Valvular disorders Flashcards
Infective endocarditis
Can cause damage to valves
Subacute: In those w/ preexisting valve disease
-req months of treatment
Acute: In those w/ healthy valves
-Rapidly progressive disease
Caused by IVDA (IV drug abuse)
Risk factors for infective endocarditis
Aging IVDA Prosthetic valve Dialysis Hospital IV devices carrying healthcare assoc. infection
IE manifestations
Low CO Organ damage from emboli Heart murmur Fever!!!! Arthralgia/myalgia Clubbing of fingers
Splinter hemorrhages (black streaks in nail bed)
Osler’s nodes (painful red/purp pea sized lesions)
Janeway’s lesions (flat, painless small red spots)
systolic murmur
Diagnostics for IE (assessing)
Dental, surgical, gynecological procedures in past 3-6 months
blood drawn from 3 different sites in an hour
Guidelines for dx of IE
2 major + 1 minor
1 major + 3 minor
5 minor
Major:
- Pos blood cultures (MOST IMPORTANT)
- Microorganisms consistent w/ IE from 2 separate cultures
- Endocardial involvement
- New valvular vegetation
Minor:
- Predisposing heart condition or IV drug use
- Vascular phenomena
- Immunologic phenomena
- Microbiologic evidence
- Echocardiograph findings consistent w/ IE but not meeting major criteria
Chest x ray can show Cardiomegaly
ECG: 1st or 2nd AV block
Vegetations forming from IE
Primary lesion of IE
Can embolize
Risk INCREASES once treatment starts
L heart: embolize to all organs
R heart: embolize to lungs
Target organ damage from IE
Spleen: Sharp LUQ pain, rigid
Kidney: Low urinary output, flank pain, hematuria, azotemia (nitrogen in blood)
Arms/legs: gangrene
Brain: Hemiplegia, ataxia, aphasia, LOC change
Pulmonary embolism
Most important IE diagnosing factor
POSITIVE BLOOD CULTURE
- report to provider
IE collab care
Prophylaxis:
-antibiotics
Amoxicillin 3g po 1h prior
If allergic to penicillin: Clindamycin 600mg po 1h prior
High risk: Amoxicillin 1g IV, gentamycin 120mg IV at induction. Amoxicillin .5g PO 6hr after
IE drug therapy
MUST identify causative organism first!!!
Long term treatment: IV antibiotics in hospital and after discharge
Monitor w/ more blood cultures
Monitor antibiotic levels for therapeutic range
Fungal/prosthetic valve endocarditis responds poorly to treatment- expect valve replacement and long term antibiotics
Long term implementation
Long term antibiotics on PICC
If shows S&S of HF go back to inpatient
Teach S&S of infection, HF, emboli (confusion, decreased CO, skin discoloration)
Eval: Normal temp Tolerating ADLs Urinary output 30+mL/hr Demonstrate understanding
Pericarditis
Acute (rapid)
Subacute (weeks-months after an event)
Chronic (6+months)
causes:
Often idiopathic
Infectious: Viral, bacterial, fungal, LYME
Non-infectious: Acute MI, Ca, renal failure, trauma
Autoimmune: Dressler syndrome (post MI syndrome), drug reactions, Rheumatic disease
Acute pericarditis manifestation triad
Pain: Progressive, severe, sharp -Inc. with inspiration and when supine May radiate to neck, arm, L shoulder -Dyspnea: deep breathing hurts-->lot of small breaths--> tachypnea
Friction Rub: HALLMARK SIGN
- Scratching, grating, high pitched
Heart rubbing on viscera–> inflamed!
Heard best at L sternal border w/ pt lean forward
ECG changes:
ST elevation
Acute pericarditis pain symptoms
Pain: Progressive, severe, sharp -Inc. with inspiration and when supine May radiate to neck, arm, L shoulder -Dyspnea: deep breathing hurts-->lot of small breaths--> tachypnea
Acute pericarditis Friction Rub symptoms
Friction Rub: HALLMARK SIGN
- Scratching, grating, high pitched
Heart rubbing on viscera–> inflamed!
