cardiac disorder 2

Question 1

Primarily affect the valves, inflammation of endocardium (lining of heart chambers) by streptococcus and staph aureus

Answer 1

Infective Endocarditis

Question 2

Risk for Infective Endocarditis

Answer 2

Incidence has decreased with the use of antibiotics, but there has been a resurgence of the problem in intravenous drug abusers
Dental work
Patients with valvular disease also at risk

Question 3

Pathophysiology Infective Endocarditis

Answer 3

Pathogens, usually bacteria, enter the bloodstream resulting in positive blood cultures
The pathogen accumulates on the heart valves and/or the endocardium and forms vegetations – will calcify

Question 4

Complications Infective Endocarditis

Answer 4

Heart failure and embolization

Question 5

s/s Infective Endocarditis

Answer 5

Fever, chills, malaise, fatigue, and weight loss
Chest or abdominal pain; may indicate embolization
Petechiae inside the mouth and on the ankles, feet, and antecubital areas
Osler’s nodes (Pea-size, tender, reddish-purple lesions) on the patient’s fingertips or toes

Question 6

medical treatment Infective Endocarditits

Answer 6

Antimicrobials, rest, limitation of activities
Prophylactic anticoagulants
Surgery to replace an infected prosthetic valve

Question 7

Assessment Infective Endocarditis

Answer 7

Review patient’s history for risk factors, recent invasive procedures, pathologic cardiac conditions, and onset of symptoms
Assess for temperature elevation, heart murmur, evidence of HF (cough, peripheral edema), and emboli

Question 8

interventions Infective Endocarditis

Answer 8

Administer prescribed 
    antibiotics 
Encourage adequate rest
Assess cardiac output &
    monitor for complications 
Teach patient about the medications prescribed and any restrictions imposed

Question 9

Inflammation of the pericardium

May be primary disease or associated with another inflammatory process

Answer 9

pericarditis

Question 10

caused by viruses, bacteria, fungi, chemotherapy, or Acute MI (Dressler’s syndrome)

Answer 10

Acute pericarditis

Question 11

caused by tuberculosis, radiation, or metastases Pathophysiology

Answer 11

Chronic pericarditis

Question 12

Acute pericarditis

Answer 12

inflammatory process increases amount of pericardial fluid and inflammation of the pericardial membranes

Question 13

Chronic pericarditis

Answer 13

scarring of the pericardium fuses the visceral and parietal pericardia together
Loss of elasticity results from the scarring
Constrictive process prevents adequate ventricular filling

Question 14

Complications pericarditis

Answer 14

Pericardial effusion or accumulation of fluid in the pericardial space. May lead to cardiac tamponade

Question 15

Fluid accumulation in
the pericardial sac
Causes compression
Can’t fill properly

Answer 15

Cardiac Tamponade

Question 16

Possible Causes ~

Cardiac Tamponade

Answer 16

Effusion
 Hemorrhage
Trauma
 MI
 Uremia (A history of renal failure can lead to a consideration of uremia as the cause of pericardial effusion)

Question 17

Signs and symptoms

Pericarditis

Answer 17

Chest pain
Most severe on inspiration
Sharp and stabbing but may be described as dull or burning
Relieved by sitting up and leaning forward
Dyspnea, chills, and fever

Question 18

Medical treatment pericarditis

Answer 18

Analgesics, antipyretics, anti-inflammatory agents, and antibiotics
Surgical creation of a pericardial window for chronic pericarditis with effusion

Question 19

assessment pericarditis

Answer 19

Assessment of heart sounds especially important

Question 20

intervention pericarditis

Answer 20

Rest and reduction of activity
Administer and teach patient about medications
Emotional support
Vital signs; auscultate for pericardial friction rub
Note pain characteristics and response to analgesics and anti-inflammatory agents
Monitor the ECG for dysrhythmias
Reduce anxiety
Assess respiratory system

Question 21

Disease of the heart muscle which usually leads to heart failure
Cause often unknown; may be secondary to another disease process
Three types:

Answer 21

Cardiomyopathy

Question 22

ventricles are too weak to pump out the blood that is in them
W/ risk factors

Answer 22

Dilated (congestive):
Cardiomyopathy
Risk factors: excessive use of alcohol, pregnancy, and infections

Question 23

ventricles are unusually thick so there is not a normal amount of room for blood inside them W/ cause

