Nursing 2005: Cardiovascular Disorders (Part 2) Disorders of the Heart Wall Flashcards
Pericardium
- double walled membranous sac that
encloses heart - Layers separated by a clear serous fluid
- 30cc
Myocardium
- cardiac muscle
Endocardium
- internal lining
- composed of connective tissue and squamous cells
Disorders of Pericardium
- Acute Pericarditis
- acute (short term problem) inflammation of pericardium
- etiology unknown or infection
What is the pathophysiology of pericarditis?
- membrane becomes inflamed
- roughened
- exudate may form = fluid becomes thick, cloudy, bloody
What are the clinical manisfestations of acute pericarditis?
a. chest pain
- d/t inflam
- sharp, abrupt, and radiates
- pain worsens with breathing and laying down
- leaning forward = takes pressure of lungs and is somewhat helpful
b. restlessness, anxiety
c. low grade fever
- d/t inflam
d. friction rub
- heard w/ stethoscope over heart
- sounds like sandpaper
What are the 2 complications of acute pericarditis?
a. pericardial effusion
b. cardiac tamponade
a. Pericardial effusion
- excess pericardial fluid
- increase in fluid = pressure =
- SOB
- cough
- inc resp rate
- heart can’t beat as strongly
- Can compress adjoining structures - pulmonary tissues
b. Cardiac tamponade
- effusion inc in size or occurs rapidly
- a lot of fluid at one time
- Fluid and pressure compromises heart’s ability to fill and empty
- dec filling of heart, can’t expand
- dec cardiac output
** dec R atrial filing -> dec ventricular filing -> dec stroke vol and cardiac output**
What are the s/s of acute pericarditis?
- pulses paradoxus
- exaggeration of a normal due in systolic bp in inspiration - muffled heart sounds
- poorly palpable pulses
What are the diagnostic tests for acute pericarditis? What are the results?
- EKG
- P and R changes - Echocardiogram
- ultrasound of the heart
- shows pericardial sac
What are the types of treatment for acute pericarditis?
a. treat cause
- it’s acute
b. pain meds
- aspirin or antibiotics
c. pericardiocentesis
- if a lot of excess fluid
- stick needle in pericardial sac to take out fluid
What is constrictive pericarditis?
- chronic inflammation of pericardium
- develops slowly
- starts acutely, maybe from pericarditis
- etiology unknown
- associated with radiation, cancer, rheumatoid arthritis
What is the pathophysiology of constrictive pericarditis?
- fibrous scarring
- pericardial layers adhere.
- no more fluid so it sticks together
- Encases heart in rigid shell
- cardiac output dec
What are clinical manifestations of constrictive pericarditis?
- same s/s of heart failure
a. fatigue, weakness
b. SOB on exertion
c. exercise intolerance
d. edema (fluid)
- kidneys can’t filer blood which causes fluid retention
e. distention of jugular vein
f. hepatic congestion
- in liver
What are the diagnostic tests for constrictive pericarditis?
a. EKG
- inflam in heart
- t wave inversions
- a fib
b. Echocardiogram
- no fluid
- layers stick together
What are the types of treatment for constrictive pericarditis?
a. digoxin
- positive inotropic agent that inc contractility
- slows down HR
- inc filing of heart to inc cardiac output
b. diuretics
- inc urine output to dec fluid
- less preload on heart
c. Na restrictions
- dec water/fluid retention
d. surgery
- cut out part of pericardium to inc more during HR
What are some additional facts about cardiomyopathy?
- inherited
- dominant gene in men
- diagnosed in young adulthood
- usually in active, athletic people
What is the pathophysiology of dilated cardiomyopathy?
- unknown
** heart chambers dilate= impaired pumping func = dec cardio output
- inflam and degenerarion of myocardial fibers that dec contraction func
- inc blood vol
- dec left ven ejection
- dec CO
ex: pregnancy, alcohol abuse
What are the clinical manifestations of dilated cardiomyopathy?
a. fatigue
b. edema
- peripheral: hands, ankles, feet
c. SOB
- blood isn’t pumping from left side of lungs
d. cough
e. murmurs
- abnormal heart sounds and rhythms
f. dysrhythmias
- abnormal heart sounds and rhythms
What kind of diagnostic tests are done to check for dilated cardiomyopathy? What are the results?
