[Exam 1] Chapter 28: Management of Patients with Structural, Infections, and Inflammatory Cardiac Disorders (Page 791-801, 809-817) Flashcards
What separates the atria from the ventricles?
Atrioventricular valves, and include the tricuspid valve and mitral valve
What does the tricuspid valve separate?
Right atrium from right ventricle
What does the mitral valve separate?
Separates the left atrium from the left ventricle
Tricuspid valve has how many leaflets
Three
Mitral valve has how many leaflets?
Two
Both the mitral and tricuspid valve have what?
Chordae tendineae that anchor valve leaflets to papillary muscles of the ventricles
What is located between the ventricles and their correspond arteries?
Semilunar valves; this includes pulmonic and aortic valve
Where does the pulmonic valve lie?
Between the right ventricle and the pulmonary artery
Where does the aortic valve lie?
Between the left ventricle and the aorta
What is regurgitation?
When the valve does not close properly, and blood backflows through the valve
What is Stenosis?
The valve does not open completely, and blood flow through the valve is reduced
The mitral valve may also have what?
Prolapse
What is valve prolapse?
The stretching of an atrioventricular valve leaflet into the atrium during diastole
Chordea Tendinae gets tight so it doesn’t close properly after that. Will see decrease in cardiac output.
What is mitrl valve prolapse?
Deformity that usually produces no symptoms.
Cause may be an inherited connective tissue disorder resulting in enlargement of one or both of the mitral valve leaflets
Pathophysiology of mitral valve prolapse
Portion of one or both mitral valve leaflets balloons back into the atrium during systole.
Blood then regurgitates from the left ventricle back into the left atrium
Mitral Valve Prolapse: Signs and Symptoms?
Most never have symptoms. Few have fatigue, shortness of breath, lightheadness, dizziness, palpitations, chest pain, or anxiety
Mitral Valve Prolapse: Often the first and only sign of mitral valve prolapse is
an extra heart sound, referred to as a mitral click. Systolic click is early sign that its ballooning into the left atrium.
Mitral Valve Prolapse: If dysrhythmias are documented and cause symptoms, patients is advised to
eliminate caffeine and alcohol from teh diet and to stop the use of tobacco products
Mitral Valve Prolapse: Chest pain that does not respond to nitrates may response to
Calcium channel blockers or beta-blockers
Mitral Valve Prolapse: Patients with severe mitral regurgitation and symptomatic heart failure may require
mitral valve repair or replacement
Mitral Valve Prolapse: Patients with mitral valve prolapse may be at risk for
infective endocarditis from bacteria entered blood stream and adhering to abnormal valve structures.
Mitral Regurgitation: What is this?
Involves blood flowing back from the left ventricle into the left atrium during systole
Often edges of valve leaflets do not close completely during systole because leaflets and chordae tendineae have thickened and fibrosed.
Mitral Regurgitation: Most common causes in developed countries are
degenerative changes in mitral valve and ischemia of the left ventricle
Mitral Regurgitation: Other conditions that lead to this include
Myxomatous Changes, which enlarge and stretch the left atrium and ventricle, causing leaflets and chordae tendineae to stretch or rupture.
Mitral Regurgitation: May result from
problems with one or more leaflets, chordae tendineae, annulus, or papillary muscles
Mitral Regurgitation: REgardless of the cause, what always happens?
blood regurgitates into the atrium during systole
Mitral Regurgitation: What happens to the lungs with this backward flow?
Lungs become congested, eventually added extra strain to the right ventricle.
Mitral Regurgitation: What evantually happens as the atrium continues to expand?
The volume overload causes ventricular hypertrophy. The ventricle dilates and systolic heart failure develops
Mitral Regurgitation: Clinical Manifestations?
Asymptomatic, but acute mitral regurgitation usually manifests as severe congestive heart fialure.
Mitral Regurgitation: Most common symptoms?
dyspnea, fatigue, and weakness.
Palpitations, shortness of breath on exertion, and cough also occur
Mitral Regurgitation: How do you find this?
Systolic murmur is a high-pitched blowing sound at the apex that may radiate to the left axilla.
