Inflammatory And Structural Heart Disorders

Question 1

Stenosis vs regurgitation

Answer 1

Stenosis: wont open

Regurgitation: leaky valve (doesnt close all the way)
blood leaks backwards when contracting

Question 2

Murmurs

Answer 2

Whoosh (abnormal blood flow)
Usually a valve disease

Asymptomatic early

Eventually lead to HF (bc blood backs up)

Question 3

Diagnostic testing

Answer 3

EKG: rhythms (remodeling)

ECHO: ultrasound (structure of heart)

Cardiac cath

Monitor:
BP (may drop due to HF)
Rhythm (due to remodeling)

Question 4

Valve replacement

Answer 4

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

Question 5

Caridiomyopathy
Dilated

Answer 5

Most common

Dilated ventricles leading to reduced contractility and HF

Causes:
HTN
Pregnancy
Genetic

Question 6

Cardiomyopathy
Hypertrophic

Answer 6

Thickening of chamber walls causing decreased CO

Causes: genetics

Question 7

Cardiomyopathy
Restrictive

Answer 7

Cause unknown
Hypertrophy causes stiffness, venticles cant fill

Associated with sarcoidosis, amyloidosis

Question 8

Cardiomyopathy
S/s
Tx

Answer 8

S/s:
Usually HF : dyspnea, fatigue, palpitations

Tx: similar to HF
Pacemaker and AICD
Heart transplant
LVAD

Question 9

Takotsubo cardiomyopathy
Broken heart syndrome
S/s
Normal
Caused
Most common

Answer 9

S/s:
Chest pain
ST elevation
Elevated troponin/ cardiac markers

Cardiac cath is normal
Caused by stress
Most common in postmenopausal women

Question 10

Rheumatic heart disease

Answer 10

Associated with strep pharyngitis in children (white patchs high fever)
Best tx is prevention

Infection damages heart valves (usually mitral)
Mitral stenosis, regurgitation

Question 11

Infective endocarditis
RF

Answer 11

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

Question 12

Infective endocarditis
What is it
RF

Answer 12

Vegetations made up of fibrin, wbc, plt, microbes

They can break off to become emboli

Rf: stroke, clot

Question 13

Infective endocarditis
Clinical manifestations

Answer 13

Fever
New murmur
Splinterhemorrhages
Osler nodes
Janeway lesions

Question 14

Septic emboli

Immune complexes deposit in fingers in toes causing

Answer 14

Septic emboli:
Splinter hemorrhages
Janeway lesions: painless, flat

Immune complexes deposit in fingers in toes causing:
Osler nodes: painful, raised

Question 15

Infective endocarditis
Diagnostic studies

Answer 15

Blood cultures

Echocardiogram

Elevated WBC

Question 16

Infective endocarditis
Management

Answer 16

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

Question 17

Pericarditis

Answer 17

Inflammation of pericardium

Can lead to fluid buildup in sac

Scarring/thickening of pericardium can decrease ability to fill

Question 18

Acute pericarditis
Clinical manifestations

Answer 18

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

Question 19

Pericarditis
Diagnostic studies

Answer 19

ECG: diffuse ST change (not localized bc pericardium surround whole heart

Echocardiogram show tamponade

Leukocytosis

Elevated troponin (damages heart muscle)

Question 20

Pericarditis tx and management

Answer 20

Pain:
NSAID, corticosteroids
Positioning

Bedrest

Monitor complications:
Pericardial effusion, cardiac tamponade

Question 21

Pericardial effusion/cardiac tamponade
What each is
S/s

Answer 21

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

Question 22

Pericardial effusion/cardiac tamponade
Management

Answer 22

Pericardiocentesis: remove fluid

Pericardiotomy: make a hole for it to leak out