Answer 23

Cardiomyopathy
Hypertrophic
Maybe genetic and more common in younger individuals(36% of deaths)
Often secondary to valvular heart disease or hypertension

Question 24

ventricles too stiff to stretch, becomes rigid, & noncompliant

Answer 24

Cardiomyopathy
Restrictive:
Amyloidosis (metabolic disorder that deposits starch like protein in tissues), sarcoidosis (unknown eithiology, formation of grain like lesion in tissue) and other immunosuppressive disorders may predispose individuals to restrictive cardiomyopathy

Question 25

Cardiomyopathy s/s

Answer 25

Dilated cardiomyopathy (A): dyspnea, fatigue, left-sided heart failure, and moderate-to-severe cardiomegaly 
Hypertrophic cardiomyopathy (B): dyspnea, orthopnea, angina, fatigue, syncope, palpitations, ankle edema, and S4 sounds
Restrictive cardiomyopathy (C): dyspnea, fatigue, right-sided HF, S3 and S4 sounds, and mitral valve regurgitation

Question 26

Medical treatment

Dilated cardiomyopathy

Answer 26

positive inotropic drugs, diuretics, ACE inhibitors and vasodilators; heart transplant

Question 27

Medical treatment

Hypertrophic cardiomyopathy

Answer 27

: antidysrhythmics, antibiotics, anticoagulants, calcium channel blockers, beta-blockers; surgical interventions; implantable cardioverter-defibrillator

Question 28

Medical treatment

Restrictive cardiomyopathy

Answer 28

: antidysrhythmics, antibiotics, anticoagulants, calcium channel blockers, beta-blockers; surgical interventions; implantable cardioverter-defibrillator

Question 29

Assessment

Cardiomyopathy

Answer 29

Primarily for heart failure

Be alert for dyspnea, cough, edema, dysrhythmias, and decreased cardiac output

Question 30

Interventions

Cardiomyopathy

Answer 30

Similar to that of patients with HF
A hopeful atmosphere and careful explanation of care requirements
Encourage the family to support the patient
Guide the patient to make lifestyle changes
Encourage patient to make decisions and choices

Question 31

narrowing of the opening in the mitral valve that impedes blood flow from the LA into the LV. Symptoms similar to CHF.
Rheumatic fever leading cause

Answer 31

Mitral stenosis

Valvular Disease

Question 32

allows blood to flow back into the LA during diastole.
Left side of heart enlarges…LA due to back flow, LV due to compensation for decreased cardiac output….eventually have S/S HF

Answer 32

Mitral regurgitation

Valvular Disease

Question 33

one or both leaflets enlarges and protrudes into the LA during systole

Answer 33

Mitral valve prolapse

Valvular Disease

Question 34

valve cusps become fibrotic and calcify, most often due to the aging process, genetic malformation, syphilis, or rheumatic fever

Answer 34

Aortic stenosis

Valvular Disease

Question 35

fibrosis and thickening of the aortic cusps progress until the valve no longer maintains unidirectional blood flow. Secondary to rheumatic fever (infection by group A beta hemolytic Strep or throat infection!)

Answer 35

Aortic regurgitation

Valvular Disease

Question 36

3 types of mechanical disruption

Answer 36

stenosis, incomplete closure, prolapse

Question 37

Cardiac transplantation back ground

Answer 37

The first heart transplantation was performed in 1967 in South Africa by Dr. Christiaan Barnard
Today in the United States, approximately 2500 are done annually for end-stage heart disease
Donor must meet the criteria for brain death, have no malignancies outside the central nervous system, be free of infection, and not have experienced severe chest trauma

Question 38

Cardiac transplantation donor criteria

Answer 38

Donor and recipient organs carefully matched
Recipient must be free of infection at the time of transplantation
Patient prepped as any open-heart procedure
Cardiopulmonary bypass initiated; recipient’s heart is removed except for the posterior portions of the atria
Donor heart trimmed and anastomosed to the remaining native heart
Patient removed from bypass, heart restarted, and chest is closed

Question 39

cardiac transplantation aftercare

Answer 39

Aftercare similar to that of coronary artery bypass surgery
Hemodynamic monitoring, ventilation, cardiac assessment, care of chest tubes, and accurate intake and output measurements are vital
Modified protective isolation used
Patients and families taught sign/symptoms of infection, to avoid crowds and others with infections
Lifelong immunosuppression
Rejection monitored by endomyocardial biopsies