infectious diseases of the heart and valve disorders

Question 1

what is endocarditis

Answer 1

caused by bacteria, fungi or virus
effects ventricular and vavle functions
mortality 20-40%
staph aureus is the most common cause

Question 2

pt with increased rf endocarditis

Answer 2

men >60
pt with poor dentition 
hx of IV drugs 
type 2 diabetics 
hemodialysis patientns 
implanted CVP devices, pacemakers, defibs, LVADs 
prosthetic heart valves

Question 3

clinical manifestations of infective endocarditis

Answer 3

different organisms can cause different symptoms/decline example, S. aureus is rapid and progressive
S. Viridian has a subtler presentation
acute onset of fever appears in 90% of cases
subsides 2-3 days after onset of antibiotics
fever in more than 14 days may indicate the infection has penetrated the myocardium or metastasized

Question 4

presenting symptoms of infective endocarditis

Answer 4

chilld, night sweats, anorexia, myalgia, arthaligia, extreme fatigue and maliase, nausea, vomiting, SOB, CP, glomerulonephritis (from emobilization), heart murmur (90% of time and get worse with destruction)

Question 5

what can accidentally be diagnosed instead of endocarditis?

Answer 5

CHF, sepsis, meningitis, vasculitis, osteomyelitis.

Question 6

dermatological clues for endocarditis

“VIP”

Answer 6

Osler’s nodes, Roth spots, Janeway leisons, splinter hemmorhage on nail beds
petechiae

Question 7

Osler nodes

“VIP”

Answer 7

painful purple nodes on the fingertips, palm of hand and toes, dorsal aspect of the feet and earlobes, caused by septic emboli and are frequently seen caused by infective emboli

Question 8

Roth spots

“VIP”

Answer 8

exudative edematous hemorrhagic lesions on the retina

Question 9

Janeway leisons

“VIP”

Answer 9

small non painful lesions, typically red, found on the palm of the hands and soles of the

Question 10

complications of emolization

Answer 10

sites include 
lungs 
liver 
spleen 
kidneys 
bowels 
extremities 
illac, mensintary, coronary and middle cerebral arteries

Question 11

consider possible emobilization when what?

Answer 11

CP, dyspnea, tachypnea, diminished pulses, abd pain, oliguria, hematuria, TIA, or change in LOC

Question 12

how does endocarditis lead to glomulernephritis

Answer 12

emobilization

Question 13

diagnosing infective endocarditis

Answer 13

exam
cxr
2 positive blood cultures 24hrs apart
echocardiogram confirms where the vegetation is taking place, may be used through treatment to monitor progression

Question 14

what drug is used to treat fungal endocarditis?

Answer 14

amphotericin B

Question 15

what to do through trx of endocarditis

Answer 15

monitor peaks and troughs of antibiotics to be sure proper trx is happening

Question 16

indications for surgery in a patient with infective endocarditis

Answer 16

prosthetic valve
vegetation larger than 1cm
develops complications with a septal perferation

Question 17

types of surgical interventiosn with infective enocarditits

Answer 17

valve debridement or excision
valve debridement/ closure of abscess
debridement
valve replacement

Question 18

valve replacement surgery

Answer 18

patients with mechanical valve present a special challenge
their infection requires valve replacement to clear the infection
both prosthetic and native valve endocarditis should not be delayed

Question 19

complications of valve replacement surgery

Answer 19

CHF 
Cardiogenic shock 
Aortic abscess 
AV block 
systemic embolization 
infection resistant to antibiotic trx

Question 20

nursing care management of infective endocarditis

Answer 20

temp
antibiotic/fungals/virals
administer fluids
planned rest periods
Administer NSAIDs
tempid bath water and fan, dont let pt shiver
assess heart sounds for worsening murmur
assess for signs and symptoms of systemic emobilization
assess for signs and symptoms of pulmonary infarction and infiltrates
manage infection (PICC line)

Question 21

pediatric considersations of bacterial endocarditis

“VIP slide” chart in wongs book

Answer 21

prophylaxisis for high risk children
dentist should be informed of childs diagnosis
SBE prophylaxisis is now reserved for very high risk pts
parents should suspect and monitor for infection
nurse stresses any unexplained fever, weight loss, change in behavior must be brought to the practitioners attention immediately

Question 22

what is pericarditis

Answer 22

inflammation of the pericardium the membranous sac surrounding the heart

Question 23

pathophysiology of pericarditis

Answer 23

idiopathic 
normally viral, rarely bacterial 
disorder of connective tissues 
sarcoidosis 
disorder of adjacent structures 
ex. MI, Dissecting aneurism, plueral and pulmonary disease, neoplasic disease, hypersensitivity issues, trauma, radiation therapy, renal failure and uremia

Question 24

what happens to the heart in pericarditis

Answer 24

heart is restricted and cannot fill, pericardium becomes calcified, further restricting ventricular filling, restricted ventricular filling can cause increased vascular pressure leading to peripheral edema and hepatic failure

