Structural, inflammatory cardiac disorders Flashcards
What is infective endocarditis?
And how is it treated?
Infection of endocardial surface of the heart that affects the cardiac valves.
treated with penicillin
Name and describe the two forms of infective endocarditis:
And what are most common bacteria’s that cause it?
1-Subacute form: which affects those with pre-existing valve disease
2- acute form: affects those with healthy valves
Most common bacterial causes: Staphylococcus aureus and streptococcus viridans
What are risk factors for getting infective endocarditis?
Principal risk factors are prior endocarditis, prosthetic valves, acquired valvular disease and cardiac lesions
What are symptoms of infective endocarditis?
Clinical findings can include low-grade fever, chills, fatigue,anorexia.
arthralgias, back pain, abdominal discomfort, headache, petechiae,
Osler’s nodes on the fingertips or toes. Janeways lesion on palms and soles.
Roths spots.
a new murmur or heart failure
Osler’s nodes
Osler’s nodes are painful, red, raised lesions found on the hands and feet.
They are associated with a number of conditions, including infective endocarditis, and are caused by immune complex deposition.
Janeway’s lesions
Janeway lesions are rare, non-tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles only a few millimeters in diameter that are associated with infective endocarditis and often indistinguishable from Osler’s nodes.
Roth’s spots
Roth Spots are defined as a white centered retinal hemorrhage and are associated with multiple systemic illnesses, most commonly bacterial endocarditis. …
Though roth spots are usually thought of as pathognomonic for bacterial endocarditis, they can occur in a number of conditions
Pericarditis
What is it and what can cause it?
Inflammation of pericardial sac a.k.a. the pericardium.
Is usually idiopathic but can be caused by various infectIons, MI, tuberculosis, neoplasm or trauma
What are the symptoms of acute pericarditis?
Progressive, severe chest pain that is sharp and pleuritic in nature and worse with deep inspiration and when lying supine.
The pain is relieved by sitting. Pain can be referred to the trapezius muscle.
Hallmark finding is pericardial friction rub.
What are some complications of pericarditis?
and what are some treatments?
Complications include pericardial effusion and cardiac tamponade.
Treatment includes antibiotics, corticosteroids or NSAIDs.
Colchicine may be used for recurrent pericarditis.
Pericardiocentesis is performed for pericardial effusion.
Chronic constrictive pericarditis.What is it?
Results from scarring with consequent loss of elasticity of the pericardial sac.
Begins with initial episode of acute pericarditis followed by fibrous scarring, thickening of the pericardium from calcium deposit and eventual obliteration of the pericardial space.
All of this interferes with the ability of the atria and ventricles to stretch adequately during diastole
What are symptoms of chronic constrictive pericarditis?
And what is treatment?
Symptoms mimic heart failure and cor pulmonale include DOE, peripheral Edema, ascites, fatigue, anorexia, weight loss.
jugular venous distention.
Pericardial knock which is a loud, early diastolic sound.
Treatment is pericardectomy which involves complete resection of the pericardium through median sternotomy with the use of cardio pulmonary bypass.
What is myocarditis and what are some causes?
Focal or diffuse inflammation of the myocardium caused by viruses, bacteria, fungi, radiation therapy, pharmacologic and chemical factors.
Frequently associated with acute pericarditis. Myocarditis result in cardiac dysfunction and has been linked to development of dilated cardiomyopathy.
What are clinical manifestations of myocarditis?
Fever, fatigue, myalgias, pharyngitis, dyspnea, lip and then apathy, nausea and vomiting.
Early cardiac manifestations appear 7 to 10 days after viral infection and include pleuritic chest pain and pericardial friction rub and effusion.
Late cardiac signs relate to heart failure: crackles, jugular venous distention, syncope, peripheral edema and angina.
What are treatments for myocarditis?
Digoxin, diuretics, nitropress, anticoagulation, immunosuppressives.
Oxygen, bed rest, restricted activity.
Intraaortic balloon pump therapy
Complications of myocarditis
Most recover spontaneously.
