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Patho > Inflammatory and structural heart disorders > Flashcards

Inflammatory and structural heart disorders Flashcards

1
Q

Infective endocarditis

A

Disease of endocardial layer of the heart including heart valves

affects aortic and mitral valves most often

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2
Q

Classification of IE

A

By cause:
-IV drug use IE
-Fungal IE

By site of involvement
-prosthetic valve endocarditis

By severity
-Subacute form affects those with preexisting valve disease
-Acute for affects those with healthy valves

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3
Q

IE causative orgnaisms

A

Bacterial is most common
-Staphylococcus aureas (30%)
-Streptococcus viridans
-Coagulase negative staphylococci

Viruses

Fungi

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4
Q

Risk factors for IE

A

categories of high, moderate, and low risk exist

Principal risk factors:
-prosthetic valves
-hemodialysis
-IV drug abuse
-aging
-intravascular devices resulting in HAIs

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5
Q

Stages of IE

A

Bacteremia

Adhesion

Vegetation
-made of fibrin, leukocytes, platelets, and microbes
-stick to the valve or endocardium
-Parts break off and enter circulation
-Left veg can move to brain, kidneys, spleen
-Right veg can move to lungs

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6
Q

Clinical manifestation of IE

A

not super specific
FEVER, chills, weakness, malaise, fatigue, anorexia

Subacute:
-arthralgias, myalgias, back pain, abdominal pain, weight loss, headache, clubbing of fingers

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7
Q

Vascular manifestation of IE

A

-Splinter hemorrhages in nail beds
-Petechiae (pinpoints)
-Osler’s nodes on fingertips or toes
-Janeway’s lesions on pads of fingers and toes
-Roth’s spots (eyes)

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8
Q

Sound and secondary manifestation of IE

A

systolic murmur
HF

Secondary septic embolisms affect CNS, extremeties, spleen, and kidneys

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9
Q

Diagnostic studies for IE

A

History

Lab tests (from 3 places)
-blood cultures
-CBC with differential
-ESR, CRP

Echo (veg)

Chest xray (cardiomegaly)

ECG (1st or 2nd AV block)

Duke criteria

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10
Q

Prophylactic antibiotic treatment for who?

A

ppl undergoing certain dental procedures

Resp tract incisions

tonsillectomy and ademoidectomy

surgical procedures involving infected skin, skin structures, or musculoskeletal tissue

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11
Q

Interprofessional care for IE

A

-identify organism
-long term IV antibiotics
-repeat blood cultures (2 sets every 24 to 48 hrs)
-valve replacement if necessary
-antipyretics
-fluid
-rest

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12
Q

important assessment things

A

staph or strep infections
immunosuppressants
recent procedures

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13
Q

Typical nursing diagnoses for IE

A

impaired CO
activity intollerance

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14
Q

What to teach patients with high IE risk to promote health

A

Stress need to avoid infectious people (esp URI)
-avoid stress and fatigue
-plan rest periods
-have good oral hygiene
-prophylactic antibiotics
-drug rehab

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15
Q

Ambulatory care for IE

A

antibiotics for 4-6 weeks
-assess home setting
-monitor labs including blood cultures
-assess IV lines
-coping strategies

Adequate rest
-moderate activity
-compressio stockings
-ROM exercises
-deep breathing and coughing every 2 hrs

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16
Q

Teaching for home care of IE after hospitalization

A

-Monitor body temp (to see if antibiotics are effective)
-look for other signs of infection
-teach nature of the disease and how to reduce risk of reinfaction
-stress follow-up care, good nutrition, and prompt treatment of common infections (cold)
-Teach ab prophylactic antibiotics before procedures

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17
Q

Valvular heart disease types

A

defined according to valves affected and type of dysfunction (stenosis vs regurgitation)

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18
Q

Stenosis

A

constricting/ narrowing
-valve opening is smaller
-forward blood flow is impeded
-pressure differences on the two sides of the valve reflect the degree of stenosis

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19
Q

Regurgitation

A

incomplete or insufficiency of closure
-results in backward blood flow

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20
Q

Mitral valve stenosis
-common cause

A

common cause is rheumatic heart disease
-scarring of valve leaflets and chordae tendineae
-contractures develop with adhesions between commissures of the leaflets

Results in decreased blood flow from LA to LV
-increased atrial pressure/volume
-increased pulmonary vasculature pressure
-risk for atrial fibrillation

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21
Q

Clinical manifestations of mitral valve stenosis

A

exertional dyspnea
LOUD S1
diastolic murmur
fatigue
palpitations
hoarseness (atria pushes on larynx)
hemoptysis (pulmonary htn)
Afib –> stroke

22
Q

Mitral valve regurgitation: what is needed for normal functioning?

A

Need
-mitral leaflets
-mitral annulus
-chordae tendinea
-papillary muscles

23
Q

What messes up normal functioning of mitral valve, resulting in regurgitation?

A

MI
chronic rheumatic heart disease
mitral valve prolapse
ischemic papillary muscle dysfunction
IE

24
Q

What even is mitral valve regurgitation?!