Echocardiography is used to diagnose and m onitor the progression of mitral regurgitation
Mitral Regurgitation: Medical Management
Same as for HF
Benefit from afterload reduction by treatment with ACE inhibitors or angtiotensin receptor blockers.
Mitral Regurgitation: Medical management, what happens once symptoms of heart failure develop?
Patient needs to restrict their activity level to minimize symptoms.
Mitral Stenosis: What is this?
Obstruction of blood flowing from the left atrium into the left ventricle.
Often caused by rheumatic endocarditis, which progresively thickens mitral valve leaflets and chordae tendineae
Mitral Stenosis: Evantually, the mitral valve orifice
narrows and progressively obstructs blood flow into the ventricle
Mitral Stenosis: Pathophysiology: Normal width vs in here?
Normally as wide as three fingers. Here, its the width of a pencil
Mitral Stenosis: Pathophysiology: LEft ventricle has difficulty
moving blood into the ventricle because of increased resistance by the narrowed orifice
Mitral Stenosis: Pathophysiology: Poor left ventricular filling can cause
decreased cardiac output.
Increased blood volume in left atrium causes it to dilate and hypertrophy.
Mitral Stenosis: Pathophysiology: With excessive strain in the left ventricle..
the right ventricle hypertorphies, eventually dilates, and fails
Mitral Stenosis: Pathophysiology: What is the first symptom?
Often is dyspnea on exertion (DOE) as a result of pulmonary venous hypertension . Symptoms usually develop after the valve opening is reduced by one third to one half its usual size
Mitral Stenosis: Pathophysiology: An enlarged left atrium may create
pressure on the left bronchial tree, resulting in a dry cough or wheezing .
May expectorate blood, or experience palpitations, orthopnea , dyspnea and repeated respiratory infecctions
Mitral Stenosis: Pathophysiology: How to determine this?
Pulse is weak and irregular in presence of atrial fibrillation. Low pitched , rumbling diastolic murmur is ehard at the apex
Mitral Stenosis: Pathophysiology: Echocardiography is used to diagnose and quantify
the severity of mitral stenosis.
Mitral Stenosis: Pathophysiology: ECG , exercise testing, and cardiac catherization with angiography may be used to help
determine the severity of mitral stenosis
Mitral Stenosis: Prevention
Minimize risk and treatment for bacterial infections.
Prevent of acute rheumatic fever depends on effective antibiotic treatment of group A streptococcal infection
Mitral Stenosis: Medical Management . patients with mitral stenosis may benefit from
anticoagulants to decrease the risk of developing atrial thrombus and may require treatment for angina.
Mitral Stenosis: Medical management, if atrial fibrillation develops..
cardioversion is attempted to restore normal sinus rhythm
In unsuccessful, the ventricular rate is contorlled with beta-blockers, digoxin, or calcium channel blockers
Mitral Stenosis: Patients are advised to avoid
strenous activites, competitive sports, pregnancy , all of which increase heart rate
Aortic Regurgitation: What is this?
The flow of blood back into the left ventricle form the aorta during diastole. May be cause dby inflammatory lesions that deform aortic valve leaflets or dilation of the aorta , preventing complete closure of the aortic valve
Aortic Regurgitation: Valvular defect may also result from
inefective or rheumatic endocarditis, congenital abnormalities, diseases such as syphilis.
Aortic Regurgitation: Pathophysiology
Blood from aorta reutnrs to left ventricle during diastole, in addition to blood normally delivered by the left atrium
Left ventricle dilates in attempt to accommodate.
Systolic blood pressure increases as well to compensate
Aortic Regurgitation: Clinical Manifestions
Develops without symptoms
Some aware of foreful heartbeat especially in head or neck.
Marked arterial pulsations visible on carotid may be present as result of increase dforce
Aortic Regurgitation: Signs and symptoms of progressive left ventricular failure include
breathing difficulties
Aortic Regurgitation: What will this sound like when assessed?
A high-pitched diasstolic murmur is heard at the third or fourth intercostal space
Aortic Regurgitation: How is the pulse pressure here?
Considerably widened in patients with aortic regurgitation
Aortic Regurgitation: Whats a characteristic sign of this?