Heard best at L sternal border w/ pt lean forward
Acute pericarditis ECG change symptoms
ST elevation
Acute pericarditis FRICTION acronym
Friction rub, fever Radiating substernal pain to L shoulder Inc. pain in supine Chest pain: stabbing/sharp/dull Trouble breathing: Orthopnea Inspiration causes pain Overall sick feeling/weak Noticeable ST changes
Acute pericarditis complications: Pericardial effusion
Pericardial effusion: fluid in pericardium
Rapid: trauma
Slow: infectious
S&S: Cough Hiccups (phrenic nerve) Hoarse voice (Laryngeal nerve) Muffled heart tones
Acute pericarditis complications: Cardiac tamponade
Cardiac tamponade:
- Acute- rupture of heart/trauma
- Sub acute: Renal failure
S&S
- chest pain
- Confusion, anxiety, restless
- Muffled heart sounds
- Tachypnea, tachycardia
May need to be treated w/pericardiocentesis
Acute pericarditis diagnostics
ECG: ST elevation globally, PR depression
Labs:
-Elevated CRP, ESR
Leukocytosis
troponin elevation in ST elevation
Treatment of Acute pericarditis
antibiotics if infectious
NSAIDS
Corticosteroids
Pericardiocentesis (tamponade)
Assess pain, treat
High fowlers
Monitor for tamponade, JVD w/clear lungs, hypotension, tachycardia
May need pericardiectomy (complete resection)
Rheumatic Heart disease (RHD)
Causes rheumatic fever: 2-3 wks post group A strep pharygitis
Can involve all layers of the heart
Can scar valves (thick, less mobility, harder to open and close)
Nodules (Aschoff’s bodies) within heart
Criteria for RHD
Two major or 1 major 1 minor
Must also have evidence of group A strep infection
Major:
-Carditis (Most important)–> 3 signs
Heart murmur, Cardiomegaly and HF from myocarditis, pericarditis w/ muffled heart sounds, friction rub, effusion
- Mono/polyarthritis
- Sydenham’s Chorea-> abnormal movement disorder
- Erythemia marginatum-> pink rings on trunk and inner surfaces arms and legs
- SubQ nodules
Minor:
Fever
Polyarthralgia
Inc WBC, ESR, CRP
Drugs for RHD
Eliminate the cause w/ antibiotics
antibiotics won’t alter the course of the disease, just help eliminate spread
symptomatic relief w./ NSAIDs, ASA, corticosteroids
Important nursing dx:
Altered tissue perfusion r/t decreased contractility AEB___
RHD health promotion:
RHD is preventable: early detection of A strep pharygitis
Treated w/ penicillin
Home care:
If you had it before, likely to have it again- prophylactic monthly injection of IM penicillin
RF w/o carditis need prophylaxis until age 20 for minimum of 5 years.
Extra dosage if surgery or dental work
Seek medical care if
- excess fatigue
- dizzy
- palpitations
- Dyspnea on exertion
MV stenosis
Restriction of blood flow from LA to LV
Pressure builds back eventually to lungs and right side of heart
Manifestations: Dyspnea on exertion A-fib Chest pain Decreased CO Emboli from L atrium stasis Hemoptysis (blood in spit) Pulmonary edema
MV regurgitation
Incomplete closure
blood regurgitates back from LV to LA
LV and LA overworked to maintain CO=hypertrophy
Acute can result in pulmonary edema/shock- no time for structures to adapt
Acute signs: Thready peripheral pulse, cool clammy skin, low CO
Chronic: Weakness, fatigue, palpitations, orthopnea, paroxysmal nocturnal dyspnea
Aortic valve stenosis
Often discovered in childhood
Older adults: Rheumatic fever is common cause
Blood flow restricted leaving LV- similar symptoms to mitral valve stenosis
Clinical manifestations Low CO LV hypertrophy Pulmonary HTN, HF Triad:---> Angina, syncope, DOE
DON’T USE NITROGLYCERIN–> kills preload
AV regurgitation
Flow back from aorta to LV (B A D)
volume overload
Eventually backflow to right heart
If acute:
- Severe dyspnea
- Chest pain
- Hypotension
- shock (?)
Chronic:
- DOE
- Paroxysmal nocturnal dyspnea
Valve heart disease diagnostic/treatment
conservative therapy
Percutaneous transluminal balloon valvuloplasty
-Mitral, pulmonic, and tricuspid stenosis
Valve repair (BEST CHOICE SURGERY)
Mechanical Valve replacement: Lasts longer w/more risks (clotting, need anticoags)- used in younger
Non mechanical valve replacement: Last less long, lower risk. For elderly
