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Kol- 410 Med Surg II > Valvular Heart Disease, Endocarditis & Cardiomyopathy > Flashcards

Valvular Heart Disease, Endocarditis & Cardiomyopathy Flashcards

1
Q

match preload and afterload with stretch and squeeze

A

preload = stretch
afterload = squeeze

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2
Q

_______ = is the end diastolic volume @ beginning of systole

A

preload

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3
Q

________ = Ventricular pressure at the end of systole, systemic resistance aka BP

A

afterload

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4
Q

stenosis vs regurgitation

A

stenosis = stiffening, narrowing, smaller
regurgitation = back flow

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5
Q

stenosis effects the heart velve when it is open or closed?

A

OPEN –>can’t open enough and blood is having a hard time getting through the valve

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6
Q

regurgitation effects the heart valve when it open or closed?

A

CLOSED –> valve is not closed well enough and blood flows backwards

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7
Q

valves between left AV and Right AV

A

LEFT AV = mitral
RIGHT AV = tRIcuspid

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8
Q

back to patho- which side of heart pumps blood to body and which side pumps to lung?

A

right side = goes to lungs
left side = goes to body

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9
Q

back to patho- which side of heart pumps blood to body and which side pumps to lung?

A

right side = goes to lungs
left side = goes to body

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10
Q

common causes of mitral valve stenosis vs aortic stenosis — which one is more common?

A

mitral valve stenosis causes = Rheumatic Carditis or congenital anomalies

aortic valve stenosis = Wear and Tear” or Congenital (Bicuspid or unicuspid)

aortic stenosis = most common cardiac valve dysfunction

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11
Q

how is mitral valve stenosis different then mitral valve prolapse?

A

stenosis = • Valve leaflets fuse, become stiff and chordae tendineae shorten • Narrow valve opening

prolapse = • Enlarged valvular leaflets that prolapse into left atrium during systole (should turn in towards the ventricle but don’t!)

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12
Q

what will mitral valve stenosis lead to?

A

• Prevents normal blood flow from left atrium to left ventricle
◦ Increased atrial pressure
◦ Dilated left atrium
◦ Increased pulmonary pressure
◦ Right ventricle hypertrophy
◦ Pulmonary congestion
◦ Right sided HF –>Left sided HF (Reduced Preload)

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13
Q

woah woah woah- what the difference between right sided and left sided heart failure?

A

Left = blood backing up into the LUNGS causing decrease O2 to the body
Right = fluid backing up into the BODY

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14
Q

assessment findings for mitral valve stenosis?

A

• May be asymptomatic
• Difficulty breathingPulmonary edema
• Coughing
• JVD
• Edema in extremities
• Development of A-fib?
• Diastolic murmur

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15
Q

type of murmur with mitral valve stenosis =

A

diastolic

◦ mitral valve is open during diastole and would hear sound of resistance of blood pushing through

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16
Q

what does mitral valve regurgitation lead to ?

A

• Backflow of blood into left atrium during left ventricle contraction
◦ Hypertrophy of left ventricle and atrium

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17
Q

causes of mitral valve regurgitation?

A

• Fibrotic and calcific changes that prevent the mitral valve from closing during systole
• Caused by aging process, endocarditis, congenital abnormalities, RHD

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18
Q

assessment findings for mitral valve regurgitation

A

• Asymptomatic for many years
• Symptoms occur when the left ventricle can no longer overcome the blood volume
• Decreased Cardiac output
• Fatigue
• Weakness
• Anxiety
• Difficulty breathing
• Palpitations
• Chest pain
• **Afib – highest risk of all the valvular disorders
• Right sided failure…
• **High pitched systolic murmur, S3

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19
Q

type of murmur with mitral regurgitation?

A

• High pitched systolic murmur, S3

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20
Q

mitral valve prolapse causes?

