References
Infections of the heart and how they relate to the ambulance service
Abstract
Background:
In the pre-hospital environment, the treatment of acute coronary syndrome (ACS) is at the forefront of most clinicians’ priorities when symptoms include non-traumatic chest pain. As ACS is a leading cause of preventable deaths, less emphasis is placed on other potentially life-changing conditions that are associated with non-traumatic chest pain.
Objectives:
This article discusses the three main groups of cardiac infections (pericarditis, myocarditis, and endocarditis). It then discusses how they can be identified in the pre-hospital setting and how the ambulance service can contribute to the subsequent diagnosis of patients presenting with these conditions.
Discussion:
Pericarditis is a relatively common cause of non-traumatic chest pain. It has symptoms that can be found in the pre-hospital environment such as specific ECG changes and symptoms that can be identified during an initial consultation. Myocarditis has a low incidence rate as well as a wide variety of symptoms that can be associated with other common ailments. It is a very hard condition to determine in the pre-hospital environment. Endocarditis in the intravenous drug user population is a significant condition and has a high mortality rate.
Infections of the heart can result in significant harm and includes cardiac tamponade, congestive heart failure, emboli, dilated cardiomyopathy (DCM) and death (McDonald, 2009; Blauwet and Cooper, 2010; Curry, 2014). These infections can be broken down into three main areas that correspond with the layers of the heart: endocarditis (endocardium), myocarditis (myocardium) and pericarditis (pericardium). Out of the three, the most common is pericarditis, which accounts for 5% of all chest pains that are presented to emergency departments (Curry, 2014). Forms of pericarditis are included in the differential diagnosis algorithm for chest pain that is documented by Naumov (2009). It is also included by Snyder et al (2012) as one of the causes of non-acute coronary syndrome (non-ACS). These indicate its prevalence enough to be considered as a relatively common cause of chest pain. Although reported cases of myocarditis are not as high as pericarditis, it is a disease that can cause life-threatening complications. It is mostly notable in the paediatric patient, where it accounts for 12% of sudden cardiac death among adolescents and young adults (Levine et al, 2010). Endocarditis has a high mortality rate for those who contract it (Weymann et al, 2014). In the general population, the incidence of endocarditis is low (1.7–6.2 cases per 100 000 patients). This rises significantly in intravenous drug users (IVDU) to 2–5% and is responsible for 5–10% of deaths in this patient group (Weymann et al, 2014).
Subscribe to get full access to the Journal of Paramedic Practice
Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.
What's included
-
CPD Focus
-
Develop your career
-
Stay informed