heart 7c inflammation

Question 1

Surgical Management

Valvular Heart Disease

Answer 1

Valve repair methods
Mechanical valves – artificial material
Biological valves –

Question 2

Valve repair methods

Answer 2

Percutaneous valvuloplasty for MS
• Mitral valve repair – CPB
• Percutaneous Mitral valve repair – for patients who are not suitable for
traditional surgical procedures. (e.g. MitraClip)
• Transcatheter aortic implantation (TAVI or TAVR) - for patients who are not
suitable for traditional surgical procedures

Question 3

Mechanical valves – artificial material

Answer 3

More durable
• Last longer
• Increased risk of thromboembolism - anticoagulation

Question 4

Biological valves

Answer 4

– bovine, porcine and human heart
valves (homografts) +/- synthetic material
• Less durable
• Tend to calcify earlier, tissue degenerates and the leaflets
stiffen.
• Wont need anti-coagulation (unless they have AF)

Question 5

Nursing considerations for conservative and

surgical management

Answer 5

• Patients may need further valve surgery in the future
• Type of valve is based on patient factors
Patient education
• Observe for symptoms of worsening valvular disease
• Patients need to attend regular follow up when conservatively managed
• Echo, ECG, CXR, physical assessments
• Teach signs of infection
• Teach signs of HF
• Advise to notify healthcare staff if needing invasive or dental procedures
• Medic Alert bracelet

Question 6

Nursing considerations for patients taking

anticoagulants

Answer 6

Warfarin commonly taken for life
• Regular blood tests required (INR)
• Inpatient care considerations
• Humidify oxygen therapy
• Perform personal care in a gentle manner
• Risk assessment for falls and pressure
areas
• Avoid restraint use where possible
• Lubricate tubes well prior to insertion
• Avoid IM injections
• Minimise venepuncture (use small gauge
needles)
• Need to apply pressure to puncture sites
for longer
• Patient education about side effects
VERY important
• Bleeding gums
• Blood in urine or stools
• Slower clotting time after cuts or
scrapes
• Drug interactions
• Use of electric v’s blade razors
• Food and drink considerations
• Use of soft toothbrushes
• Medic alert bracelet

Question 7

Aortic Aneurysm

Answer 7

• Permanent, localised outpouching or dilation of the
vessel wall
• More common in men than
women
• Incidence increases with age
• Can occur in more than one
location
• Most occur in the abdomen

Question 8

Aortic Aneurysm occurs

Answer 8

Occurs due to combination of high intraluminal
pressure and vessel wall weakness
• Growth rates unpredictable

Question 9

Aortic Aneurysm risk factors

Answer 9

• Male gender
• HTN
• Family history
• Afro-Caribbean
• Atherosclerosis
• Connective tissue disorders
• CAD
• Genetic – congenital anomalies

Question 10

Aortic Aneurysm

Signs and symptoms

Answer 10

• Often no symptoms until rupture
• Deep chest pain that may extend
to area between scapula
• Discovered on routine physical
assessment - pulsatile mass in
the middle and upper abdomen.

Question 11

Complications Aortic Aneurysm

Answer 11

Rupture is the most serious
• More than 90% die
• Hypovolaemia
• Tachycardia
• Hypotension
• Pale clammy skin
• Decreased UO
• Altered LOC

Question 12

Aortic Dissection

Answer 12

Creation of false lumen between the intima
(inner) and media (middle) of the arterial
wall
A tear develops in the inner layer of the
aorta. Blood surges through into the
middle layer causing the inner and middle
layer to separate (dissect)
If blood ruptures through the outside layer
it is often fatal

Question 13

Aortic Dissection

Management

Answer 13

Emergency
• Keep BP low
• Keep HR controlled
• Opioids and sedatives
• Fluid/blood replacement as
necessary
• Surgical resection and repair
• Endovascular repair