Exam 2: Ch 19 Endocardial & Valve Disorders Flashcards Preview

Pathophysiology > Exam 2: Ch 19 Endocardial & Valve Disorders > Flashcards

Flashcards in Exam 2: Ch 19 Endocardial & Valve Disorders Deck (39):
1

infective endocarditis

infection of endocardium including valves

vegetative growth on valve leaflets --> regurgitation

septic emboli break free from growths

requires both heart damage and introduction of the organism -- dental work in person w/ valve disease

2

infective endocarditis is most commonly seen in people with...

preexisting heart defects

IV drug use: staph. A

heart surgery: staph. epidermis from prosthetic valve

3

symptoms of infective endocarditis

systemic infection

petechial (pinpoint) hemorrhages from emboli

4

diagnosis and treatment of infective endocarditis

Dx: blood cultures and echo for regurgitation

Rx: antibiotics, treat cardiac symptoms

5

rheumatic heart disease

immune response to beta-hemolytic strep infection

6

symptoms of rheumatic heart disease

sore throat and swollen glands

carditis --> heart murmur and friction rub

polyarthritis of large joints

skin lesions

CNS involvement --> choreiform movements (jerking)

7

diagnosis/treatment of rheumatic heart disease

Dx: clinical picture, echo, presence of anti-strep Ab

Rx: prevent by treating strep throat

antibiotics to control infection

anti-inflammatories to limit valve damage

8

2 types of valvular heart disease

stenotic: produce resistance to forward blood flow

incompetent (regurgitate) valves: close incompletely, producing backflow

9

mitral stenosis

mitral valve doesn't open all the way, often from fused leaflets from RHD

LV fills poorly (low SV and CO)

LA pressure is increased (pulmonary congestion)

10

symptoms of mitral stenosis

less CO: chest pain, weakness, fatigue

pulmonary congestion: SOB, AF, thrombi, Rt side HF

diastolic murmur

11

mitral regurgitation

mitral valve fails to close fully

retrograde flow into LA during systole --> systolic murmur

high LAP leads to high SV, but low forward SV

enlarged LV b/c volume work increased

eventually LV function is impaired

12

causes of mitral regurgitation

RHD

mitral valve prolapse

chordea tenineae/papillary muscle rupture

13

mitral valve prolapse

caused by Marfan's syn, other conn. tissue disorders

beta blockers relieve symptoms

antibiotic prophylaxis to prevent complications

can cause mitral regurgitation

14

aortic stenosis

narrowed aortic valve increases resistance to LV ejection

pressure work of LV increased, SV decreased

systolic BP lowered, but LVP increased

systolic murmur

15

causes and symptoms of aortic stenosis

causes: congenital defect, acquired calcification

symptoms: angina, syncope (fainting), HF

16

aortic regurgitation

backflow from aorta to the LV during diastole

high SV, but CO to tissues decreased

low DBP, low CA perfusion

Diastolic murmur

LV failure if acute

LV dilation and hypertrophy if chronic

17

symptoms of aortic regurgitation

LV failure symptoms (dyspnea)

angina if DBP too low

18

pericardium

double-layered serous membrane ... visceral and parietal

visceral: adheres to epicardium

parietal: fibrous and still

pericardium fluid in pericardial space

19

pericardial disease 3 types

acute pericarditis

pericardial effusion

cardiac tamponade

20

acute pericarditis

inflammation of pericardium from viral infection or systemic disease

exudate common --> scar formation

scar tissue on pericardium contracts = constrictive pericarditis

21

symptoms of acute pericarditis

chest pain

pericardial friction rub

ECG changes (high ST segments, low PR interval)

22

diagnosis and treatment of acute pericarditis

Dx: low VR --> ascites and distended jugular veins

Rx: antibiotics, NSAIDS

surgical resection

23

pericardial effusion

accumulation of serous fluid or blood in pericardial space

develops from trauma, inflammation, abnormal starlings forces

Rx: NSAIDS, pericardiocentesis (depends on size)

24

cardiac tamponade

life threatening complication of pericardial effusion

sudden increase in pericardial fluid & pericardial pressure

low venous return

patient in shock: high HR, low BP/CO, jugulars distended

25

pulsus paradoxus

part of cardiac tamponade

LV compressed from effusion

inspiration leads to high VR, reptum bulges to left

low SV and BP

26

causes of cardiac tamponade

surgery

trauma

cardiac rupture from MI

27

diagnosis/treatment of cardiac tamponade

Dx: ECG

Rx: percutaneous pericardiocentesis

surgical repair of trauma or cardiac rupture

28

3 types of primary cardiomyopathy

genetic

mixed

acquired

29

genetic: hypertrophic cardiomyopathy

excessive hypertrophy in septum

causes outflow obstruction -> symptoms like aortic stenosis

can cause sudden cardiac death

30

cause of hypertrophic cardiomyopathy

autosomal dominant disorder: mutations of cardiac muscle genes

seen in children/young adults

31

symptoms of hypertrophic cardiomyopathy

dyspnes

chest pain

fatigue

syncope with outflow obstruction

32

diagnosis and treatment of hypertrophic cardiomyopathy

Dx: echo

Rx: beta blockers to lower HR and increase LV filling

surgical excision of septum

33

mixed genetic: dilated cardiomyopathy

ventricles dilated w/ thin walls --> pump poorly

from infection, toxins (EtOH), autoimmune, genetics

34

symptoms and treatment of dilated cardiomyopathy

HF (low EF, PVCs), dyspnea, weakness

Rx: relieve HF symptoms with Digoxin, diuretics, vasodilators

35

2 types of acquired cardiomyopathy

myocarditis

peripartum cardiomyopathy

36

myocarditis

inflammation of heart muscle leads to necrosis

usually viral: coxsackievirus or HIV

37

mechanism of necrosis in myocarditis

direct cell destruction from infection

toxins released by infectious agent

autoimmune -- molecular mimicry

38

symptoms, diagnosis, treatment of myocarditis

symptoms: none to HF, death, URI, flu-like symptoms

Dx: ECG, echo, CXR, biopsy

Rx: bed rest, O2, steroids, immune suppressants, antivirals, hemodynamic support

39

peripartum cardiomyopathy

develops late in pregnancy or in months after delivery

systolic HF

causes: infection, immune response, genetics???

may resolve spontaneously, but maybe not