Acute vs chronic

A

incomplete valve closure
-backward flow of blood
-LV and LA need to work harder

Acute MR –> pulmonary edema

chronic MR –> LA enlargement, ventricular dilation, eventual ventricular hypertrophy

25
Q

Acute MR manifestations

A

Thready peripheral pulse
Cool clammy extremeties

26
Q

Chronic MR manifestations

A

Asymptomatic for years

LV failure
-weakness, fatigue, palpitations, dyspnea
-progress to orthopnea, parozysmal nocturnal dyspnea
-peripheral edema

-Audible S3 an murmur

27
Q

Mitral valve prolapse

A

Abnormality of mitral valve leaflets and papillary muscle or chordae
-leaflets prolapse back into LA during systole

Usually benign, but sometimes can have complications (HF, MI, SCD,)

Unknown cause, but genetic link in some

28
Q

Diagnostic test for mitral valve prolapse

A

Echo:
-M-mode or
2D

29
Q

Clinical manifestation of mitral valve prolapse

A

Most ppl asymptomatic
-only 10% EVER get symptoms
-murmur from regurgitation
-severe MR is uncommon though

Dysrhythmias can cause
-palpitations
-light headedness
-syncope

IE

chest pain unresponsive to nitrates

30
Q

How to treat MVP

A

beta blockers help with chest pain and palpitations

valve surgery if severe MR

31
Q

Patient teaching for MVP

A

-antibiotic prophylaxis if MR present
-take your meds
-healthy diet –> avoid caffeine
-avoid OTC stimulants
-exercise
-know when to call HCP or EMS

32
Q

Aortic valve stenosis: child vs adult

A

Congenital aortic stenosis (AS) usually found in childhood or adolescence

In adults, its usually a result of rheumatic fever or degeneration

33
Q

What is AVS?

A

obstruction of blood flow from left ventricle to aorta
-causes left ventricular hypertrophy and increased myocardial oxygen consumption
-decreased CO leads to decreased tissue perfusion, pulmonary hypertension, and HF

**poor prognosis if untreated

34
Q

clinical manifestations of AVS

A

angina
syncope
exertional dyspnea

35
Q

Ausculatory findings in AVS

A

Normal to soft S1
Decreased or absent S2
Systolic murmur with radiation to carotids
Prominent S4

36
Q

Treatment of AVS

A

poor prognosis if symptomatic and not corrected

Use nitroglycerin cautiously
-reduces preload and BP
-can worsen chest pain though

37
Q

Aortic Valve Regurgitation: acute vs chronic

A

Acute AR
- from trauma, IE, or aortic dissection
-LIFE THREATENING EMERGENCY

Chronic
-rheumatic heart disease, congenital bicuspid aortic valve, syphilis, CT prob, or post-surgical issue

38
Q

What is AVR?

A

Backward blood flow from ascending aorta into left ventricle

with chronic AR, LV dilation and hypertrophy occur

Decrease in myocardial contractility

Pulmonary htn and RV failure

39
Q

Clinical manifestations of acute AR

A

-severe dypnea
-chest pain
-hypotension
-cardiogenic shock
-life-threatening emergency

40
Q

Clinical manifestation of chronic AR

A

may be asymptomatic for years
-exertional dyspnea, orthopnea, paroxysmal dyspnea
-angina
-“water-hammer” pulse if severe
-soft or absent S1
-S3 or S4
-Murmur

41
Q

Tricuspid valve stenosis

A

Almost always caused by rheumatic fever

Manifests
-fluttering discomfort in neck
-fatigue
-RUQ pain

42
Q

Pulmonic valve stenosis

A

-Almost always congenital
-Causes RV htn and hypertrophy

Manifestations
-syncope
-dyspnea
-angina

43
Q

Diagnostic studies for valvular heart diseases

A

Patient history/ physical
Echo and TEE
Chest xray
ECG (hr and hypertrophy)
Heart catheterization (pressure and valve size)

44
Q

Conservative therapy for valvular heart disease

A

-Dependent on valve invovled and disease severity
-prevent exacerbations of HF, pulmonary edema, thromboembolism, and recurrent RF and IE

Prophylactic antibiotics to prevent recurrent RF and IE

Drugs for HF
-vasodilators (nitrats, ACE-is)
-positive inotropes (dioxin)
-diuretics
-B-blockers

No sodium, anticoagulation, anti-dysrhythmic drugs

45
Q

Vavlular heart disease: Percutaneous transluminal balloon valvuloplasty

A

-split open the fused commissures
-treats stenosis for all valves
-balloon-tipped catheter inserted via femoral artery
-inflated to separate the valve leaflets

46
Q

Surgical therapy for valvular heart disease: valve repair

A

Valve repair
-preferred surgical procedure
-lower operative mortality rate than valve replacement
-might not restore total func

Types:
1. Commissurotomy (valvulotomy)
-closed or open (open is common)
2. Valvuloplasty
-open, minimally invasive
-usually for MR or TR
3. Annuloplasty

47
Q

Surgical therapy for valvular heart disease: Valve replacement

A
  1. Mechanical
    -more durable
    -lasts longer
    -higher risk of thromboembolism
    -requires long-term anticoagulation

2.Biologic (tissue)
-bovine, porcine, and human
-better blood flow
-less durable

48
Q

Transcatheter aortic valve replacement

A

For severe AS
-transfemoral approach

  1. Edwards Sapien 3 valve
  2. CoreValve transcatheter aortic valve
49
Q

Health promotion for Valvular disorders

A

Early treatment of strep
Prophylactic antibiotics for those with history
-teach patients symptoms to report

50
Q

Acute and ambulatory care for valvular disorders

A

Individualize rest and exercise
avoid strenuous activity
discourage tobacco
ongoing cardiac assessments to make sure drugs are working
Monitor INR for patient on anticoagulants

51
Q

Patient teaching: valvular disorders

A

-drug actions and side effects
-importance of prophylactic antibiotics
-info related to anticoagulation therapy
-when to seek medical care

52
Q

Follow up care for valvular disorders

A

Notify HCP for
-signs of infection, HF, or bleeding
-planned invasive or dental work

Medical-alert device or bracelet

Patho (44 decks)

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