Valvular Heart Disease, Endocarditis & Cardiomyopathy Flashcards by Kol Giessel

match preload and afterload with stretch and squeeze

preload = stretch
afterload = squeeze

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_______ = is the end diastolic volume @ beginning of systole

preload

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

afterload

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stenosis vs regurgitation

stenosis = stiffening, narrowing, smaller
regurgitation = back flow

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

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

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regurgitation effects the heart valve when it open or closed?

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

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valves between left AV and Right AV

LEFT AV = mitral
RIGHT AV = tRIcuspid

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

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

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

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

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

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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how is mitral valve stenosis different then mitral valve prolapse?

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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what will mitral valve stenosis lead to?

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

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

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assessment findings for mitral valve stenosis?

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

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type of murmur with mitral valve stenosis =

diastolic

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

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what does mitral valve regurgitation lead to ?

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

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causes of mitral valve regurgitation?

• 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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assessment findings for mitral valve regurgitation

• 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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type of murmur with mitral regurgitation?

• High pitched systolic murmur, S3

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mitral valve prolapse causes?

• Often congenital (downs syndrome, marfans syndrome)

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mitral valve prolapse assessment findings

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

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type of murmur with mitral valve prolapse?

◦ Midsystolic click, late systolic murmur

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what will aortic stenosis lead to?

• 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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assessment findings for aortic stenosis

• 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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type of murmur with aortic stenosis?

• Systolic murmur --> aortic valve is open during systole

what happens in aortic regurgitation?

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

causes of aortic regurgiation?

• Infective Carditis • Congenital anatomic abnormalities

what will aortic stenosis lead to?

left sided heart failure

assessment finding for aortic stenosis

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

type of murmur with aortic regurgitation

diastolic murmur

test for looking at all these stenosis and regurgitations =

echocardiogram

drugs we give to help with heart valve stuff?

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

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

• Transcatheter Aortic Valve Replacement (TAVR)

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

• Balloon Valvuloplasty

prosthetic vs biologic valves- duration? anticoags?

‣ prosthetic valve lasts longer --> increased risk of clotting --> anticoagulation for life ‣ biologic --> don't last as long --> don't require anticoagulation (old person)

after surgery for valve stuff patient is at great risk for

ENDOCARDITIS! ABX is have dental procedure Clots --> anticoags

most common culprits of infective endocarditis?

◦ Streptococcus viridans ◦ Staphylococcus aureus

risk factors for infective endocardiits?

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

what is the patho of infective endocarditis?

• 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

infective endocarditis populations are risk examples

• 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

when does sxs onset of infective endocarditis occur?

2 weeks after exposure

sxs of infective endocarditis

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

_____ occurs in about 50% of infective endocaridits cases

emoblization

right vs left endocarditis- what is it associated with?

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

# 1 diagnostic for infective endocarditis?

blood cultures

what kind of abx for we give infective endocarditis?

IV 4-6 weeks

interventions for infective endocardiits?

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

picc line vs central line for infective endocarditis

• PICC versus Central Line --> can keep a PICC line not sure what this means but seems important

most common type of cardiomyopathy that involves both ventricles being dilated

dilated cardiomyopthy

dilated cardiomyopthhy results in impaired ______ function

systolic

causes of dilated cardiomyopthy

Alcohol, Chemotherapy, Infection, Inflammation, Poor Nutrition

dilated cardiomyopathy sxs

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

type of cardiomyopathy common in athletes?

Hypertrophic Cardiomyopathy

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

Hypertrophic Cardiomyopathy

sxs of Hypertrophic Cardiomyopathy

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

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

Restrictive Cardiomyopathy

s/s of Restrictive Cardiomyopathy

• Symptoms of R/L HF

causes of Restrictive Cardiomyopathy

Sometimes related to Sarcoidosis or Amyloidosis

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

Arrhythmogenic Right Ventricular Cardiomyopathy (family association) (usually R ventricle)

HCM has a high rate of....

ventricular dysrhythmias

interventions for dilated and restrictive cardiomyopthy

Treat for Heart Failure • Diuretics • Vasodilators • Digoxin

HCM intervetnions

• ICD (implanted cardiac defib) • Beta Adrenergic Blockers • Calcium Channel Blockers -->Reduce outflow obstruction -->Decrease HR/ Symptom relief

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

No vasodilators, diuretics or digoxin No Extreme Exercise

type of cardiomyopthy that usually ends with heart transplant?

DCM/ Restrictive

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

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

heart transplant assessment post surgery

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

heart transpplant intervention

Permanent pacemaker Immunosuppressants ◦ Infection prevention