Inflammatory And Structural Heart Disorders Flashcards
Stenosis vs regurgitation
Stenosis: wont open
Regurgitation: leaky valve (doesnt close all the way)
blood leaks backwards when contracting
Murmurs
Whoosh (abnormal blood flow)
Usually a valve disease
Asymptomatic early
Eventually lead to HF (bc blood backs up)
Diagnostic testing
EKG: rhythms (remodeling)
ECHO: ultrasound (structure of heart)
Cardiac cath
Monitor:
BP (may drop due to HF)
Rhythm (due to remodeling)
Valve replacement
Mechanical: last longer, man made
*must have lifelong anticoagulation (warfarin)
*heart sounds will be click due to mechanical valve
*watch for bleeding, take vit k, check pt and inr
Biologic: real tissue, no AC needed
*best if noncompliant
Pre/post ops: similar to cabg (allergies, meds, anestesia reaction, malignant hypothermia, HR, BP, HF
Caridiomyopathy
Dilated
Most common
Dilated ventricles leading to reduced contractility and HF
Causes:
HTN
Pregnancy
Genetic
Cardiomyopathy
Hypertrophic
Thickening of chamber walls causing decreased CO
Causes: genetics
Cardiomyopathy
Restrictive
Cause unknown
Hypertrophy causes stiffness, venticles cant fill
Associated with sarcoidosis, amyloidosis
Cardiomyopathy
S/s
Tx
S/s:
Usually HF : dyspnea, fatigue, palpitations
Tx: similar to HF
Pacemaker and AICD
Heart transplant
LVAD
Takotsubo cardiomyopathy
Broken heart syndrome
S/s
Normal
Caused
Most common
S/s:
Chest pain
ST elevation
Elevated troponin/ cardiac markers
Cardiac cath is normal
Caused by stress
Most common in postmenopausal women
Rheumatic heart disease
Associated with strep pharyngitis in children (white patchs high fever)
Best tx is prevention
Infection damages heart valves (usually mitral)
Mitral stenosis, regurgitation
Infective endocarditis
RF
40% death rate within a year
Risk Factors:
Increased age
Prosthetic valve (foreign)
Congenital heart disease
IV drug abuse
Hospital acquired (central lines)
Dental infections
Infective endocarditis
What is it
RF
Vegetations made up of fibrin, wbc, plt, microbes
They can break off to become emboli
Rf: stroke, clot
Infective endocarditis
Clinical manifestations
Fever
New murmur
Splinterhemorrhages
Osler nodes
Janeway lesions
Septic emboli
Immune complexes deposit in fingers in toes causing
Septic emboli:
Splinter hemorrhages
Janeway lesions: painless, flat
Immune complexes deposit in fingers in toes causing:
Osler nodes: painful, raised
Infective endocarditis
Diagnostic studies
Blood cultures
Echocardiogram
Elevated WBC
Infective endocarditis
Management
Prevention:
Dental hygiene: infection get into blood stream
CVAD: CHG, hand hygiene, dressing change
Antibiotics:
Decrease WBC, fever, take 4-6 weeks
Go home on picc line
May require valve replacement
Pericarditis
Inflammation of pericardium
Can lead to fluid buildup in sac
Scarring/thickening of pericardium can decrease ability to fill
Acute pericarditis
Clinical manifestations
Sharp chest pain: improves with sitting up/leaning forward
Hallmark: pericardial friction rub
*scratching/creaky sound
*heard best at lower left sternal border with pt leaning forward
*have them hold breath
Pericarditis
Diagnostic studies
ECG: diffuse ST change (not localized bc pericardium surround whole heart
Echocardiogram show tamponade
Leukocytosis
Elevated troponin (damages heart muscle)
Pericarditis tx and management
Pain:
NSAID, corticosteroids
Positioning
Bedrest
Monitor complications:
Pericardial effusion, cardiac tamponade
Pericardial effusion/cardiac tamponade
What each is
S/s
Pericardial effusion: increased fluid around the heart
cardiac tamponade: pericardial effusion grows and compresses the heart
S/s:
Becks triad: hypotension, muffled heart sounds, JVD
Pulsus paradoxus: SBP goes down during inspiration
Pericardial effusion/cardiac tamponade
Management
Pericardiocentesis: remove fluid
Pericardiotomy: make a hole for it to leak out