ch 36 inflammatory and structural heart disorders Flashcards
three types of cardiomyopathy
- dilated
- hypertrophic
- restrictive
what age group/gender is most at risk for dilated cardiomyopathy
middle aged women
what happens to the heart in dilated cardiomyopathy
- heart muscles stretch and thin
- affects systolic bp
common causes dilated cardiomyopathy (5)
- infectious myocarditis
- alcohol
- cocaine
- HTN
- CAD
diagnostics for dilated cardiomyopathy (4)
- chest x-ray (cardiomegaly)
- ECG
- BNP levels
- echocardiogram
how does hypertrophic cardiomyopathy affect the heart
- thickening of muscles
- decreased space in ventricles
- affects diastolic bp
cause hypertrophic cardiomyopathy
chronic untreated HTN
S+S hypertrophic cardiomyopathy (4)
- fainting
- dizziness with activity
- chest pain
- dysrhythmias
treatment for dilated and hypertrophic cardiomyopathy
implanted defibrillator (same meds as for HF)
cause of restrictive cardiomyopathy
inflammatory diseases causing stiff heart muscles
S+S restrictive cardiomyopathy (4)
- fatigue
- orthopnea
- exercise intolerance
- systemic signs inflammatory disease
S+S dilated cardiomyopathy
- fatigue
- dyspnea at rest
- proxysmal nocturnal dyspnea
- orthopnea
- S3/S4 heart sounds
- pulmonary edema symptoms
what type of cardiomyopathy is often diagnosed in young, healthy males
hypertrophic
meds for hypertrophic cardiomyopathy (2)
- b blocker
- digoxin
friction between heart and pericardial sac caused by inflammation and immune response
pericarditis
S+S pericarditis (6)
- severe angina
- dyspnea
- tachycardia
- distant heart sounds
- SOB
- pericardial friction rub
possible complication of pericarditis
pericardial effusion (fluid buildup) which can lead to tamponade and cardiac arrest
classic sign of tamponade
pulsus paradoxus (decreased Sbp with inhalation)
S+S tamponade (6)
- distant heart sounds
- increased HR
- increased RR
- pulsus paradoxus
- JVD
- confusion
diagnostics for pericarditis (3)
- echocardiogram
- CT/MRI
- chest x-ray
care for pericarditis (5)
- O2
- bedrest
- NSAIDs
- IV corticosteroids
- maybe pericardiocentesis
cause of chronic constrictive pericarditis
pericardium scarring
treatment for chronic constrictive pericarditis
pericardiectomy (window procedure)
causes myocarditis
- viruses/bacteria/fungi
- radiation therapy
- autoimmune disorders
- coxsackie A+B viruses
early S+S myocarditis (8)
- fever
- fatigue
- dyspnea
- N/V
- lymphadenopathy
- angina
- pericardial friction rub
- pericardial effusion
late S+S myocarditis (6)
- S3 heart sounds
- crackles
- JVD
- fainting
- peripheral edema
- angina
diagnostics myocarditis (6)
- ECG
- ESR
- troponin
- endomyocardial biopsy (during first 6 weeks illness)
- echocardiogram
- MRI
meds myocarditis
- digoxin
- ACE inhibitors
- b blockers
- diuretics
- improve CO: nitroprusside, inamrinone, milrinone
- prednisone, azathioprine, cyclosporine
infection (often s. aureus) of the inner layer of the heart that affects cardiac valves
endocarditis
3 stages to infective endocarditis (IE)
- bacteremia
- adhesion
- vegetation
risk factors IE (5)
- older age
- IV drug use
- prosthetic valve
- intravascular devices and healthcare associated infection
- renal dialysis
2 complications IE
- heart valve damage
- emboli
S+S IE (6)
- anorexia and weight loss
- general pain
- clubbing
- splinter hemorrhages
- osler’s nodes
- janeway’s lesions
diagnostics IE (3)
- blood cultures
- echocardiogram
- duke criteria
what is duke criteria
3 blood cultures drawn over 1 hour from 3 different sites
major criteria in duke criteria (2)
- positive blood culture
- evidence vegetation on echocardiogram
minor criteria in duke criteria (4)
- predisposing heart condition
- fever
- vascular phenomena
- immunologic phenomena
treatment IE (3)
- antibiotic prophylaxis
- antipyretics
- IV fluids
painful, red or purple pea-sized lesions on fingertips or toes (seen in pts with IE)
osler’s nodes
flat painless small red spots on hands and feet (seen in pts with IE)
janeway’s lesions
what procedures should you ask if pts have had within last 6 months when evaluating for IE (4)
- dental
- urologic
- surgical
- gynecologic
chronic condition affecting all layers of the heart characterized by scarring and deformity of heart valves caused by acute inflammatory disease of heart
rheumatic heart disease
what age group is primarily affected by rheumatic heart disease
young adults
what causes rheumatic fever
group A strep
most common S+S with RF
mono/polyarthritis
3 signs of carditis with RF
- heart murmur
- heart enlargement and HF
- pericarditis
major criteria for diagnosing RF (3)
- sydenhams chorea
- erythema marginatum
- subcutaneous nodules
symptom of RF, characterized by involuntary movements of face and limbs, muscle weakness, and speech + gait problems
sydenhams chorea
symptom of RF, nonpruritic bright pink lesions on trunk and proximal extremities, intensified by heat
erythema marginatum
minor criteria for diagnosing RF (3)
- fever
- polyarthralgia
- lab tests (increased CRP and WBC)
2 diagnostics for RF
- test for group A strep
- echocardiogram
meds for RF (3)
- antibiotics (amoxicillin, erythromycin, clindamycin)
- aspirin
- corticosteroids
narrowing of heart valve that impedes forward flow,
stenosis
results from stenosis, backward flow of blood caused by incomplete closure of valve leaflets
regurgitation
does stenosis cause murmur when valve is open or closed
open
does regurgitation cause murmur when valve is open or closed
closed
most common cause mitral valve stenosis
rheumatic heart disease
appearance of stenotic mitral valve due to thickening and shortening of valve structures
fish mouth appearance
5 main causes mitral valve regurgitation
- MI
- chronic rheumatic heart disease
- mitral valve prolapse
- ischemic papillary muscle dysfunction
- infective endocarditis
serious complications mitral valve prolapse (4)
- mitral valve regurgitation
- infective endocarditis
- sudden death
- cerebral ischemia
S+S mitral valve disorder (5)
- exertional dyspnea*
- progressive fatigue caused by decreased CO
- heart murmur and palpitations
- systemic embolization
- a fib
clinical manifestations aortic valve stenosis (5)
- left ventricular hypertrophy
- decreased CO
- pulmonary HTN
- soft S1, diminished/absent S2
- prominent S4
what med is contraindicated in pts with aortic valve stenosis because of likelihood for severe hypotension and decreased preload
nitroglycerin
3 causes aortic valve regurgitation
- infective endocarditis
- trauma
- aorta dissection
clinical manifestations aortic valve regurgitation (6)
- fluid volume overload
- left ventricle dilation and hypertrophy
- syncope and vertigo
- nocturnal angina with sweating
- dysrhythmia (murmur)
- dyspnea and increasing fatigue
diagnostics for valvular disorders (2)
- cardiac cath
- transesophageal echocardiogram
treatment options valvular disorders (3)
- low sodium diet
- percutaneous ballon valvuloplasty
- surgery for repair or replacement
nursing considerations with mechanical valve replacement (3)
- lifelong anticoagulant therapy with warfarin
- monitor INR: 2.5-3.5
- bridge therapy with lovenox
definite diagnosis of myocarditis
biopsy of myocardium
