Keeping Up With The Carditises

2,000 Gallons of Blood!

Did you know that the average human heart beats 100,000 times a day, pumping 2,000 gallons of blood?

Now, imagine if this vital pump was under threat from, pericarditis, myocarditis, or endocarditis and couldn’t pump effectively.

In this article we will look at the importance of understanding carditis and an easy way that I used in nursing school to remember the area affected by each type; then, run through a quick scenario at the end to apply what we have learned.

This is going to be fun I promise 😁

Everywhere you look today, you hear about inflammation and its potential to negatively affect the body.

While it begins as a tool for the body to protect itself from harm such as infections, injuries and toxins as well as making repairs to cells and tissues, it can ultimately become chronic.

Chronic inflammation can lead to damage all throughout the body, leading to serious problems such as:

Carditis

So, let’s talk about inflammation that occurs particularly in the heart. This type of inflammation is called carditis and can be cause by many different reasons. Look at the chart below to see a few of the typical causes. 

Carditis Analogy

Imagine your heart as a diligent librarian in a bustling library, tirelessly organizing and distributing books (or blood) to eager readers (or body cells) in every corner of the library (or your body).

Suddenly, this librarian suffers from a severe allergic reaction (or inflammation), causing their movements to become sluggish and their efficiency to plummet.

Because the librarian is bogged down with inflammation, books (or blood) start to pile up, leaving readers (or body cells) to wait impatiently, and get angry because they don’t have their books.

This analogy mirrors how an inflamed heart struggles to pump blood, leading to a backlog of nutrients and oxygen that can’t reach essential organs and tissues, ultimately resulting in dysfunction all over the body.

Carditis Locations

This inflammation can manifest in 3 different areas of the heart: 

The Outer Layer pericardial sac around the heart
	The Middle Layer the heart muscle itself
The Innermost Layer the endocardium

Inflammation in any of these locations leads to dysfunction of the heart organ, affecting its ability to pump.

Pericarditis

Pericarditis is inflammation of the outermost layer of the heart, or pericardium, which is a double layered sac that contains a specific amount of fluid and protects the heart from impact, and invading pathogens.

Inflammation can cause fluid to build up, which will make the sac squeeze the heart like an anaconda and affect pumping.

This condition can be very painful, and presents similarly to anginal chest pain making diagnosis based on that symptom alone very tricky.

Severe cases may require pericardiocentesis to manually drain fluid build up, antibiotics if it’s infectious, and rarely surgery.

If we look at this image of the heart, a patient with pericarditis is going to have inflammation in this outermost layer, which is the pericardial sac. 

Myocarditis

Myocarditis is inflammation of the myocardium, or middle layer of the heart wall. This is the muscle layer, and when compromised, affects pumping.

Inflammation will cause a weakening of the heart and prevent proper perfusion due to decreased cardiac output.

Myocarditis is often misdiagnosed by physicians due to the absence of direct symptoms and is the 3rd leading cause of sudden death in adolescents and young adults between the ages of 13 and 40.

If we look at this image of the heart, a patient with myocarditis is going to have inflammation in this middle portion, in the muscle layer. 

Endocarditis

Endocarditis is inflammation of the endocardium or innermost lining of the heart’s chambers and valves.

This requires quick treatment . . . medication or surgery . . . to avoid destroying the heart’s valves which would making the heart work harder and eventually lead to heart failure.

Further complications of stroke can ensue if infectious emboli break from the valvular vegetation and travel to the brain.

If we look at this image of the heart, a patient with endocarditis is going to have inflammation right in this area – the innermost layer covering the 4 chambers and valves. 

Carditis Mnemonic

A simple way that worked for me in nursing school to remember the areas affected by each form of carditis was to use this simple mnemonic:

People On Motorcycles Must Eat Insects

• Pericarditis = Outer
• Myocarditis = Middle
• Endocarditis = Inner

Diagnosis of Carditis

Working as a nurse, I have seen these 3 conditions often get misdiagnosed. Infectious and inflammatory diseases of the heart have multiple etiologies, making diagnosis and treatment a clinical challenge.

Patients may present with acute pain mimicking a myocardial infarction (MI) or may seek medical attention because of fatigue and low-grade flu-like symptoms that fail to resolve over a period of weeks. 

Because of the permanent damage that these conditions can cause to functional areas of the heart, patients often face serious long-term cardiac disability or even life threatening complications.

Inflammatory, or infectious damage to the heart directly hinders the pump function of the heart or “vital engine”. The heart would then struggle to circulate the average of 2,000 gallons of blood per day, and not be able to keep up with perfusion demands of the body. 

As a future nurse, understanding these conditions will enable you to provide better care for patients suffering from heart inflammation, recognize symptoms early, and contribute to more effective treatment planning. 

Carditis Case Study

Lets apply what we have learned by looking at the following scenario:

A 72 year old male from the houseless community arrives at the ED complaining of symptoms like general malaise, fatigue, and weight loss.

He seems a little confused, and upon physical assessment shows an elevated temperature, left sided weakness, facial drooping, and a heart murmur.

He’s what the nurses call a “frequent flier” and has been treated on previous visits to the ED for withdrawal symptoms, and infections related to recreational IV drug use.

Now, this probably doesn’t sound like anything cardiac related at first glance, but can you tell which carditis this patient is likely suffering from?

1. Confusion
2. Elevated temperature
3. Left-sided weakness, and facial drooping
4. Face Drooping
5. Heart murmur
6. History of treatment for withdrawal, and infection from recreational IV drug use

For more information and study tools on pericarditis, myocarditis and endocarditis, be sure to visit nursing.com/heart 

We love you guys, now go out and be your best selves today, happy nursing!