Inflammatory/Structural Heart Disorders Flashcards
What is the Endocardium?
- The endocardium is the innermost layer of the heart.
- It lines the inside of the heart chambers and covers the heart valves.
- Think of it as a smooth, protective coating that helps blood flow easily inside the heart.
- It also plays a role in the heart’s electrical system, which controls your heartbeat.
Infection of the endocardial layer of the heart
INFECTIVE ENDOCARDITIS (IE)
IE is almost always caused bY
bacterial infection
2 most common organisms to cause IE are
- Staphyloccus aureus (skin)
- Streptoccus viridians (mouth, resp, GI, GU tracts)
What are the primary sites where bacteria establish infection in endocarditis?
Bacteria need these 2 things
- Previously damaged areas of the endocardium
- Artificial surfaces (e.g., prosthetic valves)
(these creates a rough surface making it easy for bacteria to latch on)
know
Irregular growths made of bacteria and cell pieces (fibrin, leukocytes, platelets) form ___.
vegetations
Pieces of the vegetations that break off and enter the systemic circulation
Emboli
Systemic emboli are going to move ___ in the circulation.
DISTALLY- with the flow of blood, not backwards!! –
causing blockages in arteries downstream from where they broke loose.
Main 3 symptoms for Infective Endocarditis
- Fever
- murmurs **
- Clubbing of fingers
know
Further assessment for endocarditis should include
listening to heart sounds to assess for NEW or WORSENING MURMURS (wooshing sounds)
What signs might be present if embolization has occurred?
The clinical signs depend on the organ or tissue affected by the embolus.
What patients are at higher risk for INFECTIVE ENDOCARTDITIS?
List 6
- Aging ( > 50% of older people have calcified aortic stenosis)
- IVDA (Intravenous Drug Abuse)
- Use of prosthetic valves
- Intravascular (IV) devices (Central lines, Implanted ports, etc.)
- Renal Dialysis
- Previous cardiac disease
know
Know the 6 signs of a STROKE
BE FAST
* Balance difficulties
* Eyesight changes
* Face weakness
* Arm weakness
* Speech difficulties
* Time- Call 911
Another term for Stroke
CEREBRAL VASCULAR ACCIDENT
S/S if vegetation is present ONLY on the LEFT SIDE of heart
List 5
- Petechiae
- Splinter Hemorrhages
- Osler’s Nodes
- Janeway’s Lesions
- Roth’s Spots
know
Small areas of bleeding under fingernails or toenails.
What am I?
Splinter Hemorrhage
(Damage to capillaries caused by small emboli)
Flat, painless red spots on palms and
soles
Janeway Lesions
Painful, pea-sized, red or purple
lesions on fingers or toes
Osler’s Nodes
Hemorrhagic retinal lesions
Roth’s Spots
How will we diagnose Infective Endocarditis?
2 main DX
- Blood cultures (most likely positive)
- Echocardiography
know
IE EKG findings would most likely read
afib or heart blocks
Tx for IE will include
List 4
- Antibiotics (usually Long-term)
- Fungal infective endocarditis (treat with anti-fungals)
- Associated fever: treated with fluids, rest, and acetaminophen
- replace infected prosthetic valves- surgically
Do we give Anticoags for IE?
No- it practically does nothing.
* will NOT break down vegetation
* bacterial clump is NOT a blood clot
A patient with a history of Infective Endocarditis (IE) is being discharged. What education should the nurse provide to ensure the patient prevents future complications?
List 6
- Avoid contact with individuals who are sick to reduce the risk of infection.
- Importance of communicating hx of IE to future healthcare providers (MD’s, DDS, etc)
- Monitor for s/s of infection such as fever, heart failure, or emboli.
- Teach importance of adherence to treatment regimen
- Schedule follow-up echocardiograms after completing the course of antibiotics.
- Possible bedrest or acitivity limitations
A condition caused by inflammation of the pericardial sac (the pericardium), which may occur in an acute or chronic form.
Pericarditis
What symptom do patients most often present with in Acute Pericarditis
frequent, severe, sharp chest pain
- bc of inflammation, the pericardium layers rub on each other or other surrounding parts causing the pain.
