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Med surg 2 > Inflammatory Dysfunction and Valvular Dysfunction > Flashcards

Inflammatory Dysfunction and Valvular Dysfunction Flashcards

1
Q

what is a stenosis valve

A

constriction/narrowing - valve opening is smaller so the forward blood flood is restricted

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2
Q

what is a regurgitation valve

A

incomplete/insufficiency - incomplete closure of valve causing back flow of blood

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3
Q

majority of mitral valve cases result from…

A

rheumatic heart disease

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4
Q

what is mitral valve stenosis

A

scaring of leaflets and chordae tendinae

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5
Q

what happens in mitral valve stenosis

A

decreased blood flow from left atrium to left ventricle inhibiting ventricular filling which increases left atrial pressure and causes congested lungs

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6
Q

why would someone with mitral valve stenosis be at risk for a fib

A

because the stretching of the atrium because blood cant go through

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7
Q

what are some common ss of mitral valve stenosis

A

exertional dyspnea, diastolic murmmur, fatigue, palpitations

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8
Q

what is mitral valve regurgitation

A

mitral valve doesn’t close tightly, which allows blood to flow backward in the lungs where it just came

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9
Q

what are some causes for mitral valve regurgitation

A

MI, infective endocarditis, chronic rheumatic heart disease, mitral valve prolapse

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10
Q

what are some ss of mitral valve regurgitation

A

loud holystolic murmur heard in left ventricle, pulmonary edema, thready peripheral pulses

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11
Q

what are some ss of chronic mitral valve regurgitation

A

asymptomatic for years until eventually left ventricle failure -> weakness, fatigue, palpitations, left atrial enlargement, ventricular hypertrophy

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12
Q

when is aortic valve stenosis usually diagnosed

A

most are congenital so child hood- young adult - can have wear and tear problems too

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13
Q

what is the most common valve issue

A

aortic valve stenosis

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14
Q

what is aortic valve stenosis

A

obstruction flow from left ventricle to aorta which cause left ventricular hypertrophy

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15
Q

what does left ventricle hypertrophy lead to

A

decreased CO, pulmonary hyerptension, HF

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16
Q

when would someone need surgery for aortic valve stenosis

A

when surface area of valve is 1cm or less

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17
Q

what are some ss of aortic valve stenosis

A

systolic murmur, left ventricular failure triad (angina, syncope, excertional dyspnea)

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18
Q

what is the treatment for aortic valve stenosis

A

BETABLOCKERS, diuretics, use nitroglycerin carefully (may make chest pain worse)

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19
Q

what is aortic valve regurgitation

A

backward blood flow from ascending aorta to left ventricle which decreases myocardial contractility

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20
Q

what are the ss of acute aortic valve regurgitation

A

left ventricular failure, and cardiogenic shock (angina, hypotension, severe dyspnea) , high pitched diastolic murmur

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21
Q

what are some ss of chronic aortic valve regurgitation

A

asymptomatic for years, excertional dyspnea, angina, murmur

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22
Q

what is the gold standard for evaluating aortic disorder and most valvular disorders

A

CT scan with contrast

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23
Q

what drugs prevent heart failure

A

vasodilators (nitrates, ACE), positive inotroped (digoxin), diuretics (furesimide or bumetanide), beta blockers (METOPROLOL)

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24
Q

what is the treatment for valvular hear disease

A

drugs that prevent heart failure, sodium restrictions (2 g), anticoagulants, antidysrhythmias, prophylatic antibiotic (penicillin)

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25
Q

what is a percutaneous translumin ballon valvuoplasty

A

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

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26
Q

what is a valvulotomy

A

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

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27
Q

what is a valvuloplasty

A

regurg - repair of the valve by suturing the torn leaflets, chordae tenineae or papillary muscles

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28
Q

what is a mechanical (artifical) prostetic

A

valve replacement - more durable and last longer then biologic, requires long term anticoagulants, so the main risk is bleeding

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29
Q

what is biologic (tissue) bioprosthetic

A

valve replacement via tissue not as durable or lasting as long but you dont have to be on anticoagulants long term

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30
Q

what does APe To Man stand for

A

Aortic(persons right) pulmonary (persons left 2nd intercostal)
Tricuspid (4th intercostal left inner) mitral (5th intercostal space more left of tricuspid)

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31
Q

what are therapeutic valve for INR after mechanical valve replacement

A

2.5-3.5 if decreases or increases call doc

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32
Q

when should you teach a patient to seek medical care

A

infection, hf, bleeding, and if going to have procedure that requires penicillin

33
Q

what is myocardium

A

muscles of the heart

34
Q

what is endocardium

A

innermost - valves

35
Q

what is epicardium

A

outer layer

36
Q

how much can the pericardium space hole

A

10-15ml

37
Q

which ventricular wall is thicker

A

left 2-3x

38
Q

what is rheumatic heart disease

A

chronic condition resulting from rheumatic fever resulting in scarring and deformity of heart valves

