structural, infectious, and inflammatory cardiac ds + PVD Flashcards
review: blood flow through heart
R atrium -> tricuspid valve -> R vent -> pulmonary valve -> pulmonary arteries -> pulmonary veins -> left atrium -> mitral valve -> L vent -> aortic valve
iclicker: which valve has the highest contractility, pressure, power house of the heart
L vent
risk factors for valve ds (5)
- HTN (LT)
- older age
- smoking
- diabetes (uncontrolled)
- rheumatic fever/infectious endocarditis
assessment findings of valve ds. (5)
- murmurs (systolic murmur, swooshing sound)
- extra heart sounds (s3,s4)
- dysrhythmias
- dyspnea (depending on back flow of blood -> stenosis)
- fatigue/syncope (mobilizing floor moving forward, cause by decreased cardiac output)
diagnostics of valve ds. (3)
- ECG: L vent hypertrophy
- CXR: shows pulmonary infiltrates
- ECHO: GOLDEN STANDARD shows valve shape, function, and mood, main for diagnosis of valve ds., can tell regurgitation/stenosis
iclicker: enlarged L ventricle causes what valve disorder
- aortic stenosis d/t overflow of L ventricle -> increased resistance -> hypertrophy
enlarged L atria causes what valve ds
- mitral stenosis
enlarged R vent causes what valve ds.
- pulmonic stenosis
enlarged R atria causes what valve ds.
- tricuspid stenosis
types of valvular ds. (7)
- valve prolapse
- regurgitation
- stenosis
SPECIFIC DISORDERS: - mitral valve prolapse/mitral regurg
- mitral stenosis
- aortic regurg
- aortic stenosis
what is valve prolapse
- stretching of atrioventricular valve leaflet into the atrium during diastole
- back flow of blood into systole from diastole
what is stenosis
valve does not OPEN completely, blood flow through valve is REDUCED
- decreased outflow = increased resistance to get more blood flow through
what is regurgitation
valve does not CLOSE properly, BLOOD BACKFLOW through valves
iclicker: if mitral stenosis, which chamber would increase in pressure
- L atrium
- can’t move forward? MOVE BACKWARDS
- if aortic stenosis -> issues in L ventricle
what occurs during aortic stenosis (3)
- valve is stenosed (constricted)
- increased pressure in L ven
- hypertrophy d/t vent needing more muscle mass to eject blood through stenosed valve
what occurs during mitral regurgitation (3)
- back flow of blood
- increased pressure in L atrium
- risk factor for AFIB
nursing mgmt for valve ds (7)
- patient education
- monitor VS trends (dyspnea)
- monitor for complications: HF, dysrhythmias, dizziness, syncope
- med schedule: education (unit repair valve)
- daily weights: monitor for weight gain (fluid retention)
- plan activity w. rest periods
- sleep with HOB elevated (orthopnea)
medical therapy for mitral regurg (2)/stenosis (2) and aortic regurg (1)/stenosis (2)
mitral regurg
- fluid congestion -> diuretics
- afterload reduction -> ACE, ARBs, Vasodilators (use BP to reduce afterload demand to make easier to move flood forward)
mitral stenosis
- can form clots
- tx: anticoags -> reduce clot formation (warfarin)
aortic regurg
- tx: control BP to promote forward BF
aortic stenosis
- tx: repair valve w/ stent, surgically
- not much can be done medically
types of surgical mgmt (2)
1) valvuloplasty (repair of valve)
- commissurotomy (break apart valve leaflets)
- balloon valvuloplasty (insert Cath intro valve space, inflate, break leaflets apart)
2) valve replacement (percutaneous approach, similar to cardiac Cath)
- mechanical valves: clicking noise upon auscultation, risk: clots
- tissue valve: bioprothesis (Xenograft: different animals, homograft: cadavers, autografts: tissue from self)
transaortic vave replacement (TAVR)
- most common way to replace aortic valve
- Cath into femoral and when reach stenosed area -> inflate Cath to deploy new valve
nursing mgmt for valvuloplast & valve replacement (3)
balloon valvuloplasty
- monitor for HF and emboli
- assess heart sounds every 4 hours
- same care as after cardiac catheterization: lay flat, homeostasis, assess entry site
surgical valvuloplasty or valve replacements
- focus on HEMODYNAMIC STABILITY & recovery from anesthesia
- frequent assessments w/ attention to neurologic, respiratory, and cardiovascular systems
patient education
- anticoagulant therapy: mechanical valve (on anticoags for rest of life), xenograft (aspirin for risk mitigation)
- prevention of infective endocarditis: diseased valve
- follow up: valves can degrade overtime (also have systemic ds if valve ds overall)
- repeat ECHO
post valve replacement med regimens (2)
anticoagulations
- mechanical valves: lifelong anticoags w/ Coumadin (vit. k antagonist), INR goal: 2.5-3.0 (therapeutic range), if eat vitamin K: need to stay consistent
- bioprosthetic valves (xenograft): daily baby ASA
prophylaxis
- if going under major dental work (scaling, root planing, NOT ROUTINE) = prophylactic abx treatment before recommended
- indicated for: valve ds., congenital heart defects (repaired, unrepaired), cardiac transplant with valve regurg
iclicker: loud diastolic murmur over R upper sternum border can be heard where? which valve?