The water hammer pulse in whihc the pulse strikes a palpating finger with a quick, sharp stroke and then suddently collapses
Aortic Regurgitation: Diagnosis can be confirmed by
echocardiography, cardiac MRI, and cardiac catherization
Aortic Regurgitation: Prevention
Prevention of aortic regurgitation is based on treatment for bacterial infection. Strategries are aimed at preventing acute and recurrent rheumatic feverr.
Aortic Regurgitation: Medical Management : Patient with decreased left ventricular function is advised to
avoid physical exertion competitive sports and isometric exercise.
Aortic Regurgitation: Patients with aortic regurgitation and also hypertension should be treated with
dihydropyridine calcium channel blockers or ACE inhibitors
Aortic Regurgitation: Symptomatic patients should be isntructed to restrict
sodium intake and avoid volume overload
Aortic Regurgitation: Treatment of choice is
aortic valve replacement or valvuloplasty, prefably performed before left ventricular fialure occurs.
Aortic Regurgitation: Surgery recommended for any patient who is
symptomatic
Aortic Stenosis: What is this?
Narrowing of the orifice between the left ventricle and aorta. As adult, often result of degerative calcifications
Aortic Stenosis: Calcifications may be caused by
proliferative and inflammatory changes that occur in response to years of normal mechanical stres, similar to changes in atherosclerotic artieral disease
Aortic Stenosis: Rheumatic Endocarditis may cause
adhesions or fusion of the commissures and valve ring, stiffening of the cusps and calcific nodules on the cusps
Aortic Stenosis: Patho: How long for this to occur?
Several years to several decades
Aortic Stenosis: Patho: Left ventricle overcomes obstruction to emptying by
contracting more slowly but with more power than normal, forcibly squeezing blood through the smaller orifice
Aortic Stenosis: Patho: Obstruction to left ventricular outflow increases
pressure on the left ventricle, so the wall hypertrophies
Aortic Stenosis: Clnical Manifesttions: How does this appear in most people?
Aymptomatic
Aortic Stenosis: Clnical Manifesttions: When symptoms develop, patients usually first have
exertional dyspnea, caused by increased pulmonary venous pressure due to left ventricular failure
Orthopnea, PND, and Pulmonary edema also may occur
Aortic Stenosis: Clinical Manifestations: Most common symptom?
Angina Pectoris resulting from increased oxygen demand of the hypertrophied left ventricle with decreased blood supply
Aortic Stenosis: Assessment and Diagnostic Findings: What might a physical examination show?
Loud, harsh systolic murmur that may be heard over the aortic area and radiate to the carotid arteries
Aortic Stenosis: Assessment and Diagnostic Findings: What diagnostic tools can be used?
Echocardiography, Cardiac MRI, and CT Scanning used to diagnose and monitor the progression.
Aortic Stenosis: Assessment and Diagnostic Findings: Evidence of left ventricular hypertrophy may be seen on a
12-lead ECG and an echocardiogram
Aortic Stenosis: Prevention:
Focused on controlling risk factors for proliferative and inflammatory responses, namely through treating diabetes, hypertension and elevated triglycerides
Aortic Stenosis: Medical Management: What is prescribed to treat?
Medications
Aortic Stenosis: Medical Management: DEfinitive treatment for aortic stenosis is
surgical replacement of the aortic valve
Aortic Stenosis: Medical Management: Patients who are not surgical candiates may beenfit from
one or two balloon percutaneous valvuloplasty procedures with or without transcatheter aortic valve implantation
Nursing Management: Valvular Heart Disorders: Patient education of
sleeping with HOB elevated while having rest periods
Nursing Management: Valvular Heart Disorders: You want to monitor for
VS Trends
Heart Failure, Dysrhythmias, Other Symptoms
Nursing Management: Valvular Heart Disorders: What do you do with medication?
Collaborate with pt to develop a medication schedule
Nursing Management: Valvular Heart Disorders: Why are daily weights done?
To monitor for weight gain.
Nursing Management: Valvular Heart Disorders: 2.2 lbs of weight gain is equal to how many L’s?
1 L
Surgical Management: Valve REpair and Replacement Procedure: What is Valvuloplasty?
