ch 36 inflammatory and structural heart disorders Flashcards
(69 cards)
1
Q
three types of cardiomyopathy
A
- dilated
- hypertrophic
- restrictive
2
Q
what age group/gender is most at risk for dilated cardiomyopathy
A
middle aged women
3
Q
what happens to the heart in dilated cardiomyopathy
A
- heart muscles stretch and thin
- affects systolic bp
4
Q
common causes dilated cardiomyopathy (5)
A
- infectious myocarditis
- alcohol
- cocaine
- HTN
- CAD
5
Q
diagnostics for dilated cardiomyopathy (4)
A
- chest x-ray (cardiomegaly)
- ECG
- BNP levels
- echocardiogram
6
Q
how does hypertrophic cardiomyopathy affect the heart
A
- thickening of muscles
- decreased space in ventricles
- affects diastolic bp
7
Q
cause hypertrophic cardiomyopathy
A
chronic untreated HTN
8
Q
S+S hypertrophic cardiomyopathy (4)
A
- fainting
- dizziness with activity
- chest pain
- dysrhythmias
9
Q
treatment for dilated and hypertrophic cardiomyopathy
A
implanted defibrillator (same meds as for HF)
10
Q
cause of restrictive cardiomyopathy
A
inflammatory diseases causing stiff heart muscles
11
Q
S+S restrictive cardiomyopathy (4)
A
- fatigue
- orthopnea
- exercise intolerance
- systemic signs inflammatory disease
12
Q
S+S dilated cardiomyopathy
A
- fatigue
- dyspnea at rest
- proxysmal nocturnal dyspnea
- orthopnea
- S3/S4 heart sounds
- pulmonary edema symptoms
13
Q
what type of cardiomyopathy is often diagnosed in young, healthy males
A
hypertrophic
14
Q
meds for hypertrophic cardiomyopathy (2)
A
- b blocker
- digoxin
15
Q
friction between heart and pericardial sac caused by inflammation and immune response
A
pericarditis
16
Q
S+S pericarditis (6)
A
- severe angina
- dyspnea
- tachycardia
- distant heart sounds
- SOB
- pericardial friction rub
17
Q
possible complication of pericarditis
A
pericardial effusion (fluid buildup) which can lead to tamponade and cardiac arrest
18
Q
classic sign of tamponade
A
pulsus paradoxus (decreased Sbp with inhalation)
19
Q
S+S tamponade (6)
A
- distant heart sounds
- increased HR
- increased RR
- pulsus paradoxus
- JVD
- confusion
20
Q
diagnostics for pericarditis (3)
A
- echocardiogram
- CT/MRI
- chest x-ray
21
Q
care for pericarditis (5)
A
- O2
- bedrest
- NSAIDs
- IV corticosteroids
- maybe pericardiocentesis
22
Q
cause of chronic constrictive pericarditis
A
pericardium scarring
23
Q
treatment for chronic constrictive pericarditis
A
pericardiectomy (window procedure)
24
Q
causes myocarditis
A
- viruses/bacteria/fungi
- radiation therapy
- autoimmune disorders
- coxsackie A+B viruses
25
early S+S myocarditis (8)
- fever
- fatigue
- dyspnea
- N/V
- lymphadenopathy
- angina
- pericardial friction rub
- pericardial effusion
26
late S+S myocarditis (6)
- S3 heart sounds
- crackles
- JVD
- fainting
- peripheral edema
- angina
27
diagnostics myocarditis (6)
- ECG
- ESR
- troponin
- endomyocardial biopsy (during first 6 weeks illness)
- echocardiogram
- MRI
28
meds myocarditis
- digoxin
- ACE inhibitors
- b blockers
- diuretics
- improve CO: nitroprusside, inamrinone, milrinone
- prednisone, azathioprine, cyclosporine
29
infection (often s. aureus) of the inner layer of the heart that affects cardiac valves
endocarditis
30
3 stages to infective endocarditis (IE)
- bacteremia
- adhesion
- vegetation
31
risk factors IE (5)
- older age
- IV drug use
- prosthetic valve
- intravascular devices and healthcare associated infection
- renal dialysis
32
2 complications IE
- heart valve damage
| - emboli
33
S+S IE (6)
- anorexia and weight loss
- general pain
- clubbing
- splinter hemorrhages
- osler's nodes
- janeway's lesions
34
diagnostics IE (3)
- blood cultures
- echocardiogram
- duke criteria
35
what is duke criteria
3 blood cultures drawn over 1 hour from 3 different sites
36
