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Cardiovascular > infectious diseases of the heart and valve disorders > Flashcards

infectious diseases of the heart and valve disorders Flashcards

1
Q

what is endocarditis

A

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

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2
Q

pt with increased rf endocarditis

A 
men >60
pt with poor dentition 
hx of IV drugs 
type 2 diabetics 
hemodialysis patientns 
implanted CVP devices, pacemakers, defibs, LVADs 
prosthetic heart valves
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3
Q

clinical manifestations of infective endocarditis

A

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

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4
Q

presenting symptoms of infective endocarditis

A

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)

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5
Q

what can accidentally be diagnosed instead of endocarditis?

A

CHF, sepsis, meningitis, vasculitis, osteomyelitis.

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6
Q

dermatological clues for endocarditis

“VIP”

A

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

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7
Q

Osler nodes

“VIP”

A

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

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8
Q

Roth spots

“VIP”

A

exudative edematous hemorrhagic lesions on the retina

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9
Q

Janeway leisons

“VIP”

A

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

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10
Q

complications of emolization

A 
sites include 
lungs 
liver 
spleen 
kidneys 
bowels 
extremities 
illac, mensintary, coronary and middle cerebral arteries
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11
Q

consider possible emobilization when what?

A

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

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12
Q

how does endocarditis lead to glomulernephritis

A

emobilization

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13
Q

diagnosing infective endocarditis

A

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

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14
Q

what drug is used to treat fungal endocarditis?

A

amphotericin B

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15
Q

what to do through trx of endocarditis

A

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

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16
Q

indications for surgery in a patient with infective endocarditis

A

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

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17
Q

types of surgical interventiosn with infective enocarditits

A

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

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18
Q

valve replacement surgery

A

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

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19
Q

complications of valve replacement surgery

A 
CHF 
Cardiogenic shock 
Aortic abscess 
AV block 
systemic embolization 
infection resistant to antibiotic trx
20
Q

nursing care management of infective endocarditis

A

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)

21
Q

pediatric considersations of bacterial endocarditis

“VIP slide” chart in wongs book

A

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

22
Q

what is pericarditis

A

inflammation of the pericardium the membranous sac surrounding the heart

23
Q

pathophysiology of pericarditis

A 
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
24
Q

what happens to the heart in pericarditis

A

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

25
Q

clinical manifestations of pericarditis

A

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

26
Q

medical management of pericarditis

A
  • 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
27
Q

myocarditis what is it?

A

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

28
Q

what can cause myocarditis?

A

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

29
Q

clinical manifestations of myocarditis

A

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

30
Q

management of myocarditis

A 
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
31
Q

what drugs should be avoided in people with myocarditis

A

no beta blockers

no NSAIDS

32
Q

mitral valve prolapse (left atrium and left ventricle)

A

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

33
Q

medical and nursing management of mitral valve prolapse

A 
eliminate ETOH and caffine 
monitor for dysrythmias 
stop tobacco 
antiarrythmic meds 
possibly hereditary 
educate pt on rf infective endocarditis and abx prophylaxis
34
Q

Chest pain w mitral valve prolapse may respond to

A

calcium channel blockers

nitrates

35
Q

pathophysiology of mitral regurgitation

A

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

36
Q

clinical manifestations of mitral regurgitation

A 
asymptomatic 
manifests as CHF if it is acute 
dyspnea, fatigue, weakness 
SOB 
Palipatations
Pulomonary congestion
37
Q

medical management of mitral regurg

A

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 )

38
Q

pathophysiology of mitral stenosis

A

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

39
Q

clinical manifestations of mitral stenosis

A

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

40
Q

Aortic regurgitation sounds

A

drum like sound no rest in heart beat

41
Q

pathophysiology of aortic regurgitation

A

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

42
Q

clinical manifestations of aortic regurg

A

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

43
Q

medical management of aortic regurg

A 
avoid physical excertion 
competitive sports 
isometric exercises 
treat dysrhythmias 
ace inhibitors 
trx of choice is valve replacement when there is LV hypertrophy
44
Q

aortic stenosis pathophysiology

A

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

45
Q

clinical manifestations of aortic stenosis

A 
pt may be asyptomatic 
dyspnea on excretion
orthopnea 
pulmonary edema 
parosyxmal nocturnal dyspnea 
syncope bc reduced bf to brain 
angina
46
Q

medical management of aortic stenosis

A

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

Cardiovascular (5 decks)

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