Structure infection week 2 Flashcards
Causes of valvular diseases?
Rheumatic heart disease
degenerative disease
infective endocarditis
What is stenosis?
Pressure problem
opening is narrowed
What is regurgitation?
Volume problem
Valves do not close properly and blood flows backwards through valve
What is the management with both biological and mechanical valves?
Mechanical valve: Lifelong anticoagulant
Biological valve – anti-platelet for 6m—year then no more
Assessments for valvular diseases?
Heart sounds: murmurs S3, S4, PVC’s, pulse irregularities
Perfusion
Chest pain hemoptysis SOB fatigue palpitations weakness orthopnea paroxysmal nocturnal dyspnea peripheral edema dizziness
Diagnostic tests for valvular disease?
Chest x-ray – cardiomegaly
CT chest
CBC
ECG- specific changes related to the valve
Cardiac Ultrasound Transesophageal echo / heart cath
Interventions for valvular disease?
- Meds to prevent or treat heart failure – anticoagulants antidysrhythmia agents
- Valve repair / replacement – may be percutaneous or surgery
- Na restrict- caffeine limit
Valvular complications for mitral stenosis
A-fib
Emboli
Stroke
Complications for mitral regurgitation
Left ventricular hypertrophy with pulmonary hypertension / edema
Complications for aortic stenosis
aortic dissection – sudden cardiovascular collapse
Complications from balloon valvuloplasty
bleeding pulmonary emboli
Patients with valve issues are more likely to develop what?
infective endocarditis
Medications for valvular disease?
Nitroglycerine
Antibiotics
Atenolol
Warfarin
Education for valve issues?
Smoking ceasation Moderate exercise Antibiotic prophylaxis for dental procedures hydration limit caffeine monitor for s/s HF Warfarin teaching
S/s heart failure
SOB, pedal edema, orthopnea, fatigue
What are s/s aortic stenosis
SAD
Syncope
Angina
Dyspnea
Valvuloplasty
Valve repair / replacement procedure. Different types include Commissurotomy Annuloplasty Leaflet repair Chordoplasty
Commissurotomy
Valve Repair and Replacement Procedures
MitraClip
TMVR
TAVR
Surgical valve replacement
Valve Repair and Replacement Procedures
Types of valve prostheses
Mechanical - warfarin lifelong
Bioprosthetic
What is cardiomyopathy?
Broad term for abnormality in cardiac muscle
- hypertrophic
- dilated
- restrictive
Treat like CHF
Surgical interventions for cardiomyopathy
Septal myectomy and alcohol septal ablation Mechanical circulatory support IABP ECMO VAD TAH (Total Artificial Heart) Heart transplant
Endocarditis - what?
infection of endocardium
The infection often colonizes the valve – referred to as vegetation
Who is at risk for developing endocarditis?
People who have had or have... Prosthetic heart valve Structural defect Implantable device Previous episode of endocarditis Immunosuppression Neutropenia Malignancy Intravenous drug use Nosocomial hospital exposures Central venous catheter
What is infective endocarditis?
Pathogens can enter endocardium through dental or surgical procedures
s/s infective endocarditis?
Fever & heart murmur will dev. W night sweats
Osler nodes
Janeway lesions
Roth spots
Splinter hemorrhage under nails
Petechiae on chest, abdomen conjunctiva and mucous membranes
infective endocarditis treatment
Eliminate infection - culture needed
a. long term abx therapy (6m+)
- blood cultures needed to monitor fx of therapy
- serum blood levels of selected abx
b. long term IV access
What is pericarditis
inflammation of pericardium
Describe the pain with pericarditis
Friction rub – worsens with deep breath, inspiration, coughing, lying down or turning
Pericarditis treatment
relieve pain - NSAIDS
Pericarditis diagnostic tool
12 lead ECG demonstrates ST elevation widespread