- CXR
- shows enlarged heart
- Echocardiogram
- can measure the chambers of the heart
What are the types of treatment for dilated cardiomyopathy?
a. digoxin
- inc contractility
b. diuretics
- inc urine output to dec preload
c. vasodilators
- dec bp and easy for heart to pump
d. heart transplant
- only chance for cure
- 50% of heart surgeries is for this condition
What is the patho for hypertonic cardiomyopathy?
- myocardial hypertrophy without dilation
- ** dec vol and obstruction = dec cardiac output
- inc in myocardial tissue
- Walls = hypertrophy
- thick septum = small volumes
- Hypertrophy also causes impaired relaxation.
- Possible aortic outflow obstruction
- strong contraction but dec in blood flow d/t lack of blood
What are the clinical manifestations of hypertonic cardiomyopathy?
- similar to dilated CMP = dec CO
b. syncope
- dizziness d/t dec cardiac output
c. angina
- chest pain d/t thick heart wall = more oxygen by coronary arteries
What types of diagnostic tests are done? What are the results?
a. CXR
- chest X-ray
- wont show diff, just enlarged heart
b. echocardiogram
- can see thick muscle and small vessels
What are the types of treatments?
a. Beta blockers:
- meds to dec HR and dec contractility
- inc filling of ventricles and dec HR
b. antiarrythmics
- control abnormal HR and rhythm
- keeps heart regular
c. Surgery
- take out part of heart muscle to inc chamber size = inc blood vol
What are the patho to restrictive cardiomyopathy?
- stiff muscle fibers
- loss of compliance
- Ventricles resistant to filling
- a lot of pressure to fill ventricles
What is additional info to restrictive cardiomyopathy?
- scarring d/t radiation
- systemic coronary disease
What are the clinical manifestations to restrictive cardiomyopathy?
- similar to dilated CMP d/t dec CO
- exercise intolerance
- most common in restrictive because its worse
- ventricles won’t fill even more
What kind of diagnostic tests are done for restrictive cardiomyopathy? What are the test results?
- CXR
- enlarged heart
- echocardiogram
- small or normal sized heart chambers
What type of treatment is used for restrictive cardiomyopathy?
- treat the underlying cause
- improve diastolic filling
a. digoxin
- dec HR to improve filing of heart
b. meds to dec SVR (systemic vascular resistance)
- diuretics
- anti hypertensive
- heart transplant
Disorder of the endocardium
A. Infective endocarditis
- infection of endocardium aka bacterial endocarditis
– development of lesions filled with microorganisms
Ex: staph
What is the patho of infective endocarditis?
- endocardium damage exposes basement membrane
- prepositions valve issue
- attracts platelets = thrombus.
- Microorganisms adhere to endocardial surface.
- through dental, IV drug use, skin infection
- Vegetative lesions form, grow and cause valve dysfunction.Ex: blood clot, debri, “garden in heart”
- Lesions can break apart =emboli
– get lodged- hemorrhage
What are the clinical manifestations of infective endocarditis?
a. fever
b. weakness, fatigue
- d/t infection and inflam
c. arthralgias
- back pain
- joint pain
d. splinter hemorrhages
- lodged in fingers
- make longitudinal lines in nail bed
e. petechiae
- red pin point lesions on skin and eyes
f. oslers nodes
- lesions on fingers and toes
- pea sized
- r/t micro emboli
g. Janeway lesions
- red painless lesions on palm of hands and feet
h. murmur
- damage of valves in chambers
- hear turbulence, irregular heart sounds
i. systemic embolization in organs
- emboli can got to diff organs
What are the diagnostic tests for infective endocarditis? What are the results?
a. blood cultures
b. WBC
- inc in WBC
c. echocardiogram
- see lesions on lining of heart and valves
What are the treatments for infective endocarditis?
antibiotics:
- long term
- by IV for 4-6 weeks
- multiple kinds
B. Rheumatic fever
– inflammatory disease caused by delayed infection by group A beta-hemolytic strept.
- mainly with elderly because it was prevalent in the 60s, now its curable
- scarring and deformity of cardiac structures -> RHD.
- develop strept throat
- not treated with antibiotics= RF = scarring = valve problems
What is the patho to rheumatic fever?
- inflam in skin, throat
- RF = pharyngeal infection.
- Delayed and Abnormal immune response to group A strept cell membrane antigen.
- Antigens bind to receptors in heart as well as other parts of the body -> damage valves.
