Inflammatory Dysfunction and Valvular Dysfunction Focus Flashcards
what is mitral valve stenosis
Scarring of leaflets and chordae tendae decreasing blood flow from LA to LV increasing the pressure in LA
what is mitral valve regurgitation ss
loud holystolic murmur in LV, pulmonary edema, thready peripheral pulses
what could cause mitral valve stenosis
MI, ineffective endocarditis, chronic rheumatic heart disease, mitral prolapse
what is aortic valve stenosis
obstructive blood flow from LV to aorta which cause ventricular hypertrophy
what is the gold standard for diagnosing aortic valve disorders
CT scan with contrast
what does LV hypertrophy lead to
decreased cardiac output, pulmonary hypertension, HF
what meds prevent HF
vasodilators (nitrates, ACE), positive inotroped (digoxin), diuretics (furesimide, bumetanide), beta blockers (metoprolol)
what are the ss of chronic aortic valve regurgitation
asymptomatic for years
excertional dyspnea, angina, murmurs
what is the management/treatment of valvular heart disease
meds that prevent HF, sodium restriction less then 2 g, anticoagulants, anti dysrhythmias, prophylatic antibiotic (penicillin)
what is the teaching for when to seek medical care after someone gets a mechanical prosthetic
infection, HF, if going to have a procedure that requires penicillin
how much fluid can the pericardial space hold
10-15ml
what are the ss of mitral valve stenosis
congested lungs, exertional dyspnea, diastolic murmur, fatigue, palpitations
what do majority of mitral valve problems result from
rheumatic heart disease
when is surgery needed for aortic valve stenosis
when opening is 1cm or less
what is mitral valve regurgitation
mitral valve doesnt close properly causing back flow into the lungs
what are the ss of chronic mitral valve regurgitation
Asymptomatic for years until finally LV failure then weakness, fatigue, palpations, LA enlargement, ventricular hypertrophy
what meds are given for aortic valve stenosis
beta-blockers, diuretics, nitroglycerin (cautiously may make chest pain worse)
what is the most common valve issue
aortic valve stenosis - congenital
what are the ss of aortic valve stenosis
systolic murmur, LV failure triad (angina, syncope, exertional dyspnea)
what is a valvulotomy for and how does it work
for stenosis - takes dilator through top of LV into mitral valve opening and can remove clot
what is rheumatic heart disease and what is it caused by
caused by rheumatic heart fever = scaring and deformity of the heart valves
what is the therapeutic range for INR with a mechanical prosthetic
2.5-3.5 if not in range call doc
what are the ss of acute aortic regurgitation
LV failure, cardiogenic shock (angina, decreased BP, severe dyspnea) high pitched diastolic murmur
what is percutaneous transluminal balloon valvuloplasty and what is it used for
for stenosis, a balloon tipped catheter is taken up the femoral artery and inflated to open valve
who normally gets a percutaneous transluminal balloon valvuloplasty
someone who is poor surgery candidate
can you prevent rheumatic heart fever
if antibiotics started in time
who is mostly at risk for getting rheumatic heart fever
young adults, under developed countries
what is rheumatic endocarditis
swelling and erosion of valve leaflets
what labs diagnosis rheumatic heart disease
elevated erythrocyte sedimentation rate, C-reactive protien
when would someone need to take prophylactic antibiotic
any procedure effecting the mouth, infected skin, respiratory biopsy, or angioedema
what could be some causes for pericarditis
acute mi, cancer, trauma, lupus, scleroderma, viral/bacterial infections
what are the ss of pericarditis
pain worse with inspiration, pain decreased when sitting forward, fever, dyspnea, pericardial rub
when listening for pericardial rub what should you ask your patient
to hold their breath so you can hear it better
what are the meds of choice for pericarditis
NSAIDs, colchicine
what is the treatment for cardiac tamponade
fluid bolus until someone can pull that fluid off
what do you want to make sure you do before a pericadiocentesis
stop anticoagulants
what are the ss of rheumatic heart disease
polyarthritis, carditis, nodules, heart enlargement, erythema marginatum (skin rash), sydenhams chorea (involuntary movement of muscles), prolonged PR interval
how do you diagnosis rheumatic heart disease
ECHO to show heart valves, chest x ray to show heart enlargement, ECG to show prolonged PR interval
what are the meds used for rheumatic heart disease
penicillin (erythromycin if allergic), inflammatory NSAIDs or corticosteroids, prophylaxis antibiotic until at least early 20s
what do you see on an ECG for pericarditis
wide spread ST elevation
what are some complications for pericarditis
pericardial effusions (build up of fluid), cardiac tamponade (fluid compressing the heart)
what are the ss of cardiac tamponade
muffled heart sounds, narrowed pulse pressure, neck vein distention, decrease systolic BP on inspiration
what is ineffective endocarditis
infection of inner heart layer including the valves caused by staph viridans or strep aureus, viruses, or fungi
what are the risks for ineffective endocarditis
age, IV drug abuse, mechanical prosthetic, renal dialysis, rheumatic heart disease
what labs would you take to diagnosis ineffective endocarditis
2 blood cultures from 2 different sites, WBC, elevated erythrocyte sedimentation rate, c-reactive
what causes myocarditits
virues, bacteria, fungi, radiation, autoimmune
how do you confirm myocarditits with diagnostic tests
endomyocardial biopsy in first 6 weeks following infection
what are some interventions you can do for HF
elevate head of bed 30 degree or more, rest periods, quiet environment, decrease risk for infection
what are the 3 main types of cardiomyopathy
dilated (degeneration of the heart), hypertrophic (LV hypertrophy), restrictive (ventricular is resistant to filling)
what are the risks for cardiomyopathy
African Americans, male, middle age, genetics, alcoholism (if only cause is alcohol if they stop drinking the heart will heal)
what is the treatment for cardiomyopathy
HF treatment, eventually a new heart
what are the ss of ineffective endocarditis
new or worsening murmur, fever, chills, weakness, anorexia,
what are the ss of vascular endocardititis
splinter hemorrhages on nails, petechiae, osler nodes on finger tips or toes, lesions of pas of fingers or toes
how do you treat endocardititis
IV antibiotics for 4-6 weeks, repeat blood cultures every 24-48 hours, valve replacement if needed, Tylenol for fever
what are the ss of myocardititis
7-10 days after viral infection, fever, fatigue, myalgias, pharyngitis, dyspnea, nv
what is cardiomyopathy
group of disease that directly effect myocardial structure or function
what are the ss of cardiomyopathy
fatigue, dyspnea, orthopnea, nv, anorexia, edema
how do you diagnosis cardiomyopathy
ECHO, elevated NT-pBNP or BNP
