Inflammatory Dysfunction and Valvular Dysfunction Flashcards
what is a stenosis valve
constriction/narrowing - valve opening is smaller so the forward blood flood is restricted
what is a regurgitation valve
incomplete/insufficiency - incomplete closure of valve causing back flow of blood
majority of mitral valve cases result from…
rheumatic heart disease
what is mitral valve stenosis
scaring of leaflets and chordae tendinae
what happens in mitral valve stenosis
decreased blood flow from left atrium to left ventricle inhibiting ventricular filling which increases left atrial pressure and causes congested lungs
why would someone with mitral valve stenosis be at risk for a fib
because the stretching of the atrium because blood cant go through
what are some common ss of mitral valve stenosis
exertional dyspnea, diastolic murmmur, fatigue, palpitations
what is mitral valve regurgitation
mitral valve doesn’t close tightly, which allows blood to flow backward in the lungs where it just came
what are some causes for mitral valve regurgitation
MI, infective endocarditis, chronic rheumatic heart disease, mitral valve prolapse
what are some ss of mitral valve regurgitation
loud holystolic murmur heard in left ventricle, pulmonary edema, thready peripheral pulses
what are some ss of chronic mitral valve regurgitation
asymptomatic for years until eventually left ventricle failure -> weakness, fatigue, palpitations, left atrial enlargement, ventricular hypertrophy
when is aortic valve stenosis usually diagnosed
most are congenital so child hood- young adult - can have wear and tear problems too
what is the most common valve issue
aortic valve stenosis
what is aortic valve stenosis
obstruction flow from left ventricle to aorta which cause left ventricular hypertrophy
what does left ventricle hypertrophy lead to
decreased CO, pulmonary hyerptension, HF
when would someone need surgery for aortic valve stenosis
when surface area of valve is 1cm or less
what are some ss of aortic valve stenosis
systolic murmur, left ventricular failure triad (angina, syncope, excertional dyspnea)
what is the treatment for aortic valve stenosis
BETABLOCKERS, diuretics, use nitroglycerin carefully (may make chest pain worse)
what is aortic valve regurgitation
backward blood flow from ascending aorta to left ventricle which decreases myocardial contractility
what are the ss of acute aortic valve regurgitation
left ventricular failure, and cardiogenic shock (angina, hypotension, severe dyspnea) , high pitched diastolic murmur
what are some ss of chronic aortic valve regurgitation
asymptomatic for years, excertional dyspnea, angina, murmur
what is the gold standard for evaluating aortic disorder and most valvular disorders
CT scan with contrast
what drugs prevent heart failure
vasodilators (nitrates, ACE), positive inotroped (digoxin), diuretics (furesimide or bumetanide), beta blockers (METOPROLOL)
what is the treatment for valvular hear disease
drugs that prevent heart failure, sodium restrictions (2 g), anticoagulants, antidysrhythmias, prophylatic antibiotic (penicillin)
what is a percutaneous translumin ballon valvuoplasty
stenosis for valvular heart disease - a balloon tipped catheter inserted through the femoral artery and inflated to separate valve leaflets - generally for poor surgery candidates
what is a valvulotomy
stenosis - surgeon inserts a dilator through the apex of the left ventricle into the opening of the mitral valve and then can remove the clot from the atrium
what is a valvuloplasty
regurg - repair of the valve by suturing the torn leaflets, chordae tenineae or papillary muscles
what is a mechanical (artifical) prostetic
valve replacement - more durable and last longer then biologic, requires long term anticoagulants, so the main risk is bleeding
what is biologic (tissue) bioprosthetic
valve replacement via tissue not as durable or lasting as long but you dont have to be on anticoagulants long term
what does APe To Man stand for
Aortic(persons right) pulmonary (persons left 2nd intercostal)
Tricuspid (4th intercostal left inner) mitral (5th intercostal space more left of tricuspid)
what are therapeutic valve for INR after mechanical valve replacement
2.5-3.5 if decreases or increases call doc
when should you teach a patient to seek medical care
infection, hf, bleeding, and if going to have procedure that requires penicillin
what is myocardium
muscles of the heart
what is endocardium
innermost - valves
what is epicardium
outer layer
how much can the pericardium space hole
10-15ml
which ventricular wall is thicker
left 2-3x
what is rheumatic heart disease
chronic condition resulting from rheumatic fever resulting in scarring and deformity of heart valves
what is rheumatic fever
complication of group a strep pharyngitis
