HTHSCI 2HH3 Lecture Notes - Lecture 7: Hypotension, Beta Blocker, Nonsteroidal Anti-Inflammatory Drug
26 May 2018
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Department
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Cardiovascular System Infections
Bacteremia: Presence of bacteria in the bloodstream; may or may not be clinically significant- simply a
finding
Transient Bacteremia: Self-resolving in clients with NO underlying illness, immune deficiency or
turbulent cardiac blood flow, present in the blood stream from a short period of time that is then
handled by the immune system, normal flora from out body moves to the blood stream but is handled
by the immune system, asymptomatic
Primary Bacteremia: nosocomial, IV drug use, inappropriate skin prep, inappropriate management of
lines); Directly inserted into the blood stream
Secondary Bacteremia (opportunistic): Microorganisms causing infection at another site (e.g.
pneumonia) invade the blood stream and disseminate via the circulation to other body areas
(hematogenous spread)
Sepsis
• Life-threatening organ dysfunction due to a dysregulated host response to infection
• Body is either unable to fight of the bacteria or it is doing so in a way that is harming the host
• In lay terms, sepsis is a life- threatening condition arising when the body's response to an
infection injures its own tissues and organs
• Extensive edema: fluids are pooling because the vasculature has become permeable, the heart
cannot effectively pump, and BP is extremely low
Charaterized y…
1. Infection (suspected or confirmed- diagnosis/ clinical reasoning based on present symptoms)
2. Acute, life threatening organ dysfunction as defined by 2 or more points on a sepsis-related
organ dysfunction assessment (SOFA)
a. SOFA measures respiratory, hepatic, cardiovascular, renal, central nervous system, and
platelet dysfunction: looks for clinical signs for organ dysfunction
Septic shock
Shock: lack of blood flow to cells results in metabolic abnormalities
Subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound
enough to substantially increase mortality
Clinical criteria for septic shock
1. Sepsis (infection & organ malfunction)
2. Hypotension requiring vasopressors to maintain mean arterial pressure MAP ≥ Hg
despite fluid resuscitation, AND
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a. Unresponsive to fluid intervention (normal saline given but patient remains
hypotensive)
3. Lactate ≥ to ol/L: indicates when the body is moving from aerobic to anaerobic
metabolism because the body is not receiving enough oxygen
With these criteria, hospital mortality is in excess of 40%
Sepsis Management
• Elimination of the original site of infection
o Surgical removal of abscesses and biofilms, drainage
• Intravenous antimicrobial therapy
• Fluid replacement- increase BV to increase BP
• Vasopressors and Inotropes (norepinephrine, dobutamine)- increase total visceral pressure and
the heart’s fore of otratio ad rate
• Supportive therapy for organ dysfunction
o Dialysis- attempt to conserve kidney function
o Mechanical ventilation
Structure of the heart
Endocardium: thin lining inside the chambers of the heart, typically bacterial infections
Myocardium: muscle tissue of the heart, typically viral infections
Pericardium: thin double-layered sac that encloses the heart
A Care Scenario & A Question
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A 5-year old indigenous child presents to the clinic with joint pain, a rash on his legs, and shortness of
breath. Patient history reveals that the child had a fever and a red, swollen sore throat roughly 2 weeks
ago. No treatment was sought for the sore throat at the time.
What condition do you suspect?
What does this scenario have to do with cardiovascular infections?
a) I have no idea, you tell me!
b) *I think it might be related to that issue of turbulent blood flow we were talking about-
rheumatic fever
c) The client has obviously developed signs of sepsis and requires immediate antibiotic therapy- no
sign of organ disfunction
Rheumatic Fever
• A rare complication of streptococcal pharyngitis (strep throat) infections- beta-hemolytic
o Streptococcus pyogenes aka Group A streptococcus (GAS)
o Most commonly observed in children (5 – 15 years of age) and adults in developing
countries
• Autoimmune reaction, lasting approximately 3 months
• Immune system acts against the group A strep and against the myocytes
• antibodies against beta-hemolytic streptococci cause inflammation and damage to heart valves
o Carditis – inflammation heart valves, no active infection- autoimmune attack, arthritis
o Polyarthritis – large joints, lasting approximately 2 – 4 weeks
▪ Suspect rheumatic fever in children who have symptoms of arthritis
o Erythema marginatum – rarely observed in adults- pink rings on the torso and inner
surfaces of the limbs
o Chorea – rarely observed in adults, observed in children- jerky involuntary movements
affecting especially the shoulders, hips, and face.
Rheumatic Fever
• Treat with anti-inflammatories, diuretics (first live therapy for heart failure to decrease
workload on the heart) and bed rest
• Prevent further attacks with antibiotics
o antibiotic therapies can increase risk of septic shock because antibiotics can cause lysis
of more bacteria and the release of more the endotoxin
o No residual heart disease: Penicillin (IM), once monthly for a minimum of 10 years or
until 25 years old
o Residual heart disease: Penicillin (IM), once monthly until 40 - 45 years old, but often
continued for life
o Residual heart disease includes rheumatic valve (has caused residue problems in the
heart- murmur), heart failure valve replacement may be required
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Document Summary
Bacteremia: presence of bacteria in the bloodstream; may or may not be clinically significant- simply a finding. Primary bacteremia: nosocomial, iv drug use, inappropriate skin prep, inappropriate management of lines); directly inserted into the blood stream. Secondary bacteremia (opportunistic): microorganisms causing infection at another site (e. g. pneumonia) invade the blood stream and disseminate via the circulation to other body areas (hematogenous spread) Life-threatening organ dysfunction due to a dysregulated host response to infection: body is either unable to fight of the bacteria or it is doing so in a way that is harming the host. Shock: lack of blood flow to cells results in metabolic abnormalities. Subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. With these criteria, hospital mortality is in excess of 40% Sepsis management: elimination of the original site of infection, surgical removal of abscesses and biofilms, drainage.