- aortic heart sound
- surgery is treatment
- assessment is important!
what is cardiomyopathy (what, can lead to, etiology, types)
- what: disease of myocardium resulting in impaired cardiac output (not contracting as it should)
- can lead to: HF, sudden death, dysrhythmias
- etiology: primary or secondary (HTN, valve ds)
- types (3): dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), restrictive/constrictive cardiomyopathy (RCM)
dilated cardiomyopathy (DCM) (fact, what, manifestation, s/sx, diagnostics, tx)
- most common cardiomyopathy w/ long standing HTN
- what: dilation of vent w/o hypertrophy and systolic dysfunction (balloon out chamber -> not as efficient)
- manifestation: low CO w/ subsequent pulmonary congestion (activates SNS (HR), RAAS (BP)
- s/sx: pulmonary edema, peripheral edema, restlessness/agitation, angina, syncope (chamber: AV valve regurg - mitral, narrowed pulse pressure, S3/murmur -> blood smacking dilated ventricular wall)
- diagnostics: CXR (enlarged heart), ECHO (EF, valve function), angiography (if caused by MI or cardiac Cath), BNP (high d/t vent stretch, immobilization of fluid)
- tx: (manage BP) ACE inhibitors, beta blockers/ca channel blockers, digoxin (inotropic, increased contractility), diuretics (fluid overload) (tip: ABCDD)
restrictive cardiomyopathy (what, manifestation, etiology, s/sx, diagnostics, tx)
- what: restrictive/hard walls which don’t pump effectively - inadequate diastolic filling (can’t fully relax, decreased pump efficiently)
- manifestation: less blood in = less CO
- etiology: familial, protein deposition (amyloidosis), sarcoidosis (collagen deposition ds., leads to scaring d/t damage of myocardium)
- s/sx: pulmonary edema, peripheral edema, restless/agitation, angina, syncope
- diagnostics: CXR (normal w/ congestion at times d/t no dilation, hypertrophy), ECHO (normal EF w/ some wall motion abnormalities)
- tx: prevention (primary), transplant
hypertrophic cardiomyopathy (what, manifestation, s/sx, diagnostics, tx)
- what: thickened walls s/d to increased demand (HTN, CAD - risk factors)
- in peds: rare, deadly, GENETIC
- manifestation: low CO, subsequent demand for O2 d/t hypertrophic muscle, increases strain on already hypertrophied myocardium
- s/sx: often asymptomatic unless under strain -> SOB
- diagnostics: CXR (normal, mildly enlarged in severe cases), ECHO (septal thickening walls)
- tx: beta blockers, ca channel blockers (myocardial relaxation) OR excision of hypertrophic muscle (surgery, peds, too much muscle)
L vent hypertrophy issues?
- thickened ventricular septum -> increased O2 demand -> decreased efficient pump
HOCM (hypertrophic obstructive cardiomyopathy) (5)
- deadly in peds
- vents enlarged but can’t see on ECHO or XRAY or BP
- bulges -> no BF d/t HOCM -> sudden death
- not often caught
- dangerous
- tx: sugerical removement
patient education for cardiomyopathy (5)
- diet: low Na, low FAT
- rest periods with activity
- exercise with appropriate rest periods
- stop smoking and alcohol
- stress reduction
nursing assessment of cardiomyopathy (6 + physical assessment)
- hx (predisposing facors (PMH), family history)
- chest pain
- ROS: presence of orthopnea, syncope (distal extremities, pulmonary)
- review of diet: Na reduction, vitamin supplements
- psychosocial history: impact on family, stressors, depression
physical assessment:
- VS pulse pressure
- pulsus paradoxus (deep breath causes BP/HR to change)
- weight gain/loss
- PMI, murmurs
- S3/S4
- pulmonary auscultation for crackles (indicates congestion)
- JVD
- edema
potential complications of cardiomyopathy (6)
- HF
- ventricular dysrhythmias (vtach, fib)
- atrial dysrhythmias (afib, aflutter)
- cardiac conduction defects
- pulmonary or cerebral embolism
- valvular dysfunction