Exam 2: Ch 19 Endocardial & Valve Disorders Flashcards
infective endocarditis
infection of endocardium including valves
vegetative growth on valve leaflets –> regurgitation
septic emboli break free from growths
requires both heart damage and introduction of the organism – dental work in person w/ valve disease
infective endocarditis is most commonly seen in people with…
preexisting heart defects
IV drug use: staph. A
heart surgery: staph. epidermis from prosthetic valve
symptoms of infective endocarditis
systemic infection
petechial (pinpoint) hemorrhages from emboli
diagnosis and treatment of infective endocarditis
Dx: blood cultures and echo for regurgitation
Rx: antibiotics, treat cardiac symptoms
rheumatic heart disease
immune response to beta-hemolytic strep infection
symptoms of rheumatic heart disease
sore throat and swollen glands
carditis –> heart murmur and friction rub
polyarthritis of large joints
skin lesions
CNS involvement –> choreiform movements (jerking)
diagnosis/treatment of rheumatic heart disease
Dx: clinical picture, echo, presence of anti-strep Ab
Rx: prevent by treating strep throat
antibiotics to control infection
anti-inflammatories to limit valve damage
2 types of valvular heart disease
stenotic: produce resistance to forward blood flow
incompetent (regurgitate) valves: close incompletely, producing backflow
mitral stenosis
mitral valve doesn’t open all the way, often from fused leaflets from RHD
LV fills poorly (low SV and CO)
LA pressure is increased (pulmonary congestion)
symptoms of mitral stenosis
less CO: chest pain, weakness, fatigue
pulmonary congestion: SOB, AF, thrombi, Rt side HF
diastolic murmur
mitral regurgitation
mitral valve fails to close fully
retrograde flow into LA during systole –> systolic murmur
high LAP leads to high SV, but low forward SV
enlarged LV b/c volume work increased
eventually LV function is impaired
causes of mitral regurgitation
RHD
mitral valve prolapse
chordea tenineae/papillary muscle rupture
mitral valve prolapse
caused by Marfan’s syn, other conn. tissue disorders
beta blockers relieve symptoms
antibiotic prophylaxis to prevent complications
can cause mitral regurgitation
aortic stenosis
narrowed aortic valve increases resistance to LV ejection
pressure work of LV increased, SV decreased
systolic BP lowered, but LVP increased
systolic murmur
causes and symptoms of aortic stenosis
causes: congenital defect, acquired calcification
symptoms: angina, syncope (fainting), HF
aortic regurgitation
backflow from aorta to the LV during diastole
high SV, but CO to tissues decreased
low DBP, low CA perfusion
Diastolic murmur
LV failure if acute
LV dilation and hypertrophy if chronic
symptoms of aortic regurgitation
LV failure symptoms (dyspnea)
angina if DBP too low
pericardium
double-layered serous membrane … visceral and parietal
visceral: adheres to epicardium
parietal: fibrous and still
pericardium fluid in pericardial space
pericardial disease 3 types
acute pericarditis
pericardial effusion
cardiac tamponade
acute pericarditis
inflammation of pericardium from viral infection or systemic disease
exudate common –> scar formation
scar tissue on pericardium contracts = constrictive pericarditis
symptoms of acute pericarditis
chest pain
pericardial friction rub
ECG changes (high ST segments, low PR interval)
diagnosis and treatment of acute pericarditis
Dx: low VR –> ascites and distended jugular veins
Rx: antibiotics, NSAIDS
surgical resection
pericardial effusion
accumulation of serous fluid or blood in pericardial space
develops from trauma, inflammation, abnormal starlings forces
Rx: NSAIDS, pericardiocentesis (depends on size)
cardiac tamponade
life threatening complication of pericardial effusion
sudden increase in pericardial fluid & pericardial pressure
low venous return
patient in shock: high HR, low BP/CO, jugulars distended
pulsus paradoxus
part of cardiac tamponade
LV compressed from effusion
inspiration leads to high VR, reptum bulges to left
low SV and BP
causes of cardiac tamponade
surgery
trauma
cardiac rupture from MI
diagnosis/treatment of cardiac tamponade
Dx: ECG
Rx: percutaneous pericardiocentesis
surgical repair of trauma or cardiac rupture
3 types of primary cardiomyopathy
genetic
mixed
acquired
genetic: hypertrophic cardiomyopathy
excessive hypertrophy in septum
causes outflow obstruction -> symptoms like aortic stenosis
can cause sudden cardiac death
cause of hypertrophic cardiomyopathy
autosomal dominant disorder: mutations of cardiac muscle genes
seen in children/young adults
symptoms of hypertrophic cardiomyopathy
dyspnes
chest pain
fatigue
syncope with outflow obstruction
diagnosis and treatment of hypertrophic cardiomyopathy
Dx: echo
Rx: beta blockers to lower HR and increase LV filling
surgical excision of septum
mixed genetic: dilated cardiomyopathy
ventricles dilated w/ thin walls –> pump poorly
from infection, toxins (EtOH), autoimmune, genetics
symptoms and treatment of dilated cardiomyopathy
HF (low EF, PVCs), dyspnea, weakness
Rx: relieve HF symptoms with Digoxin, diuretics, vasodilators
2 types of acquired cardiomyopathy
myocarditis
peripartum cardiomyopathy
myocarditis
inflammation of heart muscle leads to necrosis
usually viral: coxsackievirus or HIV
mechanism of necrosis in myocarditis
direct cell destruction from infection
toxins released by infectious agent
autoimmune – molecular mimicry
symptoms, diagnosis, treatment of myocarditis
symptoms: none to HF, death, URI, flu-like symptoms
Dx: ECG, echo, CXR, biopsy
Rx: bed rest, O2, steroids, immune suppressants, antivirals, hemodynamic support
peripartum cardiomyopathy
develops late in pregnancy or in months after delivery
systolic HF
causes: infection, immune response, genetics???
may resolve spontaneously, but maybe not
