Cardio Exam 2 Flashcards
What is infective endocarditis (IE)?
Infection of the endocardium that may include valves. Can be caused by bacteria, virus, or fungus.
What does FROM JANE stand for?
Sign of bacterial endocarditis. Fever, roth spot (ruptured blood vessel in the eye), Osler nodes (painful red lesions on the hands/feet), murmur, janeway lesions (red non-tender hemorrhagic macules on plantar surface o the toes), anemia, nail bed hemorrhage, and emboli.
What is pericarditis?
Inflammation of the pericardium.
Signs and symptoms of pericarditis?
Chest pain, fever, orthopnea, fatigue, cough, palpitations, and edema. Can also hear a pericardial friction rub (a grating, scratchy, high-pitched sound).
Complications of pericarditis?
Pericardial effusion, cardiac tamponade, pericardiocentesis.
What are s/sx of cardiac tamponade?
Confusion, hypotension, tachycardia, JVD, tachypnea, distant heart sounds.
Treatment of pericarditis?
Treat the underlying cause, antibiotics, bed rest, NSAIDs, corticosteroids, bedrest, pericardiocentesis, pericardial window, pericardiectomy.
S/sx of myocarditis?
Typically asymptomatic. Fatigue, fever, pharyngitis, malaise, dyspnea, palpitations, GI discomfort, chest pain, tachycardia, sudden death.
What is thrombophlebitis?
Need Virchow’s triad. Stasis of blood flow, endothelial injury, and hyper coagulability. Is the formation of a clot and followed by inflammation of the vein. Can be superficial (IV site) or deep.
S/sx of phlebitis?
Redness, warmth, swelling, tenderness, leg fatigue, pain, positive Homan’s sign, or may be asymptomatic.
Risks for thrombophlebitis?
Decreased muscle movement, venous stasis, reduced blood flow, dilated veins, faulty valves, venous wall injury, increased blood coagulation.
Complications of thrombophlebitis?
Venous insufficiency, varicose veins, recurring DVT, pulmonary embolism (most serious), post-thrombotic syndrome.
S/sx of pulmonary embolism?
Chest pain, SOB, tachypnea, restlessness, and anxiety.
How to diagnose thrombophlebitis?
D-dimer (>0.5), compression ultrasonography, Venous US.
What anticoagulants are used for thrombophlebitis?
Warfarin (Coumadin) oral, therapeutic INR is 2-3, antidote is vitamin K.
Heparin SQ or IV, check PTT levels, antidote is protamine sulfate.
Factor Xa inhibitors Apixaban, Rivaroxaban, edoxaban, enoxaparin (all oral except enoxaparin)
What causes cardiac valve disorders?
Congenital defects, rheumatic fever (spreads from strep throat), and infections. Left valves most commonly affected.
What is an echocardiogram?
It is an ultrasound to create pictures of the heart. It records all movement including valves and chambers in addition to heart size, shape, and position. Results used for ejection fraction.
Causes of mitral valve regurgitation?
Rheumatic heart disease, endocarditis, rupture of chordae tendineae or papillary muscle, MVP, HTN, MI, cardiomyopathy, aging, congenital defects
Mitral valve stenosis complications and treatment?
Complications: AFIB (which may result in emboli or stroke) and pulmonary edema. Treatment: anticoagulants, percutaneous balloon valvuloplasty, surgical valve replacement.
What is aortic stenosis?
When blood from the left ventricle into aorta is obstructed through stenosed aortic valve. Left ventricle contracts more forcefully leads to hypertrophy.
What can cause atrial stenosis?
Congenital defects, rheumatic heart disease, and calcification of aortic valve with aging.
Complications of aortic stenosis?
Life-threatening arrhythmias (v-fib, v-tach), sudden death, endocarditis, HF, and emboli.
S/sx of aortic regurgitation?
Severe dyspnea, chest pain, fatigue, hypotension, atypical angina (based on when it starts and stops), forceful pulse that quickly collapses (corrigan’s pulse), widened pulse pressure (>60), HF symptoms, murmur.
What are the ways to repair a valve?
Valvotomy (valvuloplasty)- which is a balloon to widen opening of stenosed valve.
Commissurotomy- repairs stenosed valve.
Annuloplasty- repair or reconstruction of valve flaps or annulus.
Mechanical valve replacement?
Creates turbulent blood flow (pt will have to be on an anticoagulant for life like warfarin), you can hear a click, IE can develop due to organisms growing on valve leaflets.
Biologic valve replacement?
Xenograft (porcine or bovine), allograft (human tissue), or autograft (self graft using pulmonary valve then the pulm valve is replaced), do not last as long as mechanical valve.
TAVR?
Done for high-risk patients and go through femoral artery (is minimally invasive).
What is heart failure?
It is a chronic progressive condition and affects perfusion. Heart does not generate adequate cardiac output. Ventricles of heart are unable to pump blood effectively. The heart cannot meet the body’s requirements.
What are the compensatory mechanisms?
It ensures blood is being pumped out to the body (this can lead to HF however). SNS activation, RAAS activated, ADH released from the posterior pituitary. Remodeling takes place (chambers dilate, heart hypertrophies, heart walls stiffen.)
What is systolic left sided heart failure?
Left ventricle loses ability to contract. Blood can not be pushed into circulation. May also be called left ventricular systolic dysfunction.
What is diastolic left sided heart failure?
Left ventricle loses ability to relax. Heart cannot properly fill with blood. Normally means decreased ejection fraction.
What are s/sx of left sided heart failure?
Paroxysmal nocturnal dyspnea, elevated pulmonary wedge pressure, pulmonary congestion (cough, crackles, wheezes, blood tinge sputum, and tachypnea), restlessness, confusion, orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis.
What are s/sx of right sided heart failure?
Fatigue, increased peripheral venous pressure, ascites, enlarged liver and spleen, JVD, anorexia, GI distress, weight gain, dependent edema.
What is pulmonary edema?
Acute heart failure. Sudden, severe fluid congestion within lung alveoli. (Conceptual concern is gas exchange)
S/sx of pulmonary edema?
Pink, frothy sputum. Severe dyspnea, coughing, rapid respirations, crackles, anxiety/restlessness.
What are nursing actions for pulmonary edema?
Vitals, place pt in semi/high fowlers, five O2 as ordered, meds as ordered.
How to diagnose HF?
Clinical assessment (edema, SOB, cough, crackles) BNP >100 BUN/Creatine (indicate kidney damage) Liver enzymes Chest X-ray (may see enlarged heart) ECG Echo Coronary angiogram (diagnose CAD, obtain EF) Myocardial biopsy
How to calculate EF?
Stroke volume divided by estimated diastolic value/total amount of blood in ventricle.
Therapeutic measures for HF?
O2, activity (swimming, walking), sodium restriction (2g typically), fluid restriction, decrease weight, daily weigh, medications.
What medication are given for HR?
Diuretics (decreased fluid volume), aldosterone antagonists (blocks effects of aldosterone), inotropes (increase CO)
What are s/sx of digoxin toxicity?
N/V/D, arrhythmias, vision changes, decreased appetite, restlessness, confusion.
What level for digoxin indicates toxicity?
2.3
What is the antidote for digoxin?
Digibind