Question 25

clinical manifestations of pericarditis

Answer 25

may be asymptomatic chest pain is a characteristic symptom May have pain beneath clavical, neck or scapula pain is constant and may worsen on inspiration creaky/scratchy friction is heart and most commonly at the LL sternal border mild fever, elevated WBC, Anemia, elevated ESR elevated c-reactive proteins

Question 26

medical management of pericarditis

Answer 26

- determine cause - administer therapy for trx and relief - anaglesics and NSAIDS and steriods - periocardiocentisis - pericardial window allows continious drainage into the chest cavity - surgical removal of drainage into chest cavity - surgical removal of tough encasing pericardium may be necessary to release both ventricles from restrictive inflammation and scaring - pain management - sitting or leaning forward may help - reassure chest pain is not a MI - watch for cardiac tapomade - monitor for HF - monitor and manage cardiac function

Question 27

myocarditis what is it?

Answer 27

Inflammatory process of the myocardium causes heart dilation and mural thrombi mortality is based on severity of symptoms most people with mild symptoms recover completely most patients may recover completely

Question 28

what can cause myocarditis?

Answer 28

Microorganisms immune related agours after a systemic infection in patients receiving immunosuppressive therapy such as infective endocarditis, systemic lupus, and Chron's disease pharmacological trx like ethanol or radiation

Question 29

clinical manifestations of myocarditis

Answer 29

depends on the type of infection and degree of myocardial damage some patients may be a symptomatic or develop chest pain, syncope, palpitations, shortness of breath, flu like symptoms CHF or sudden cardiac death can occur

Question 30

management of myocarditis

Answer 30

``` undetectable abnormalities, so illness can go undetected tachy, chest pain, cardiac enlargement changed T and ST waves S1 mumur, gallop, systolic mumur treat w abx (PCN) elevated ESR and WBC place on best rest limit activity- no sports ```

Question 31

what drugs should be avoided in people with myocarditis

Answer 31

no beta blockers | no NSAIDS

Question 32

mitral valve prolapse (left atrium and left ventricle)

Answer 32

produces no symptoms rarely progresses causes sudden death portion of one or both leaflets balloons back into the atruim during systole

Question 33

medical and nursing management of mitral valve prolapse

Answer 33

``` eliminate ETOH and caffine monitor for dysrythmias stop tobacco antiarrythmic meds possibly hereditary educate pt on rf infective endocarditis and abx prophylaxis ```

Question 34

Chest pain w mitral valve prolapse may respond to

Answer 34

calcium channel blockers | nitrates

Question 35

pathophysiology of mitral regurgitation

Answer 35

results from one or more leaflets, or any structures of the valves annulus may stretch from enlargement of the heart

Question 36

clinical manifestations of mitral regurgitation

Answer 36

``` asymptomatic manifests as CHF if it is acute dyspnea, fatigue, weakness SOB Palipatations Pulomonary congestion ```

Question 37

medical management of mitral regurg

Answer 37

same ad heart failure after load reduction w ACE inhbitors may need surgical intervention such as valvoplasty or valve replacement anti coags and cardioversion to NSR ( tried first )

Question 38

pathophysiology of mitral stenosis

Answer 38

obstruction in blood flow to the LA to the LV leaflets may fuse together mitral valve may narrow orifice and progressively obstructs blood flow into the left ventricle

Question 39

clinical manifestations of mitral stenosis

Answer 39

symptoms may occur after valve losses 1/3 capacity progressive fatigue increases rt decreased CO enlarged atrium and increased pressure on lungs dry cough and wheezing hemopytisis palpatations orthopnea PND repeated respiratory infections

Question 40

Aortic regurgitation sounds

Answer 40

drum like sound no rest in heart beat

Question 41

pathophysiology of aortic regurgitation

Answer 41

blood from aorta returns to the left ventricle during diastole left ventricle dilates in attempt to accommodate the excess of blood LV hypertrophies

Question 42

clinical manifestations of aortic regurg

Answer 42

asymptomatic feeling of a forceful heart beat marked visable heart beats at temporal or coratid arteries dyspnea on exertion and fatigue

Question 43

medical management of aortic regurg

Answer 43

``` avoid physical excertion competitive sports isometric exercises treat dysrhythmias ace inhibitors trx of choice is valve replacement when there is LV hypertrophy ```

Question 44

aortic stenosis pathophysiology

Answer 44

progressive narrowing of the orifice bicuspid aortic valve occurs usually over several years or decades

Question 45

clinical manifestations of aortic stenosis

Answer 45

``` pt may be asyptomatic dyspnea on excretion orthopnea pulmonary edema parosyxmal nocturnal dyspnea syncope bc reduced bf to brain angina ```

Question 46

medical management of aortic stenosis

Answer 46

medications to treat dysrythmias or LV failure definitive treatment is valve replacement pts who are not candidates for surgery can have two balloon percutaneous treatments with or with out transcatheter aortic valve replacements