A

• Often congenital (downs syndrome, marfans syndrome)

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21
Q

mitral valve prolapse assessment findings

A

• Asymptomatic or Symptomatic
◦ Chest pain
◦ Dizziness
◦ Palpitations
◦ Midsystolic click, late systolic murmur

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22
Q

type of murmur with mitral valve prolapse?

A

◦ Midsystolic click, late systolic murmur

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23
Q

what will aortic stenosis lead to?

A

• Ventricular hypertrophy
◦ Over time, left ventricle cannot meet the needs of body on exertion
**Left sided HF –> Right sided failure

–> may need surgery

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24
Q

assessment findings for aortic stenosis

A

• Fixed cardiac output (can’t accommodate increased demand)
◦ poor perfusion abilities (decreased pulses, kidney function)
• Angina
• Difficulty breathing
• Syncope
• Fatigue
• Debilitation
• Peripheral cyanosis
• Systolic murmur –> aortic valve is open during systole

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25
Q

type of murmur with aortic stenosis?

A

• Systolic murmur –> aortic valve is open during systole

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26
Q

what happens in aortic regurgitation?

A

• Aortic valve leaflets don’t close well during diastole
• Blood flows back from aorta to left ventricle
◦ Dilated ventricle/ Hypertrophy

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27
Q

causes of aortic regurgiation?

A

• Infective Carditis
• Congenital anatomic abnormalities

28
Q

what will aortic stenosis lead to?

A

left sided heart failure

29
Q

assessment finding for aortic stenosis

A

• Left failure symptoms
• Difficulty breathing
• Nocturnal dyspnea/ angina
• Diaphoresis
• Bounding pulse –> development of R side HF –> later finding
• Widened pulse pressure
• Diastolic murmur

30
Q

type of murmur with aortic regurgitation

A

diastolic murmur

31
Q

test for looking at all these stenosis and regurgitations =

A

echocardiogram

32
Q

drugs we give to help with heart valve stuff?

A

◦ Diuretics- preload
◦ Beta Blockers - slow heart rate to reduce heart demand
◦ Digoxin- contractility
◦ Oxygen
◦ CCB’s - afterload
◦ Anticoagulants -afib and risk for clot

33
Q

◦ Bioprosthetic valve is placed through femoral or apical artery
◦ Balloon valvuloplasty then new valve is inserted
◦ New valve is deployed during transvenous pacin
=

A

• Transcatheter Aortic Valve Replacement (TAVR)

34
Q

◦ Run catheter to mitral valve or aortic valve and enlarges balloon =

A

• Balloon Valvuloplasty

35
Q

prosthetic vs biologic valves- duration? anticoags?

A

‣ prosthetic valve lasts longer –> increased risk of clotting –> anticoagulation for life

‣ biologic –> don’t last as long –> don’t require anticoagulation (old person)

36
Q

after surgery for valve stuff patient is at great risk for

A

ENDOCARDITIS! ABX is have dental procedure
Clots –> anticoags

37
Q

most common culprits of infective endocarditis?

A

◦ Streptococcus viridans
◦ Staphylococcus aureus

38
Q

risk factors for infective endocardiits?

A

• IV Drug Use
• History of valve replacement
• Systemic Infection
• Structural cardiac defect

39
Q

what is the patho of infective endocarditis?

A

• Infective vegetation grown on valve
As bacteria circulates in blood, it forms clumps (mixes with other components of blood) = vegetation
–>Platelets and fibrin accumulate = bigger vegetation
–>This vegetation destroys the valve leading to –>
◦ Valvular insufficiency
◦ Valve obstruction
◦ Vegetation embolizes

40
Q

infective endocarditis populations are risk examples

A

• Post operative patient with insufficient venous access (and subsequent PICC line insertion)
• A mother of four with strep throat
• A patient with sepsis related to a UTI
• A patient who had his molars removed

41
Q

when does sxs onset of infective endocarditis occur?