How to alleviate pain for patients with Acute Pericarditis?
Sitting up and leaning forward often relieves pain
How do you differentiate Pericarditis and MI?
Nothing alleviates pain for MI
A patient presents with chest pain, and the nurse suspects pericarditis. What is the hallmark finding that would support this diagnosis?
A. Elevated blood pressure
B. Pericardial friction rub
C. Decreased breath sounds
D. Jugular vein distention
B. Pericardial friction rub
scratching, grating, high-pitched sound
know
A patient is being assessed for chest pain, and the nurse is trying to differentiate between pericardial friction rub and pleural friction rub. Which statement correctly describes a key difference between the two types of friction rubs?
A. A pericardial friction rub will disappear when the patient holds their breath, while a pleural friction rub will persist.
B. A pleural friction rub will disappear when the patient holds their breath, while a pericardial friction rub will persist.
C. Both pericardial and pleural friction rubs will disappear when the patient holds their breath.
D. Neither pericardial nor pleural friction rubs will change when the patient holds their breath.
B. A pleural friction rub will disappear when the patient holds their breath, while a pericardial friction rub will persist.
(pleural = lungs ; pericardial = heart)
EKG finding on Pericarditis
Diffuse (all over) ST Segment ELEVATIONS
- ST Segment should be isoelectric
(troponin levels high)
Abnormal collection of fluid in the pericardial sac
What am I?
Pericardial Effusion
FIRST step to treat Pericardial Effusion?
Treat whatever is causing the pericardial effusion FIRST
(Example: if pericarditis is causing p.effusion, treat pericarditis first)
Compression of the heart that results as pericardial fluid volume continues to increase. Restricts the heart from stretching.
What am I?
Cardiac Tamponade
(ALWAYS a medical emergency- can kill pt)
S/S of cardiac tamponade
- Patient may report chest pain
- confused, anxious, and restless
- tachypnea
- tachycardia
- JVD
Beck’s Triad= Distant/muffled heart sounds, JVD, Hypotension
As a nurse, how would you help your pt alleviate Cardiac Tamponade s/s?
Nurse arent able to do anything for Tamponade. We need to get Dr involved so they can perform PERICARDIOCENTESIS.- surgically remove fluid
What 4 meds are available to manage/treat Pericarditis
Management is aimed at treating underlying cause
- NSAIDS – used to control pain and inflammation
- Indomethacin, aspirin, ibuprofen
-
Colchicine – anti-inflammatory drug often used for gout – used for recurrent
pericarditis -
Corticosteroids – used if cause is rheumatologic or autoimmune
-Avoided if possible due to multiple side effects - its an immunosupressant - Antibiotics- treats bacterial pericarditis9
What are the FIRST meds you will use for Pericarditis?
NSAIDs and Colchecine
You are caring for a patient with pericarditis. Which of the following interventions are most appropriate for managing their condition?
Select all that apply:
A. Position the patient in a high Fowler’s or tripod position to facilitate pain relief and optimize respiratory mechanics.
B. Initiate oxygen therapy (if indicated) and closely monitor pulse oximetry and arterial blood gases (ABGs) to assess and manage oxygenation status.
C. Implement strategies for pain and anxiety control, including instructing the patient to sit up and lean forward and applying chest splinting techniques as necessary.
D. Educate the patient on their condition and treatment plan.
E. Advise the patient to lie flat to maximize lung expansion, despite the risk of exacerbating pain and discomfort.
A. Position the patient in a high Fowler’s or tripod position to facilitate pain relief and optimize respiratory mechanics.
B. Initiate oxygen therapy (if indicated) and closely monitor pulse oximetry and arterial blood gases (ABGs) to assess and manage oxygenation status.
C. Implement strategies for pain and anxiety control, including instructing the patient to sit up and lean forward and applying chest splinting techniques as necessary.
D. Educate the patient on their condition and treatment plan.
NOT E.
