Chapter 40: Inflammatory & Structural Heart Disorders

Infective endocarditis represents a serious microbial invasion of the endocardium and cardiac valves, typically caused by staphylococci, streptococci, or HACEK organisms, leading to vegetation formation and systemic embolization with manifestations including fever, new cardiac murmurs, splinter hemorrhages, and neurological complications. Pericarditis involves inflammation of the pericardial sac, presenting with characteristic sharp chest pain that worsens with inspiration and improves when leaning forward, accompanied by pericardial friction rubs and potential progression to pericardial effusion or life-threatening cardiac tamponade. Myocarditis encompasses viral, bacterial, or autoimmune inflammation of the myocardium that can progress from flu-like symptoms to severe heart failure, arrhythmias, or sudden cardiac death. Rheumatic fever and rheumatic heart disease result from autoimmune responses following group A streptococcal pharyngitis, causing pancarditis and chronic valvular deformities that particularly affect mitral and aortic valves. Valvular heart disease includes stenotic and regurgitant lesions affecting any cardiac valve, with mitral stenosis causing dyspnea and atrial fibrillation risk, aortic stenosis presenting the classic triad of angina, syncope, and dyspnea, and regurgitant lesions producing volume overload states. Management strategies encompass prolonged antimicrobial therapy for infectious conditions, anti-inflammatory medications for pericarditis and myocarditis, prophylactic antibiotics for rheumatic disease prevention, and surgical interventions including valve repair or replacement for severe valvular dysfunction, all requiring careful nursing assessment of hemodynamic status and patient education regarding infection prevention and medication compliance.