heart 7b inflammation Flashcards
Myocarditis
Focal or diffuse inflammation of the myocardium Most patients with mild symptoms completely recover Others may develop cardiac dysfunction and cardiomyopathy The degree of inflammation and necrosis determines the haemodynamic effect
Myocarditis causes
Viral (influenza, HIV, coxsackievirus A & B) Bacterial Parasitic Rheumatic Fever Patients with IE Rheumatic disease (SLE, Chrohns) Radiation therapy Pharmacological agents (immunosuppressants, anthracycline antibiotics for cancer patients)
Multidisciplinary Care and Management myocarditis
Determine cause and treat as appropriate.
• Educate and reassure patient
• Ensure adequate rest (physical activity to be reduced until cardiac
function improves, sometimes up to 6 months)
• Prevent thromboembolic complications
• Monitor for signs and symptoms of heart failure
• Patient may need cardiac monitoring
Valvular Heart Disease
Stenosis:
• Prolapse
• Regurgitation
Stenosis:
valve that is unable to open fully,
restricting the forward flow of blood.
Prolapse:
valve (mitral) abnormality in the leaflet,
papillary muscles or cordae that allows the leaflets
to buckle back (prolapse) into the atrium during
systole
Regurgitation
ncomplete closure of the valve
resulting in backwards flow of blood (also called
incompetence or insufficiency)
Aortic Valvular Disease
Aortic Stenosis
Aortic regurgitation
Aortic Stenosis
• One of the most commonly acquired valvular diseases. • Normal aortic valve has three leaflets, however some people are born with 1 or 2 aortic valve leaflets. • The narrowed aortic valve leads to LV dilation. Eventually leading to LV failure with decrease in cardiac output and ejection fraction.
Causes Aortic Stenosis
Aortic stenosis is often the result of
degenerative calcifications caused by
inflammatory processes, congenital
abnormalities or rheumatic endocarditis
Aortic regurgitation
Leads to leakage of blood from the aorta into the LV during diastole/repolarisation as the valve leaflets do not close properly Regurgitation through the aortic valve leads to LV dilation and hypertrophy, eventually LVF.
Aortic regurgitation causes
Causes include congenital heart abnormalities, infectious diseases, endocarditis, dissecting aneurysm or deterioration of an aortic valve replacement. Can also be idiopathic.
Mitral Valve disease
Mitral valve prolapse
Mitral valve regurgitation
Mitral valve stenosis
Mitral valve prolapse
This valve is under significant pressure • It is the most common valve disorder, 25 -50% of cases are hereditary. • Can progress to MR
Mitral valve regurgitation
MR leads to leakage of blood between the LV and LA during systole • Caused by degenerative changes in the mitral valve (stenosis) or ischaemia to LV (MI), IE, RHD, structural changes to the left atrium or ventricle and collagen - vascular diseases (SLE)
Mitral valve stenosis
Decreases the amount of
blood flowing into the LV
due to thickened,
narrowed valve.
Pulmonary Valve Disease
Pulmonary valve disease usually related to congenital problems • Leads to right sided heart failure • Often discovered in infants more commonly than in adults • Causes include congenital anomalies, cardiac tumors, pulmonary hypertension, dilation of pulmonary artery and trauma
Tricuspid valve disease
rare/uncommon • Stenosis occurs more commonly than regurgitation • Leads to right atrial enlargement and elevated systemic venous pressures • Causes include RHD, congenital anomalies, right atrial tumor, extracardiac tumors and pacemaker leads
Although rare triple
valve disease can
occur in patients who
have RHD
involves the mitral, aortic and tricuspid valves. Patients often present in heart failure and need prompt surgical management
Diagnosis of Valvular Heart Disease
• Patient history • Physical assessment • Chest X-ray • ECG • Echocardiogram (Doppler or TOE) • Cardiac catheterisation
Management of Valvular Heart Disease
The purpose of valvular intervention is to improve symptoms and/or
prolong survival, as well as to minimize the risk of valvular heart
disease related complications such as asymptomatic irreversible
ventricular dysfunction, pulmonary hypertension, stroke and atrial
fibrillation.
Management of Valvular Heart Disease
Conservative therapy
Prevent ARF and IE
• Ensure patient understands and adheres to medication regime
• Monitor for adverse effects of medications
• Monitor vital signs
• Auscultate heart and lung sounds and assess peripheral pulses
• Monitor for signs and symptoms of heart failure
• Monitor patient for angina and palpitations. Ensure patient is aware of how to
take glyceryl trinitrate for angina
• Ensure patient gets adequate rest and sleep
• Weigh patient daily and monitor for weight gain over 1.5 kg in a day or 3 kg in a
week
Surgical Management
The majority of valve replacements are aortic valves followed by mitral. Many surgical
procedures require a sternotomy and cardiopulmonary bypass surgery. Some
procedures can not be performed via minimally invasive techniques