Location of pericarditis pain
- Precordium or left trapezius ridge
* has a sharp, pleuritic quality that increases with inspiration
- Precordium or left trapezius ridge
Diffuse (entire) inflammation of the myocardium (heart muscle)
What am I?
Myocarditis
Myocarditis is often present concurrently with what two other conditions
pericarditis and endocarditis
(s/s vary for myocarditis)
Myocarditis:
EARLY cardiac signs mimic ___.
Pericarditis
* pleuritic chest pain, fricition rub, effusion
Late cardiac signs mimic ___.
Heart Failure
6 S/S of Heart failure
- S3/S4 heart sound
- crackles- in lungs due to fluid buildup in lungs
- jugular venous distention
- syncope
- peripheral edema
- angina (chest pain)
Specific MYOCARDITIS diagnostic
Endo-Myocardial Biopsy
* Invasive procedure and therefore accompanied by risks
Is there a NON-INVASIVE diagnostic for Myocarditis?
Nope
What do treatment and interventions for myocarditis primarily focus on?
managing the signs and symptoms of HEART FAILURE.
Drug therapy for Heart Failure (and myocarditis) includes
- ACE-Inhibitors: end in -pril
- Beta-blockers: end in -olol
- Diuretics: loop, thiazide, k+ sparing
- Nitrates: nitroglycerin vasodilator
- Positive Inotropes
How does the stage of a patient’s HEART FAILURE affect their medication regimen?
The stage of a patient’s heart failure dictates which medications they are prescribed, as treatment is tailored to the severity of their condition
An inflammatory process that can develop as a complication of inadequately treated strep throat or scarlet fever.
What am I?
RHEUMATIC FEVER
It is an autoimmune response to the bacteria Streptococcus pyogenes. After a strep throat infection, the immune system can mistakenly attack healthy tissues, particularly in the heart, leading to inflammation.
Strep throat and scarlet fever are caused by an infection with ___ bacteria
streptococcus
Rheumatic fever can cause inflammation and physical changes affecting the heart. Which of the following statements is correct regarding its impact on the heart?
A. Rheumatic fever only affects the outer layer of the heart.
B. Rheumatic fever results in inflammation and physical changes that can impact all layers of the heart.
C. Rheumatic fever exclusively impacts the myocardium without affecting other layers.
D. Rheumatic fever causes changes limited to the pericardium and does not affect the myocardium or endocardium.
B. Rheumatic fever results in inflammation and physical changes that can impact ALL layers of the heart.
What is Pancarditis?
Inflammation that affects all three layers of the heart: the endocardium, myocardium, and pericardium.
How does Rheumatic Heart Disease develop, and what heart layers are involved?
- Rheumatic Heart Disease develops from inflammation caused by ALL 3: endocarditis, myocarditis, and pericarditis **
- It affects ALL layers of the heart (pancarditis) and often leads to chronic valve damage.
What 2 functions are impaired once the heart has fibrous scar tissue
- Contractility: Reduced pumping ability → risk of heart failure.
- Compliance: Impaired relaxation of heart muscle → leads to diastolic dysfunction.
Is Rheumatic heart Disease cureable?
No- damage is already done.
Once a patient has Rheumatic Heart Disease, what meds will they be on?
Antbx - lifetime
and
anti-inflammatory agents
How is valvular heart disease classified?
- Based on affected valve(s): mitral, tricuspid, aortic, pulmonic
-
3 Types of valvular dysfunctions:
Stenosis (narrowing)
Regurgitation (leaking)
Prolapse (improper closure)
Define: Constriction or narrowing of the opening
(Valves can’t open fully)
Stenosis
How does valve stenosis affect pressure in the heart?
- Causes a pressure difference on each side of the stenotic valve.
- Pressure on both sides is usually equal.
- Higher pressure builds up behind the valve where blood is flowing from
Define:
* Incomplete closure of valves- can’t close
* Also ocalled “incompetence” or “insufficiency”
Regurgitation
What are the effects of regurgitation on blood flow in the heart?
- Backward flow of blood through the valve.
- The heart has to re-pump the same blood multiple times.