- scarring = RH
What are the clinical manifestations for rheumatic fever?
a. carditis
- inflam of heart
- heart murmur
- chest pain
b. polyarthritis
- inflam in joints
c. chorea
- disorder of CNS
- involuntary body movements
- fixed with treatment
d. erythema marginatum
- red rash in abdomen
- worse with heat
What are the diagnostic tests for RF?
a. throat culture
- look for strept
b. anti-streptolysin O titer
- exposure to strept
c. WBC
- inc
d. echocardiogram
- to look at valve function
- if closing properly
What are the types of treatment for RF?
a. antibiotics
- to clear stept but damage of RF
b. aspirin
- dec inflam and clots from developing
c. cardiac drugs
- improve contractility of heart
- depends how severe
d. surgical repair of valve
- to repair valve if that damaged
Valvular Disease
- 2 types
- d/t endocarditis and RH
- left side of heart = more problems
- Stenosis
- valve opening constricted- narrow valves
- hypertrophies
- valves gets bigger because pumping blood though little opening
- Regurgitation:
– valve doesn’t close all the way = leaking valve
- allows blood to flow in reverse -> inc volume
- hypertrophy and dilation of chamber d/t getting more blood to put out and get in
Types of vavluar disease:
1. What is the patho for Aortic Stenosis
- results in obstruction of flow from L ventricle to aorta
- L ventricle must pump harder -> hypertrophy -> inc O2 consumption
- congenital disorder
- found when younger
- develops slowly = obstruction of flow from left ventricle
- pumps harder to get blood through aortic valve = hypertrophy
- inc myocardial oxygen consumption = angina
What are the clinical manifestations for aortic stenosis?
- dec HR
- d/t less blood - dec SBP
- less blood being pumped out - dec stroke volume
- <70 cc of blood vol
- dizziness - systolic murmur
- can hear a longer or extra sound in heart - angina
- needs more oxygen
- What is the patho of aortic regurgitation?
- caused by heart disease, HTN, syphilis
- valve does not close -> retrograde blood flow from ascending aorta into Left ventricle
- Volume overload.
- blood from L atrium and aorta
- Left ventricle dilation and hypertrophy.
- Dec contractility d/t it’s getting overworked
- blood backs up into pulmonary system = goes into the lungs
- Can lead to Right ventricle failure
What are the clinical manifestations of aortic regurgitation?
- inc in stroke volume
- early on because blood from both directions
- strong, throbbing pulses - murmur
- from not closed valves - S&S of heart failure
- d/t blood back up in left ventricles with makes right side work harder
- What is the patho of mitral stenosis
- narrowing and fibrosis of valve
– obstruction causes incomplete emptying of L atrium = atrium enlarges
- inc L atrial pressure/volume - > pulmonary congestion
- CO and stroke volume dec
- d/t less filling of left ventricle
- L atria hypertrophy
- d/t endocarditis, heart disease
What are the clinical manifestations of mitral stenosis?
- pulmonary congestion
- d/t blood backup into lungs
- SOB - palpitations
- abnormal heart rate d/t change in size of atria - diastolic murmur
- fatigue, weakness
- dec cardiac output
- What is the path of mitral regurgitation?
Ex: RH, congenital, coronary heart disease
- backflow of blood from L ventricle into L atria and right side of heart
- L atria dilates due to inc volume
- L ventricle dilates
- hypertrophies to maintain CO
- L ventricle fails d/t backup of blood
- then right side fails
What are the clinical manefestation of mitral regurgitation?
- fatigue, weakness, palpitations
2. systolic murmur
What re the types of diagnostic tests for mitral regurgitation?
a. CXR
- can see enlargement of heart and valves
b. EKG
- look for damage to heart
- ischemia
c. echocardiogram
- see valves
- measure it
d. cardiac catheterization
- insert catheter into femoral artery to measure pressure of heart
What are the types of treatment for mitral regurgitation?
a. digoxin
- inc contractility to inc cardiac Output
b. vasodilators
- dec after load
c. diuretics
- dec vol of blood
- dec fluid retention
d. anticoagulants
- prevent clotting
e. antiarrhythmics
- to normalize HR
F.surgery
- Balloon valvuloplasty
- stretch valves= stenosis
- good for elderly - Repair placement
What is the patho for mitral valve prolapse?
- failure of one or both valves leaflets to fit together
- Usually benign
- can lead to mitral regurgitation and inc risk of endocarditis
Additional info for mitral valve prolapse
- most common valve disorder in women 8x more
- can live with it for years w/o problems
- dangers = infection d/t damage of valve
What are the clinical manifestations for mitral valve prolapse?
- murmur
- dysrhythmias
What types of treatment is prescribed for mitral valve prolapse?
a. antibiotics prophylactically
b. meds to control palpitations