major criteria in duke criteria (2)
- positive blood culture
| - evidence vegetation on echocardiogram
37
minor criteria in duke criteria (4)
- predisposing heart condition
- fever
- vascular phenomena
- immunologic phenomena
38
treatment IE (3)
- antibiotic prophylaxis
- antipyretics
- IV fluids
39
painful, red or purple pea-sized lesions on fingertips or toes (seen in pts with IE)
osler's nodes
40
flat painless small red spots on hands and feet (seen in pts with IE)
janeway's lesions
41
what procedures should you ask if pts have had within last 6 months when evaluating for IE (4)
- dental
- urologic
- surgical
- gynecologic
42
chronic condition affecting all layers of the heart characterized by scarring and deformity of heart valves caused by acute inflammatory disease of heart
rheumatic heart disease
43
what age group is primarily affected by rheumatic heart disease
young adults
44
what causes rheumatic fever
group A strep
45
most common S+S with RF
mono/polyarthritis
46
3 signs of carditis with RF
- heart murmur
- heart enlargement and HF
- pericarditis
47
major criteria for diagnosing RF (3)
- sydenhams chorea
- erythema marginatum
- subcutaneous nodules
48
symptom of RF, characterized by involuntary movements of face and limbs, muscle weakness, and speech + gait problems
sydenhams chorea
49
symptom of RF, nonpruritic bright pink lesions on trunk and proximal extremities, intensified by heat
erythema marginatum
50
minor criteria for diagnosing RF (3)
- fever
- polyarthralgia
- lab tests (increased CRP and WBC)
51
2 diagnostics for RF
- test for group A strep
| - echocardiogram
52
meds for RF (3)
- antibiotics (amoxicillin, erythromycin, clindamycin)
- aspirin
- corticosteroids
53
narrowing of heart valve that impedes forward flow,
stenosis
54
results from stenosis, backward flow of blood caused by incomplete closure of valve leaflets
regurgitation
55
does stenosis cause murmur when valve is open or closed
open
56
does regurgitation cause murmur when valve is open or closed
closed
57
most common cause mitral valve stenosis
rheumatic heart disease
58
appearance of stenotic mitral valve due to thickening and shortening of valve structures
fish mouth appearance
59
5 main causes mitral valve regurgitation
- MI
- chronic rheumatic heart disease
- mitral valve prolapse
- ischemic papillary muscle dysfunction
- infective endocarditis
60
serious complications mitral valve prolapse (4)
- mitral valve regurgitation
- infective endocarditis
- sudden death
- cerebral ischemia
61
S+S mitral valve disorder (5)
- exertional dyspnea*
- progressive fatigue caused by decreased CO
- heart murmur and palpitations
- systemic embolization
- a fib
62
clinical manifestations aortic valve stenosis (5)
- left ventricular hypertrophy
- decreased CO
- pulmonary HTN
- soft S1, diminished/absent S2
- prominent S4
63
what med is contraindicated in pts with aortic valve stenosis because of likelihood for severe hypotension and decreased preload
nitroglycerin
64
3 causes aortic valve regurgitation
- infective endocarditis
- trauma
- aorta dissection
65
clinical manifestations aortic valve regurgitation (6)
- fluid volume overload
- left ventricle dilation and hypertrophy
- syncope and vertigo
- nocturnal angina with sweating
- dysrhythmia (murmur)
- dyspnea and increasing fatigue
66
diagnostics for valvular disorders (2)
- cardiac cath
| - transesophageal echocardiogram
67
treatment options valvular disorders (3)
- low sodium diet
- percutaneous ballon valvuloplasty
- surgery for repair or replacement
68
nursing considerations with mechanical valve replacement (3)
- lifelong anticoagulant therapy with warfarin
- monitor INR: 2.5-3.5
- bridge therapy with lovenox
69
definite diagnosis of myocarditis
biopsy of myocardium