Define:
* Valves that are often referred to as “floppy”
* valves that have “bulged” backwards
Prolapsed valves
Isn’t an opening or closing problem, but a general change in the overall shape/structure/function of the valve (Think of this as the valve has stretched out and it is now not sitting in the space where it shouldnt be)
How does the degree of prolapse affect management and symptoms?
- Severity of symptoms is influenced by the degree of prolapse.
- Management: managed medically or require surgical intervention
- Same concept applies to all valvular issues
What is Mitral Valve Stenosis
- The valve leaflets (or cusps) become thickened, stiffened, or fused together, reducing the size of the opening through which blood flows.
- This constriction impairs the normal flow of blood from the left atrium to the left ventricle.
What are the effects of MITRAL valve stenosis? (left side valve)
- Decreased blood flow from ATRIUM into the left VENTRICLE.
- Left atrium dilates and may hypertrophy.
- Pulmonary congestion and increased pressures.
- Increased risk for atrial fibrillation (Afib).
What is the primary symptom of Mitral Valve Stenosis?
Dyspnea on exertion
(exertion: shortness of breath occurs during physical activity or exercise.)
Why does dyspnea on exertion occur with mitral valve stenosis?
- Decreased lung compliance: Stiffer lungs reduce the ability to expand and contract, restricting airflow.
- Decreased cardiac output: Reduced blood flow from the heart means less oxygenated blood reaches muscles, causing shortness of breath during activity.
Mitral Valve Stenosis:
It’s Chronic stage may eventually manifest s/s of ___ sided heart failure.
Right sided heart failure
- as fluid continues to build up from the lungs into RIGHT VENTRICLE.
How can Mitral valve stenosis (left side valve) lead to symptoms of RIGHT-sided heart failure?
Mechanism:
- Fluid buildup: Increased pressure in the lungs (from the left side) causes fluid to back up into the right ventricle.
- Symptoms: This can lead to swelling in the legs, distended neck veins, and fluid accumulation in the abdomen.
Cardiac Output
(review)
- Is a measure of how efficiently the heart is pumping blood throughout the body PER MINUTE
- It’s crucial for ensuring that all tissues and organs receive adequate oxygen and nutrients.
Formula for Cardiac Output (CO)
CO = Stroke Volume (SV) × Heart Rate (HR)
- Stroke Volume (SV): The volume of blood ejected by the left ventricle with each heartbeat.
- Heart Rate (HR): The number of heartbeats per minute.
What happens when the left atrium and left ventricle work harder to preserve cardiac output?
Over time, this increased effort can lead to HEART FAILURE!!!
Mitral Valve PROLAPSE:
What type of chest pain might be present if symptomatic?
Atypical Chest Paint
(refers to chest discomfort that does not fit the classic description of angina (chest pain) or myocardial infarction)
Is it okay to give anti-anginals for Mitral valve prolapse pain?
No- Does NOT respond to anti-anginals
Patient teaching for Mitral Valve PROLAPSE
List 3
- Staying hydrated
- Regular Exercise
- Avoid Caffeine
Causes obstruction of blood from Left ventricle to the Aorta
What am I?
Aortic Valve Stenosis
How does aortic valve stenosis affect the heart’s structure and function?
- Structure: Causes Left Ventricular Hypertrophy (thickening of the heart’s left ventricle).
- Function: Leads to Increased Myocardial Oxygen Demand (the heart requires more oxygen due to the increased workload).
What is the “Classic Triad” of symptoms for AORTIC valve stenosis?
SAD:
* Syncope (fainting)
* Angina (chest pain)
* Dyspnea on exertion (shortness of breath with activity)
Aortic Valve REGURGITATION results in 3 things
- Dilated / Hypertrophied Left Ventricle
- Decreased CO
- CHF
Main S/S of Tricuspid AND Pulmonic valve disease
(RIGHT SIDED OF HEART)
“Right sided Heart Failure”
Problems with Right side of heart mimics ___ heart failure s/s
RIGHT
Problems with LEFT side of heart mimic ____ heart failure s/s
LEFT side heart failure
What is valvular heart disease?