39
Q

what is rheumatic fever

A

complication of group a strep pharyngitis

40
Q

can rheumatic fever be prevented

A

if antibodies started in time

41
Q

where is rheumatic fever mostly seen

A

young adults and underdeveloped countries

42
Q

what is rheumatic endocarditis

A

swelling and erosion of valve leaflets

43
Q

what are the ss of rheumatic heart disease

A

polyarthritis, carditis, nodules, heart enlargement, erythema marginatum, sydenhams chorea, fever, prolonged PR interval prolonged

44
Q

what labs would show rheumatic heart disease

A

elevated erythrocyte sedimentation rate, C-reactive protein (inflammation)

45
Q

what other tests could you do to diagnosis rheumatic heart disease

A

ECHO (valvular issues), chest xray (heart enlargement), ECG (PR interval prolonged)

46
Q

what is the treatment for rheumatic heart disease

A

penicillin 10 day course (erythromycin if allergic), inflammatory (NSAIDS or corticosteroids), prophylaxis antibiotic atleast till early 20s

47
Q

why would someone need to restart prophylaxis for rheumatic heart disease

A

any procedures affecting the mouth, infected skin or mucous layer, respiratory biopsy, or adenoidectomy

48
Q

what is pericarditis

A

inflammation of the pericardial sac

49
Q

what is the most common cause for pericarditis

A

idiopathic aka no one knows

50
Q

what could be some other causes for pericarditis

A

acute mi, cancer, trauma, lupus, scleroderma, viral/bacterial infections

51
Q

what are some ss of pericarditis

A

pain that worsens with deep inspiration but lessens when sitting forward, fever, dyspnea, pericardial friction rub (ask them to hold their breath)

52
Q

what labs would you take for pericarditis

A

CRP and ESR (inflammation)

53
Q

what would you see on an ECG for pericarditis

A

widespread ST elevation

54
Q

what could be some complications of pericarditis

A

pericardial effusion (build up of fluid making heart sound muffled), cardiac tamponade (all the fluid is compressing the heart),

55
Q

what are some ss of cardiac tamponade

A

muffled heart sounds, narrowed pulse pressure, neck vein distension, decrease in systolic BP on inspiration,

56
Q

what is the treatment for pericarditis

A

NSAIDs, Colchicine

57
Q

what is the treatment for cardiac tamponade

A

fluid bolus to dilate and allow the heart to pump until someone can get in there a pull that fluid out

58
Q

what is a pericardiocentesis

A

echo guided needle inserted to pull the extra fluid out

59
Q

what is something the nurse should do before pericardiocentesis

A

stop anticoagulants

60
Q

what is infective endocarditis

A

infection of the inner layer of heart including the valves (step viridans or strep aureus) can also be caused by viruses or fungi

61
Q

what are the risk factors for endocarditis

A

age, IV drug abuse, mechanical prosthetic devices, renal dialysis, rheumatic heart disease

62
Q

what are the ss for endocarditis

A

new or worsening murmur, fever, chills, weakness, anorexia,

63
Q

what are some vascular ss of endocarditis

A

splinter hemorrhages on nail beds, petechiae, Osler nodes on fingertips or toes, lesions on pads of fingers and toes

64
Q

what are some manifestations second to embolism for endocarditis

A

LUQ pain, hematuria, renal failure, necrotic toes, changes in mental status (worried about stroke), pulmonary emboli

65
Q

what kind of labs will you take for endocarditis

A

2 blood cultures from 2 different places, WBC, elevated erythrocyte sedimentation rate, c-reactive protien

66
Q

what is the treatment for endocarditis

A

IV antibiotics 4-6 weeks, repeate blood cultures every 24-48 hours, valve replacement if needed, Tylenol for fever, fluids, rest,

67
Q

what is myocarditis

A

focal or diffuse inflammation of the myocardium

68
Q

what could be the cause of myocarditis

A

viruses, bacteria, fungi, radiation, autoimmune, and idiopathic

69
Q

what are some ss of myocarditis

A

usually happens 7-10 days after viral infection - fever, fatigue, myalgias, pharyngitis, dyspnea, nv

70
Q

what is myocarditis usually the progression of

A

pericarditis and then myocarditis then heart failure

71
Q

how do you confirm myocarditis

A

endomyocardial biopsy in the first 6 weeks following infection

72
Q

what are some interventions for heart failure

A

elevate head of bed 30 degrees or more, rest periods, quiet enviornment, reduce risk for infection

73
Q

what is the main reason for heart transplant

A

cardiomyopathy

74
Q

what is cardiomyopathy

A

a group of diseases that directly affects myocardial structure or function

75
Q

what are the three main types of cardiomyopathy

A

dilated (degeneration of the heart), hypertrophic (left ventricular hypertrophy), or restrictive (ventricle is resistant to filling impairing diastolic filling)

76
Q

what are the risk factors for cardiomyopathy

A

african american, males, middle age, genetic, alcoholism (if just alcohol if they stop the heart can recover)

77
Q

what are the ss of cardiomyopathy

A

fatigue, dyspnea, orthopena, nv, anorexia, edema

78
Q

how do you diagnosis cardiomyopathy

A

ECHO, elevated NT-pBNP, or BNP

79
Q

what is the treatment for cardiomyopathy

A

heart failure treatment and eventually maybe a new heart

Med surg 2 (12 decks)

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