Some may develop dilated cardiomyopathy. If severe heart failure occurs, may require heart transplant.
Rheumatic Fever
Inflammation of heart involving all layers.
Causes rheumatic heart disease
Rheumatic fever is an inflammatory disease that affects the skin, joints, heart, and central nervous system.
Aschoff bodies
nodules found in the hearts of individuals with rheumatic fever. They result from inflammation in the heart muscle and are characteristic of rheumatic heart disease.
What is rheumatic heart disease
Rheumatic heart disease is when permanent damage is done to the heart valves from rheumatic fever. It results in mitral stenosis or aortic stenosis which is narrowing of those heart valves.
Difference between valvular stenosis and valvular regurgitation
Stenosis is when the valve opening becomes narrow and restricts blood flow.
Prolapse is when a valve slips out of place or the valve flaps (leaflets) do not close properly.
Regurgitation is when blood leaks backward through a valve, sometimes due to prolapse.
What causes mitral valve stenosis?
And what are symptoms?
Caused by rheumatic heart disease, congenital, rheumatoid arthritis or lupus.
Symptoms: DOE, fatigue, palpitations,
loud first heart sound and low rumbling diastolic murmur. Crackles and wheezes from pulmonary edema.
Mitral regurgitation
Causes and symptoms:
Causes: MI, chronic rheumatic heart disease, mitral valve prolapse,
Symptoms: could be asymptomatic,
thready peripheral pulses,
cool, clammy extremities,
New systolic murmur
Could develop into left ventricular failure or pulmonary hypertension
Mitral valve prolapse
What is it? What causes it?
Abnormality of mitral valve leaflets and the papillary muscles or chordae that allow the leaflets to prolapse, or buckle, back into the left atrium during systole.
Cause of MVP is not known.
What are clinical manifestations of mitral valve prolapse?
Murmur from regurgitation that gets more intense through systole, chest pain, dyspnea, palpitation, syncope.
Aortic valve stenosis
Causes?
And complications?
Symptoms?
Result of rheumatic fever or senile fibrocalcific degeneration that may have similar etiology to CAD.
Aortic valve stenosis results in left ventricular hypertrophy and increased myocardial oxygen consumption. Then eventually leads to reduced cardiac output leading to pulmonary hypertension and heart failure.
Angina, syncope, DOE
Aortic valve regurgitation
Causes?
Caused by infective endocarditis,
trauma, or aortic dissection.
Chronic aortic valve regurgitation is generally result of rheumatic heart disease, congenital bicuspid aortic valve, syphilis or chronic rheumatic conditions.
Symptoms of acute Aortic valve regurgitation:
Symptoms of chronic Aortic valve regurgitation:
Acute:Severe dyspnea, chest pain, hypotension indicating left ventricular failure and shock that would be emergency.
Chronic: DOE, orthopnea, paroxysmal nocturnal dyspnea after myocardial dysfunction has occurred.
Cardiomyopathy describes a group of diseases. What does it mean to have a classification of cardiomyopathy?
Cardiomyopathy constitutes a group of diseases that directly affect the structural or functional ability of the myocardium.
It can be either the primary cause or caused by another disease process.
Cardiomyopathies can lead to cardiomegaly and heart failure and are the leading cause of for heart transplant.
3 types of cardiomyopathy
Dilated cardiomyopathy : inflammation and degeneration of myocardial fibers
Hypertrophic cardiomyopathy: asymmetrical left ventricular hypertrophy
Restrictive cardiomyopathy: least common, impairs diastolic filling. Etiology unknown.
Dilated cardiomyopathy
Etiology:
Symptoms:
Treatment
Etiology:develops acutely after infection OR insidiously over time.
Symptoms: fatigue, dyspnea at rest, orthopnea, palpitations, N/V, anorexia
Results in ventricular dilation, atrial enlargement, stasis of blood in left ventricle
Treatment: doesn’t respond well to therapy. Some implantable defibrillator or ventricular assist device (VAD) or transplant.