A

2 weeks after exposure

42
Q

sxs of infective endocarditis

A

◦ Fever (might not show up in elderly)
◦ Murmurs
◦ S3 and S4
◦ Heart failure
• Organ dysfunction
• PE/ Pulmonary infarct
• Stroke
• Petechiae
• Splinter hemorrhages

43
Q

_____ occurs in about 50% of infective endocaridits cases

A

emoblization

44
Q

right vs left endocarditis- what is it associated with?

A

◦ right side with IV drug –> first place it hits when introduced to body
◦ left side used to be more common

45
Q

1 diagnostic for infective endocarditis?

A

blood cultures

46
Q

what kind of abx for we give infective endocarditis?

A

IV 4-6 weeks

47
Q

interventions for infective endocardiits?

A

• Antibiotics–>administered IV/ 4-6 weeks
• Rest/ Activity
• Support Heart Failure
• Surgery (if neccessary)
◦ Remove infected valve
◦ Repair injured valve
◦ Drain abscesses

48
Q

picc line vs central line for infective endocarditis

A

• PICC versus Central Line –> can keep a PICC line

not sure what this means but seems important

49
Q

most common type of cardiomyopathy that involves both ventricles being dilated

A

dilated cardiomyopthy

50
Q

dilated cardiomyopthhy results in impaired ______ function

A

systolic

51
Q

causes of dilated cardiomyopthy

A

Alcohol, Chemotherapy, Infection, Inflammation, Poor Nutrition

52
Q

dilated cardiomyopathy sxs

A

leads to Decreased Cardiac Output (DOE) / Decreased Exercise Capacity
• Fatigue
• Palpitations
(looks like left sided HF)

53
Q

type of cardiomyopathy common in athletes?

A

Hypertrophic Cardiomyopathy

54
Q

type of cardiomyopathy with asymmetric ventricular hypertrophy –>Stiff Left Ventricle causes Obstruction in left ventricular outflow?

A

Hypertrophic Cardiomyopathy

55
Q

sxs of Hypertrophic Cardiomyopathy

A

-Asymptomatic until death (Athletes)
• DOE
• Palpitations
• Dizziness

56
Q

-Rarest Cardiomyopathy, poorest prognosis of the cardiomyopathy
-Stiff ventricles that restrict filling =

A

Restrictive Cardiomyopathy

57
Q

s/s of Restrictive Cardiomyopathy

A

• Symptoms of R/L HF

58
Q

causes of Restrictive Cardiomyopathy

A

Sometimes related to Sarcoidosis or Amyloidosis

59
Q

type of cardiomyopthy where Myocardial tissue replaced with fibrous and fatty tissue

A

Arrhythmogenic Right Ventricular Cardiomyopathy

(family association)
(usually R ventricle)

60
Q

HCM has a high rate of….

A

ventricular dysrhythmias

61
Q

interventions for dilated and restrictive cardiomyopthy

A

Treat for Heart Failure
• Diuretics
• Vasodilators
• Digoxin

62
Q

HCM intervetnions

A

• ICD (implanted cardiac defib)

• Beta Adrenergic Blockers
• Calcium Channel Blockers
–>Reduce outflow obstruction
–>Decrease HR/ Symptom relief

63
Q

HCM interventions- what cant we give them? what can’t they do?

A

No vasodilators, diuretics or digoxin
No Extreme Exercise

64
Q

type of cardiomyopthy that usually ends with heart transplant?

A

DCM/ Restrictive

65
Q

heart transplant criteria ( i doubt we need to know this)

A

Less than one year life expectancy
Less than 65 years
NYHA Class III or IV
Normal- slightly increased pulmonary vascular resistance
No infection
Stable psychosocial status
No drug or alcohol use

66
Q

heart transplant assessment post surgery

A

Assess for tamponade
• Low blood pressure
• Muffled Heart sounds
• Chest pain, radiating to shoulder
• JVD
• Difficulty breathing
May have concealed post-op bleeding

67
Q

heart transpplant intervention

A

Permanent pacemaker
Immunosuppressants
◦ Infection prevention

Kol- 410 Med Surg II (27 decks)

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