Repair, rather than replacement of a cardiac valve
They do not require continuous anticoagulation
Surgical Management: Valve REpair and Replacement Procedure: What is a Commissurotomy?
Repair that is made to commissures between the leaflets to the annulus to the valve by annuloplasty to leaflets or to chordae
Surgical Management: Valve REpair and Replacement Procedure: What is performed at the conclusion to evaluate teh effectiveness of the proceudre?
Transesophageal Echocardiogram (TEE)
Valve Repair and Replacement Procedure - Commissurotomy: This is the most common
valvuloplasty procedure
Valve Repair and Replacement Procedure - Commissurotomy: Each valve has
leaflets; the site where the leaflets meet is called the commissure
Valve Repair and Replacement Procedure - Closed Commissurotomy: They do not require
Cardiopulmonary bypass. Valve is not directly visualized
Valve Repair and Replacement Procedure - Closed Commissurotomy: This is more commonly performed in
developing nations
Valve Repair and Replacement Procedure - Closed Commissurotomy: Performed where?
Surgical technique performed in the operating room with the patient under general anesthesia
Valve Repair and Replacement Procedure - Closed Commissurotomy: This is the preferred technique for patients with
congenital mitral stenosis, severe calcified mitral stenosis, left atrial thrombosis or those with tricuspid regurgitation
Valve Repair and Replacement Procedure - Closed Commissurotomy: Simple explanation of procedure
Midsternal incision is made, a small hole is cut into the heart and a dilator is used to open the commissure
Valve Repair and Replacement Procedure - Closed Commissurotomy: Percutaneous balloon valvuloplasty is the technique most commonly performed in the united states as a bridge to
surgical valve replacement or transfermoral aortic valve replacement for closed commissurotomy.
Valve Repair and Replacement Procedure - Closed Commissurotomy: Balloon valvuloplasty is beneficial for
mitral valve stenosis in younger patients and for patients with complex medical conditions that place them at high risk
Valve Repair and Replacement Procedure - Closed Commissurotomy: Procedure contraindicated for
patients with left atrial or ventricular thrombus, serve aortic root dilation, significant mitral valve regurgitation
Valve Repair and Replacement Procedure - Closed Commissurotomy: Where is balloon valvulloplasty performed?
Cardiac catherization lab
Valve Repair and Replacement Procedure - Closed Commissurotomy: Medication before balloon valvuplasty?
Receive light or moderate sedation or a local anesthetic
Valve Repair and Replacement Procedure - Closed Commissurotomy: What does mitral balloon valvuloplasty involve?
Advancing one or two catheters into the right atrium, through the atrial septum in to the left atrium, across the mitral valve, and into the left ventricle
Guidewire placed through each catheter.
Valve Repair and Replacement Procedure - Closed Commissurotomy: Mitral Balloon Valvuloplasty three sections?
- First expands in the ventricle to help position the catheter the valve
- Balloon expands above the valve, holding catheter across the valve
- Middle section of the balloon expands in the valve orifice opening the commissures
Valve Repair and Replacement Procedure - Closed Commissurotomy: Mitral Balloon Valvuloplasty do not completely occlude the
valve, thereby permitting some forward flow of blood during the inflation period.
Valve Repair and Replacement Procedure - Closed Commissurotomy: All patients have some degree of what after the procedure?
Mitral regurgitation
Valve Repair and Replacement Procedure - Closed Commissurotomy: Other possible complications after procedure include
bleeding from teh catheter insertion sites, emboli resulting in strokes, and left-to-right atrial shunts
Valve Repair and Replacement Procedure - Closed Commissurotomy: Aortic balloon valvuloplasty is performed most commonly by introducing
a catheter through the aorta , across the aortic valve, and into the left ventricle .
Valve Repair and Replacement Procedure - Closed Commissurotomy: How does Aortic Balloon Valvuloplasty work?
Balloons infated for 15-60 seconds and inflation is repeated several times.
Valve Repair and Replacement Procedure - Closed Commissurotomy: Possible complications from aortic balloon valvuloplasty include
aortic regurgitation, emboli, ventricular perforation, and rupture of the aortic valve annulus.
