart failure from valve pericardial sac  Pericardial effusion
dysfunction. y Complications
y Sudden weight gain
Pericardial effusion can progress to life-
y Dyspnea threatening cardiac tamponade.
y Edema y Pericardial scar tissue can form and cause
4. Client education: chronic (constrictive) pericarditis.
y Instruct client to follow-up for repeat blood Assessment findings
cultures to ensure infection clearance.
Sharp, pleuritic chest pain that:

Instruct client to monitor temperature daily y Worsens with lying flat or inspiration
and notify HCP of fever, which could indicate
Is relieved by sitting or leaning forward
endocarditis recurrence.
Pericardial friction rub (scratchy sound on
y Instruct client to notify all HCPs, including auscultation)
dentists, of history of infectious endocarditis. y ECG changes: Widespread ST elevation;

Instruct client that prophylactic antibiotics atrial fibrillation
are required before invasive dental or surgical y Echocardiogram: May show excess fluid in
procedures in the future. pericardium (pericardial effusion)
y Stress importance of proper oral hygiene
(brushing teeth twice daily) torisk of recurrence.

 Endocarditis complications: Immediately notify  Endocarditis teaching: Teach clients to

the HCP if signs of embolism occur, including monitor temperature daily for signs of
dyspnea and chest pain (pulmonary); stroke recurrence and to take prophylactic antibiotics
symptoms (cerebral); or flank pain (renal). before invasive dental or surgical procedures.

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3. Acute Pericarditis, Continued Assessment findings
Interventions
Beck triad (findings of cardiac compression and
1. Pain management: cardiac output)

Position client upright and leaning forward to y Hypotension
relieve pain. y JVD (jugular venous distension)
y Maintain strict bed rest tocardiac demand. y Muffled heart sounds
y Administer NSAIDs (ibuprofen), colchicine, or y Tachycardia
corticosteroids for inflammation.
Pulsus paradoxus (SBP>10 mmHg during
inspiration)

Cardiovascular
y Administer antibiotics if caused by
bacterial infection. Interventions
2. Closely monitor for life-threatening cardiac
Prepare for pericardiocentesis (needle aspiration of
tamponade (see CARDIAC TAMPONADE). fluid from pericardial sac) (FIGURE 5).
y Following pericardiocentesis, monitor:
4. Cardiac Tamponade y Continuous hemodynamic status (BP, HR,
pulse oximetry)
Cardiac tamponade: A life-threatening condition where y For complications such as pneumothorax
fluid rapidly builds up in the pericardial sac, compressing (absent breath sounds) or recurrence of
the heart and impairing its function (FIGURE 4) tamponade
y Administer IV fluids tocardiac output if
FIGURE 4. CARDIAC TAMPONADE unstable (BP,HR).

FIGURE 5. PERICARDIOCENTESIS

Pathophysiology
y Fluid compresses the heart ability to pump
blood effectively cardiac output and hypotension

 Pericarditis pain: Pericarditis is characterized by Cardiac tamponade: If a client develops signs

Top5 Targets:
sharp, pleuritic chest pain that is worsened by lying 1.of cardiac tamponade, immediately notify
flat and relieved by leaning forward. the HCP and prepare the client to undergo a
pericardiocentesis to drain the pericardial sac.
 Pericarditis complications: Monitor clients with
pericarditis for signs of cardiac tamponade, which
include Beck triad (hypotension, JVD, muffled
heart sounds) and pulsus paradoxus (drop in SBP
>10 mmHg during inspiration).

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  Monitor clients with endocarditis for signs of  What life-threatening complication should
septic emboli, such as _____ and chest pain clients with pericarditis be monitored for? What
for pulmonary emboli; _____-like symptoms for three findings make up Beck triad?
cerebral emboli; and _____ pain for renal emboli.
 For cardiac tamponade treatment, prepare the
 Clients with endocarditis should monitor _____

Cardiovascular
client for a _____ to drain the pericardial sac.
(which VS?) daily for signs of recurrence and
take prophylactic _____ before invasive dental or
surgical procedures.

 What are the characteristics of pericarditis pain?

What position relieves it?

4. Cardiac tamponade; Hypotension, JVD, muffled heart sounds 5. pericardiocentesis

Answers: 1. dyspnea, stroke, flank 2. temperature, antibiotics 3. Sharp, pleuritic chest pain; Relieved by leaning forward

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Pearson. surgical nursing in Canada: Assessment and management
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Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (Eds.).
(2023). Lewis’s medical-surgical nursing: Assessment and Attributions:
management of clinical problems (12th ed.). Elsevier. y Infective Endocarditis Pathophysiology: Created with
Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024). BioRender.com
Medical-surgical nursing: Concepts for clinical judgment y Pericarditis: Created with Biorender.com
and collaborative care (11th ed.). Elsevier.
y Cardiac Tamponade: Created with Biorender.com

y Pericardiocentesis: Created with BioRender.com

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