- Involves: Any of the four heart valves (aortic, mitral, tricuspid, pulmonic).
- Impact: Affects the heart’s ability to pump blood efficiently and can have significant clinical consequences.
Main diagnostic study for Valvular Heart Disease
Echocardiogram
(reveals valve structure, function, muscle thickness, and heart chamber size)
Valvular heart disease conservative therapy would include
- Prevention: rheumatic fever, endocaditis
- Medication tx: Rx for heart failure
Valve Replacement:
Prosthetic heart valves may be __ or ___.
Mechanical or biological
How long will a patient have a MECHANICAL prosthetic heart valve?
for entire life
How long will a patient have a BIOLOGICAL prosthetic heart valve?
5-10 - yrs since they tend to stiffen and calcify
Mechanical prosthetics require what type of meds?
anticoagulations- LONG TERM
(no way around them)
know
Why do we use blood thinners for Mechanical prosthethics valves?
- Due to its synthetic material.
- Can not risk anything sticking to that material.
What is the ONLY blood thinner used for Mechanical Prosthetics?
Warfarin- the only one that works
* Normal range for INR = 1
INR levels for a MECHANICAL prosthetic valves should be
3-4
The BIOLOGICAL prosthetics come from
animal or human donors
What blood thinners will pts with a BIOLOGICAL prosthetic valve be on?
NONE- do not require anticoagulant therapy
Another word for CARDIOMYOPATHY?
HEART FAILURE
List the 3 types of Cardiomyopathies (heart failure)
- Dilated cardiomyopathy
- hypertorphic cardiomyopathy
- Restrictive cardiomyopahty
What am I:
- Englarged heart chambers WITHOUT associated thickening of heart muscle walls as seen in heart failure
- Heart muscle fibers are impaired by diffuse (widespread) inflammation
- think of it as SYSTOLIC heart failure- heart cant contract effectively
Dilated Cardiomyopathy
know
Review:
What is Systolic Heart Failure
`
- also known as heart failure with reduced ejection fraction or HFrEF
- The heart’s left ventricle cannot contract effectively, leading to a reduced ejection fraction (the percentage of blood pumped out of the left ventricle to the rest of the body with each heartbeat).
What is a unique consideration for clients with Dilated Cardiomyopathy?
know
- Blood Flow: Slows down (stagnates), increasing risk for clots/strokes.
- Management: Clients may need to be on anticoagulants unless contraindicated.
know
Dilated Cardiomyopathy mimics what EKG
AFib
Dilated Cardiomyopathy are at great risk for:
clot formation and emboli
* (due to stasis of blood flow THROUGHOUT the heart- not just atria)
Left ventricular hypertrophy WITHOUT ventricular dilation (enlarged and stretched)
* Heart walls are enlarged but NOT stiff!!!
* Can block aortic valve due to thickening
* Deadliest of them all- this is important
Hypertrophic Cardiomyopathy
- Systolic function is normal
- Diastolic function is impaired
- Ventricles are resistant to filling
- stiff ventricle wall- this is important
- Cardiac output fails
RESTRICTIVE CARDIOMYOPATHY
For Hypertrophic and Restrictive Cardiomyopathy – Think of these more like
Diastolic Heart Failure
- heart muscle can not relax so it can not fill either.
* also called heart failure with preserved ejection fraction (HFpEF)
Unique consideration for Hypertrophic cardiomyopathy
client/family teaching
regarding Sudden Cardiac Death
Diastolic Heart Failure (review)
- Occurs when the heart’s ventricles become stiff and are unable to relax properly during diastole (the filling phase).
- This limits the amount of blood the ventricles can hold and pump out, even though the heart’s pumping ability (ejection fraction) remains normal.
- leading to reduced overall blood volume being pumped to the body.
- Because the ventricles can’t expand properly, blood backs up into the lungs or veins, causing fluid buildup.
What am I?
Hypertrophic Cardiomyopathy
What am I?
Dilated Cardiomyopathy
What am I?
- Stiff heart muscle (rock hard muscle)
Restrictive Cardiomyopathy