can rheumatic fever be prevented
if antibodies started in time
where is rheumatic fever mostly seen
young adults and underdeveloped countries
what is rheumatic endocarditis
swelling and erosion of valve leaflets
what are the ss of rheumatic heart disease
polyarthritis, carditis, nodules, heart enlargement, erythema marginatum, sydenhams chorea, fever, prolonged PR interval prolonged
what labs would show rheumatic heart disease
elevated erythrocyte sedimentation rate, C-reactive protein (inflammation)
what other tests could you do to diagnosis rheumatic heart disease
ECHO (valvular issues), chest xray (heart enlargement), ECG (PR interval prolonged)
what is the treatment for rheumatic heart disease
penicillin 10 day course (erythromycin if allergic), inflammatory (NSAIDS or corticosteroids), prophylaxis antibiotic atleast till early 20s
why would someone need to restart prophylaxis for rheumatic heart disease
any procedures affecting the mouth, infected skin or mucous layer, respiratory biopsy, or adenoidectomy
what is pericarditis
inflammation of the pericardial sac
what is the most common cause for pericarditis
idiopathic aka no one knows
what could be some other causes for pericarditis
acute mi, cancer, trauma, lupus, scleroderma, viral/bacterial infections
what are some ss of pericarditis
pain that worsens with deep inspiration but lessens when sitting forward, fever, dyspnea, pericardial friction rub (ask them to hold their breath)
what labs would you take for pericarditis
CRP and ESR (inflammation)
what would you see on an ECG for pericarditis
widespread ST elevation
what could be some complications of pericarditis
pericardial effusion (build up of fluid making heart sound muffled), cardiac tamponade (all the fluid is compressing the heart),
what are some ss of cardiac tamponade
muffled heart sounds, narrowed pulse pressure, neck vein distension, decrease in systolic BP on inspiration,
what is the treatment for pericarditis
NSAIDs, Colchicine
what is the treatment for cardiac tamponade
fluid bolus to dilate and allow the heart to pump until someone can get in there a pull that fluid out
what is a pericardiocentesis
echo guided needle inserted to pull the extra fluid out
what is something the nurse should do before pericardiocentesis
stop anticoagulants
what is infective endocarditis
infection of the inner layer of heart including the valves (step viridans or strep aureus) can also be caused by viruses or fungi
what are the risk factors for endocarditis
age, IV drug abuse, mechanical prosthetic devices, renal dialysis, rheumatic heart disease
what are the ss for endocarditis
new or worsening murmur, fever, chills, weakness, anorexia,
what are some vascular ss of endocarditis
splinter hemorrhages on nail beds, petechiae, Osler nodes on fingertips or toes, lesions on pads of fingers and toes
what are some manifestations second to embolism for endocarditis
LUQ pain, hematuria, renal failure, necrotic toes, changes in mental status (worried about stroke), pulmonary emboli
what kind of labs will you take for endocarditis
2 blood cultures from 2 different places, WBC, elevated erythrocyte sedimentation rate, c-reactive protien
what is the treatment for endocarditis
IV antibiotics 4-6 weeks, repeate blood cultures every 24-48 hours, valve replacement if needed, Tylenol for fever, fluids, rest,
what is myocarditis
focal or diffuse inflammation of the myocardium
what could be the cause of myocarditis
viruses, bacteria, fungi, radiation, autoimmune, and idiopathic
what are some ss of myocarditis
usually happens 7-10 days after viral infection - fever, fatigue, myalgias, pharyngitis, dyspnea, nv
what is myocarditis usually the progression of
pericarditis and then myocarditis then heart failure
how do you confirm myocarditis
endomyocardial biopsy in the first 6 weeks following infection
what are some interventions for heart failure
elevate head of bed 30 degrees or more, rest periods, quiet enviornment, reduce risk for infection
what is the main reason for heart transplant
cardiomyopathy
what is cardiomyopathy
a group of diseases that directly affects myocardial structure or function
what are the three main types of cardiomyopathy
dilated (degeneration of the heart), hypertrophic (left ventricular hypertrophy), or restrictive (ventricle is resistant to filling impairing diastolic filling)
what are the risk factors for cardiomyopathy
african american, males, middle age, genetic, alcoholism (if just alcohol if they stop the heart can recover)
what are the ss of cardiomyopathy
fatigue, dyspnea, orthopena, nv, anorexia, edema
how do you diagnosis cardiomyopathy
ECHO, elevated NT-pBNP, or BNP
what is the treatment for cardiomyopathy
heart failure treatment and eventually maybe a new heart