Valve Repair and Replacement Procedure - Closed Commissurotomy: Aortic valve procedure is not as effective as
mitral valve procedure
Valve Repair and Replacement Procedure - Open Commissurotomy: Performed with direct
visualization of the valve
Valve Repair and Replacement Procedure - Open Commissurotomy: How is the procedure performed?
Patient under anesthesia
Midsternal or left thoracic incision made
Cardiopulmonary bypass initiated and incision is made into heart
Valve exposed and scalpel or finger used to open commissures
Valve Repair and Replacement Procedure - Open Commissurotomy: Added advantage of visualizing valve is that
thrombus and calcification may be identified and removed
Valve Repair and Replacement Procedure - Annuloplassty: What is this a repair of?
The valve annulas (junction of valve leaflets and muscular heart wall).
Valve Repair and Replacement Procedure - Annuloplassty: What is required for this?
General anesthesia and cardiopulmonary bypass are required for most annuloplasties
Valve Repair and Replacement Procedure - Annuloplassty: This procedure narrows
the diameter of the valve’s orifice adn is a useful treatment for valvular regurgitation
Valve Repair and Replacement Procedure - Annuloplassty: What are the two annuloplasty techniques?
One technique uses an annuloplasty ring which may be preshaped or flesxible . Leaflets sutured to a ring, creating an annulus of the desired size
Second technique is tight then annulus involves folding elongated tissue over into itself in leaflets or tacking leaflets to the atrium
Valve REpair and Replacement Procedure - Leaflet Repair: What is this?
Repair for elongated, ballooning, or other excess tissue leaflets is removal of the extra tissue
Valve REpair and Replacement Procedure - Leaflet Repair: Elonged tissue may be tucked and
sutured. Wedge of tissue may be cut from middle and gap sutured closed.
Valve REpair and Replacement Procedure - Chordoplasty: What is this
Repair of chordae tendineae . Mitral valve is most often invoved with chordoplasty
Valve REpair and Replacement Procedure - Chordoplasty: Tricuspid valve seldom requires chordoplasty because
tricuspid valve disease is often a result of mitral or aortic valve disease or left ventricular dysfunction
Valve Replacement: What is used for most valve replacements?
General anesthesia and cardiopulmonary bypass
Valve Replacement: Mitral and aortic valve replacements may be performed with
minimally invasive technique that do not involve cutting through length of sternum .
Instead 2-4 inch incision made on lower half of sternum
Valve Replacement: What happens after valve is visualized?
Leaflets of the aortic or pulmonic valve are removed. Some or all of mitral valve structures left in place .
Sutures palced around the annulus and then through the valve prosthesis . Replacement valve slide down the suture into position and tied.
Valve Replacement: What is TAVI?
Minimally invasive aortic valve replacement procedure, may be performed in a catherization laboratory
Valve Replacement: TAVI indicated for patients with
aortic stenosis who are not cadinates for surgical valve replacement or have high risk
Valve Replacement: How does TAVI performed?
Pt under general anesthesia, balloon valvuloplasty is performed. Then tisssue replacement valve attached to a catheter is inserted, positioned at aortic valve, and implanted.
Valve Replacement: TAVI is beneficial for patients with
severe symptomatic mitral regurgitation who have high surgical risk. Crreates mechanical bridge between two leaflets.
Valve Replacement: Mechannical Valves: What are these?
Are of bileaflet ,, tilting-disc or ball-and-cage design and are thought to be more durable than tissue prosthetic valves. Often use in younger patients and those with kidney injury.
Do not deteriorate or become infected
Valve Replacement: Significant complications of mechanical valves include
thromboemboli and long-term use of required anticoagulants
Valve Replacement: What are the three types of tissue valves?
Bioprostheses, homografts, and autografts .
Less likely to generate thromboemboli and long-term anticoagulation not required.
Tissue Valves: What are Bioprosthses?
Tissue valves used for aortic, mitral, and tricuspid valve replacement. Patients od not need long-term anticoagulation therapy.
Tissue Valves: Bioprosthesis used for women of what age?
Childbearing because potential complications of long-term anticoagulation associated with menses, placental transfer to a fetus.