****Family must learn CPR and how to access emergency care. **
Hypertrophic cardiomyopathy
What are the 4 main characteristics?
1: massive ventricular hypertrophy
2: Rapid, forceful contraction of left ventricle
3: Impaired relaxation (diastole)
4: Obstruction to aortic outflow (not present in all patients.)
SCD
Sudden cardiac death
What is the most common cause of sudden cardiac death an otherwise healthy young people?
Hypertrophic cardiomyopathy
Symptoms of hypertrophic cardiomyopathy
Sometimes asymptomatic
exertional dyspnea, fatigue, angina, syncope, dysrhythmias
Heart disease
Heart disease is a term used to describe any heart disorder.
Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke.
Other heart conditions, such as those that affect your heart’s muscle, valves or rhythm, also are considered forms of heart disease.
Heart failure
Impaired cardiac pumping that results in vasoconstriction and fluid retention.
Difference between systolic and diastolic heart failure
systolic : most common- ventricles lose the ability to contract
diastolic : ventricles unable to relax and fill during diastole.
What happens with left sided heart failure?
Most common form of heart failure.
Left ventricle dysfunction.
Blood backs up into left atrium and into pulmonary veins causing pulmonary congestion and edema.
Acute decompensated heart failure (ADHF)
Manifests as pulmonary edema.
A life threatening situation
What are common symptoms of heart failure?
What are complications of heart failure?
Sx: fatigue, dyspnea, tachycardia,
Edema
Complications: pleural effusion, a fib, thrombus , renal insufficiency, hepatomegaly
What are the reasons to use diuretics for heart failure?
Reduce edema
Reduce pulmonary pressure
Reduce preload
Pacemaker concerns/ interventions/ teaching
Avoid contact with electrical equipment and stand back from microwaves (5 feet)
Wear medic alert.
Pulse for a full minute.
Inform dentist.
No MRI
Report persistent hiccuping because it can indicate misfiring defibrillator.
May be told not to drive car for 6 months.
Thiazides side effects or teaching
Contraindication in sulfa allergies.
Can cause hyperglycemia, hyperuricemia, hypercalcemia.
Digitalis toxicity symptoms
What is the lab level of digoxin that is considered to toxic?
Sx: nausea, vomiting, halos around lights.
Toxic level: greater than 2.0
What is cardiac tamponade?
Medical emergency
Liquid accumulated in pericardium in short time. Pressure prevents proper filling of heart chambers.
Then shock and death.
Difference between left and right sided CHF
LEFT- affects lungs: pulmonary edema- pink frothy sputum. SOB, orthopnea.
Crackles, wheezes, tachypnea, periods of cyanosis.
RiGHT- blood backs up into periphery. Pitting edema, ascites, oliguria
Coronary artery bypass graft (CABG) teaching
Small frequent meals. Low sodium, fat and cholesterol.
Prevent constipation.
Limit caffeine due to vasoconstriction.
Can resume sex after 6 weeks or when able to climb flight of stairs without chest pain. No bending or valsalva maneuver.
Will probably be discharged on anticoagulation.
Viagra and CABG
Viagra is discouraged for post coronary artery bypass.
Never take within 24 hours of nitrate.
Digitalis use:
Symptoms of digitalis toxicity and interventions.
Used for CHF.
Sx of toxicity: anorexia, n/v, confusion, vision disturbances.
Interventions for toxicity: check potassium because hypokalemia can contribute to toxicity.
Constipation contributes to toxicity.
Valves of heart in order
TPMA (toilet paper my ass) Tricuspid Pulmonary Mitral Aortic
What problem may cause an extra heart sound- a click?
Mitral valve prolapse.
Mitral click.
A valve leaflet is ballooning into the left atrium.
A murmur may also be heard.
What is the most frequent sign of pulmonary embolism?
Tachypnea
Tachypnea can distinguish PE from MI when having chest pain.
What order does a nurse Inspect Palpate Percuss Auscultate
Inspect
Palpate
Percuss
Auscultate