Tissue Valves: Bioprostheses are made from
pigs but some are from cows or horses
Tissue Valves: What are homografts / allografts?
Obtained from cadaver tissue donations and are used for aortic and pulmonic valve replacement.
Tissue Valves: How long do homografts last for?
10-15 years
Tissue Valves: What are autografts?
Obtained by excising patients own pulmonic valve and portion of pulmonary artery to use an aortic valve
Tissue Valves: Autografts and Anticoagulation
Unneccessary because its patients own tissue. Alternative for children and those who cannot tolerate anticoagulation
Infectious Diseases of the Heart: Infections are named for
layer of heart most involved in the infectious process
Endocarditis (Endocardium)
Myocarditis (Myocardium)
Pericarditis (Pericardium)
Infectious Diseases of the Heart: What is Rheumatic Endocarditis?
Unique infective endocarditis syndrome
Infectious Diseases of the Heart: Diagnosis of infection is made primarily on
basis of patients symptoms
Rheumatic Endocarditis: Acute Rheumatic Fever occurs most often in
school-age children
Rheumatic Endocarditis: Patients with rheumatic fever may develop
rheumatic heart disease as evidenced by a new heart murmur, cardiomeagaly, pericardtis, and heart failure.
Rheumatic Endocarditis: Prompt and effective treatment of “Strep” throat with antibiotics can prevent
development of rheumatic fever
Rheumatic Endocarditis: Signs of Rheumatic Fever?
Fever
Chills
Sore Throat
Diffuse redness of throat
Petechiae on the roof
Enlarged and tender lymph nodes
Inefective Endocarditis: What is this?
Microbial infection of the endothelial surface of the heart
Inefective Endocarditis: Usually develops in people with
prosthetic heart valves, cardiac devices, or structural cardiac defects
Inefective Endocarditis: More comon in
older adults who are more likely to have degenerative or calcify valve lesions
Inefective Endocarditis: Staphylococcal endocarditis infections of valves in right side of heart are common among
IV drug abusers
Inefective Endocarditis: HAI Endocarditis occurs most often in
patients with debilitating disease or indwelling catheters and in patients who are receiving hemodialysis
Inefective Endocarditis: People taking immunosuppressive medications or corticosteroids are more suspectible to
fungal endocarditis
Inefective Endocarditis: Deformity or injury to the endocardium leads to
accumulation of fibrin and platelets on the endocardium .
Infectious ocrangisl invade the clot and endocardial lesions
Inefective Endocarditis: Infection most frequently results in
platelets, fibrin, blood cells, and microorganisms that cluser as vegetations on the endocardium
Inefective Endocarditis: As the clot on the endocardium continues to expand,
the infecting organism is covered by new clot and concealed from the bodys normal defenses
May erode through the endocardium causing tears or other deformities.
Inefective Endocarditis: Signs develop from
toxic effects of the infection, destruction of heart valves, and embolization of fragments of vegetative frowths
Inefective Endocarditis: PRimary present symptoms include
fever and heart murmur.
FEver may be intermittent or absent. Heart murmur may be absent at first, but develops in almost all patients
Inefective Endocarditis: In addition to fever and heart murmur, what else may be found?
Clusters of petechiae may be found . Also Nodes and irregular macules as well.
Inefective Endocarditis: What may be observed in the eyes?
Hemorrhages with pale centers. Petechiae may appear in conjunctiva and mucous membranes
Inefective Endocarditis: CNS manifestations include
Headache
Temporary or transient cerebral ischemia
Strokes
Embolization may be a present symptom.
HEart Failure, indicates poor prognosis wth medical therapy
Inefective Endocarditis: Vague complaints of malaise, anoreia, weight loss, cough and back and joint pain may be mistaken for
influenza.Definitive diagnosis made when microorganism is found in two separate blood cultures. Must have two within a 24 hour period in order to administer antimicrobial agents
Inefective Endocarditis: What may assist with diagnosing?
Echocardiography may assist with diagnosis by demonstrating mass on a valve, prosthetic valve or supporting structures
Inefective Endocarditis: How to prevent bacterial endocarditis in high risk patients?
Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after dental procedures that involve manipulation of gingival tissue.
Inefective Endocarditis: Poor dental hygiene can lead to
bacteremia
Inefective Endocarditis: Female patients are advised not ot use
IUD devides .
Inefective Endocarditis: Antibiotic therapy usully is given for
2-6 weeks every 4 hours or continuously by IV infusion
Inefective Endocarditis: PN Therapy is given in doses that produce
high serum concentration for a significant period to ensure eradication of dormant bacteria
Inefective Endocarditis: Patients temperature is monitored at
regular intervals because the course of fever is one indication of treatment effectiveness
Inefective Endocarditis: Surgical management may be required if
the infection does not respond to medication or the patient has prosthetic heart valve endocarditis, mobile vegation, HF, heart block, or develops complications
Inefective Endocarditis: Surgical interventions include
valve debridement or excision, debridegement of vegations, debridement and closure of an abscess
Inefective Endocarditis: Most patients who have prosthetic valve endocarditis require
valve replacement
Inefective Endocarditis: Nursing Management: Nurse monitors
patients temp, may have fever for week.
Administer antibiotic, antifungal, or antiviral meds.
Inefective Endocarditis: Nursing Management: Patients need enough fluid to keep their urine
light yellow
Inefective Endocarditis: Nursing Management: FEver often causes
fatigue, rest periods should be planned and activites spaced to get rest.
Inefective Endocarditis: Nursing Management: Whae else may be prescribed?
NSAIDS as antipyretics or to decrease the discomfort of fever
Inefective Endocarditis: Nursing Management: Heart sounds assessed. New or worsening murmur may indicate
dehiscence of a prosthetic valve, rupture of an abscess, or injury to valve leaflets or chordae tendinae
Inefective Endocarditis: Nursing Management: Patient care direted toward managmeent of infection. Long term IV antimicrovbial therapy often is necessary meaning
many patients may have peripherally inserted central catheters orother long-term IV access
Myocarditis: What is this?
Inflammatory process involving the myocardium that can cause heart dilation, thrombi on the heart wall, infiltration of circulating blood cells and degeneration of muscle fibers
Myocarditis: Most patients with mild symptoms recover
completely. Some develop cardiomyopathy and heart fialure
Myocarditis: Usually results from
viral, bacterial, rickettsial, fungal, parastic or spirochental infection. May also be immune related after acute systemic infection like rheumatic fever
Myocarditis: MAy develop in patients receiving
immunosuppressive therapy or in those with inefectiv endocarditis, chrohns disease, or lupus
Myocarditis: May result from an inflammatory reaction to
toxins such as pharmacologic agents used in the treatent of other diseases, ethanol, or radiation
Myocarditis: Symptoms of acute myocarditis depend on
the type of infection, the degree of myocardial damage, and the capacity of the myocardium to recover.
Myocarditis: Patients may develop mild-to-moderate symptoms reporting
fatigue and dyspnea, syncope, palpitations and occasional discomfort in teh chest and upper abdomen
Myocarditis: What is being used for assessment?
Cardiac MRI is being used more often as a diagnostic tool because of its noninvasive approach.
With contrast, it can guide clinicians to sites for endocardial biopsies
Myocarditis: Patients without any abnroaml heart structures may suddenly develop
dysrhythmias or ST-T wave changes
Myocarditis: If pt has structural heart abnormalities, clienical assessment may disclose
cardiac enlargement, faint heart sounds, pericardial friction rub, a gallop rhythm , or a systolic murmur
Myocarditis: Prevention
Preventing disease by means of appropriate immunizations and early treatment appears to be important to prevent incidienc of myocarditis
Myocarditis: Medical Management: Patient are given specific treatment for underlying cause if it is known and are placed on
bed rest to decrease cardiac workload .
Best rest decreases myocardial damage and complications of myocarditis..
Myocarditis: Medical Management: For young patients, they should be limited for
6 month period or at least until heart size and function return to normal
Myocarditis: Medical Management: What should not be used?
NSAIDs should not be used for pain and control… ineffective in relieving the inflammatory process in myocarditis and worsens the inflammation
Myocarditis: Nursing Management: Assesses for
resolution of tachycardia, fever, and other clinical manifestations.
Myocarditis: Nursing Management: CArdiovascular assessment focuses on
signs and symptoms of heart failure and dysrhythmias.
Myocarditis: Nursing Management: Anti-embolism stocks and passive and active exercises should be used because
embolization from venous thrombosis and mural thrombi can occur.
Pericarditis: What does this refer to?
Inflammation of the pericardium, which is the membranous sac eveloping the heart
Pericarditis: May be a
primary illness, or it may devvelop during various medical and surgical disorders
Pericarditis: May occur how long after acute myocardial infarction?
10 days to 2 months
Pericarditis: Percarditis may be
acute, chronic, or recurring
Pericarditis: Classified as either
adhesive(constrictive) because of the periocardium becomes attached to each other, serous (serum), purulent (pus) calcific (calcium deposits) or fibrinous (clotting proteins).
Pericarditis: Inflammatory process of pericarditis may lead to
accumulation of fluid in the pericardial sac and increased pressure on the heart, leading to cardiac tamponade
Pericarditis: Prolonged episodes may lead to
thickening and decreased elasticity of the pericardium or scarring may fuse the viscerala and perital
Pericarditis: Signs, may be
aymptomatic
Pericarditis: Most characteristic symptom of pericarditis is
chest pain, although pain also may be located beneath the clavicle in the neck or scpaula region
Pericarditis: Signs: Pain or discomofrt remains fairly
constant, but it may worsen with deep inspiration and when lying down or turning
Pericarditis: Signs: Most characteristic clinical manifestation of pericarditis is
a creaky or scratchy friction rub heard most clearly at the left lower sternal border.
Other signs include Increased WBC, anemia, and eleved ESR.
May have nonproducitve cough
Percarditis: Diagnosis most often made i s
on the basis of history, signs, and symptoms.
Percarditis: Echocardiogram may detect
inflammation, pericardial effusion, or tamponade and heart failure.
May be used to guide pericardiocentesis (needle or catheter drainage of the pericardium)
Percarditis: TEE useful in diagnosis but
may underestimate the extend of pericardial effusions
Percarditis: What may be the best diagnostic tool?
CT imaging, helps determine size, shape, and location and peripheral effusions and can guide pericardioentesis as well
Percarditis: CArdiac MRI may assist with
detection of inflammation and adhesions.
Percarditis: Occassionaly a video assisted pericardioscop guided biopsy of the pericardium and epicardium is performed to obtain
tissue samplesfor culture and microscopic examination
Percarditis - Medical Management: Objective of pericarditis management are to
determine the cause, administer therapy for treatment and symtom relief, and detect signs and symptoms of cardiac tamponade.
Percarditis - Medical Management: When cardiac output is impaired, patient is
placed on bed rest until fever, chest pain, and friction rub have subsided.
Percarditis - Medical Management: What medications may be prescribed?
Analgesic medications and NSAIDS such as aspirin or ibuprofen during acute phase.
Hasten reabsorption of fluid in patients with rheumatic pericarditis.
Percarditis - Medical Management: Why is Indomethacin contraindicated?
Decreases coronary blood flow
Percarditis - Medical Management: Why would Colchicine be prescribed?
This or corticosteroids may be prescribed if the pericarditis is severe or if patient does not respond to NSAIDS
Percarditis - Medical Management: Pericardiocentesis can be done… what is this?
Procedure in which some pericardial fluid is removed, rarely is necessary
Performed if there are signs of heart failure or tamponade
Percarditis - Medical Management: Pericardial fluid cultured if
bacterial, tubercular, or fungal disease is suspected
Percarditis - Medical Management: Pericardial windows may be made, which is?
Small opening made in the pericardium, that may be performed to allow continuous drainage into the chest cavity
Percarditis - Nursing Management: Patients with acute pericarditis require
pain management with analgesics, assistance with positioning, and psychological support
Percarditis - Nursing Management: Patients with chest pain benefit from
education and reassurance that the pain is not due to a heart attack
Percarditis - Nursing Management: Pain may be releived with
a forward leaning or sitting position
Percarditis - Nursing Management: Relief of pain achieved by
rest
