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Inflammatory and structural heart disorders Flashcards

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1
Q

Infective endocarditis

A

Disease of endocardial layer of the heart including heart valves

affects aortic and mitral valves most often

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2
Q

Classification of IE

A

By cause:
-IV drug use IE
-Fungal IE

By site of involvement
-prosthetic valve endocarditis

By severity
-Subacute form affects those with preexisting valve disease
-Acute for affects those with healthy valves

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3
Q

IE causative orgnaisms

A

Bacterial is most common
-Staphylococcus aureas (30%)
-Streptococcus viridans
-Coagulase negative staphylococci

Viruses

Fungi

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4
Q

Risk factors for IE

A

categories of high, moderate, and low risk exist

Principal risk factors:
-prosthetic valves
-hemodialysis
-IV drug abuse
-aging
-intravascular devices resulting in HAIs

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5
Q

Stages of IE

A

Bacteremia

Adhesion

Vegetation
-made of fibrin, leukocytes, platelets, and microbes
-stick to the valve or endocardium
-Parts break off and enter circulation
-Left veg can move to brain, kidneys, spleen
-Right veg can move to lungs

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6
Q

Clinical manifestation of IE

A

not super specific
FEVER, chills, weakness, malaise, fatigue, anorexia

Subacute:
-arthralgias, myalgias, back pain, abdominal pain, weight loss, headache, clubbing of fingers

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7
Q

Vascular manifestation of IE

A

-Splinter hemorrhages in nail beds
-Petechiae (pinpoints)
-Osler’s nodes on fingertips or toes
-Janeway’s lesions on pads of fingers and toes
-Roth’s spots (eyes)

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8
Q

Sound and secondary manifestation of IE

A

systolic murmur
HF

Secondary septic embolisms affect CNS, extremeties, spleen, and kidneys

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9
Q

Diagnostic studies for IE

A

History

Lab tests (from 3 places)
-blood cultures
-CBC with differential
-ESR, CRP

Echo (veg)

Chest xray (cardiomegaly)

ECG (1st or 2nd AV block)

Duke criteria

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10
Q

Prophylactic antibiotic treatment for who?

A

ppl undergoing certain dental procedures

Resp tract incisions

tonsillectomy and ademoidectomy

surgical procedures involving infected skin, skin structures, or musculoskeletal tissue

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11
Q

Interprofessional care for IE

A

-identify organism
-long term IV antibiotics
-repeat blood cultures (2 sets every 24 to 48 hrs)
-valve replacement if necessary
-antipyretics
-fluid
-rest

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12
Q

important assessment things

A

staph or strep infections
immunosuppressants
recent procedures

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13
Q

Typical nursing diagnoses for IE

A

impaired CO
activity intollerance

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14
Q

What to teach patients with high IE risk to promote health

A

Stress need to avoid infectious people (esp URI)
-avoid stress and fatigue
-plan rest periods
-have good oral hygiene
-prophylactic antibiotics
-drug rehab

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15
Q

Ambulatory care for IE

A

antibiotics for 4-6 weeks
-assess home setting
-monitor labs including blood cultures
-assess IV lines
-coping strategies

Adequate rest
-moderate activity
-compressio stockings
-ROM exercises
-deep breathing and coughing every 2 hrs

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16
Q

Teaching for home care of IE after hospitalization

A

-Monitor body temp (to see if antibiotics are effective)
-look for other signs of infection
-teach nature of the disease and how to reduce risk of reinfaction
-stress follow-up care, good nutrition, and prompt treatment of common infections (cold)
-Teach ab prophylactic antibiotics before procedures

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17
Q

Valvular heart disease types

A

defined according to valves affected and type of dysfunction (stenosis vs regurgitation)

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18
Q

Stenosis

A

constricting/ narrowing
-valve opening is smaller
-forward blood flow is impeded
-pressure differences on the two sides of the valve reflect the degree of stenosis

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19
Q

Regurgitation

A

incomplete or insufficiency of closure
-results in backward blood flow

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20
Q

Mitral valve stenosis
-common cause

A

common cause is rheumatic heart disease
-scarring of valve leaflets and chordae tendineae
-contractures develop with adhesions between commissures of the leaflets

Results in decreased blood flow from LA to LV
-increased atrial pressure/volume
-increased pulmonary vasculature pressure
-risk for atrial fibrillation

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21
Q

Clinical manifestations of mitral valve stenosis

Study These Flashcards
A

exertional dyspnea
LOUD S1
diastolic murmur
fatigue
palpitations
hoarseness (atria pushes on larynx)
hemoptysis (pulmonary htn)
Afib –> stroke

22
Q

Mitral valve regurgitation: what is needed for normal functioning?

Study These Flashcards
A

Need
-mitral leaflets
-mitral annulus
-chordae tendinea
-papillary muscles

23
Q

What messes up normal functioning of mitral valve, resulting in regurgitation?

Study These Flashcards
A

MI
chronic rheumatic heart disease
mitral valve prolapse
ischemic papillary muscle dysfunction
IE

24
Q

What even is mitral valve regurgitation?!

Acute vs chronic

Study These Flashcards
A

incomplete valve closure
-backward flow of blood
-LV and LA need to work harder

Acute MR –> pulmonary edema

chronic MR –> LA enlargement, ventricular dilation, eventual ventricular hypertrophy

25
Acute MR manifestations
Thready peripheral pulse Cool clammy extremeties
26
Chronic MR manifestations
Asymptomatic for years LV failure -weakness, fatigue, palpitations, dyspnea -progress to orthopnea, parozysmal nocturnal dyspnea -peripheral edema -Audible S3 an murmur
27
Mitral valve prolapse
Abnormality of mitral valve leaflets and papillary muscle or chordae -leaflets prolapse back into LA during systole Usually benign, but sometimes can have complications (HF, MI, SCD,) Unknown cause, but genetic link in some
28
Diagnostic test for mitral valve prolapse
Echo: -M-mode or 2D
29
Clinical manifestation of mitral valve prolapse
Most ppl asymptomatic -only 10% EVER get symptoms -murmur from regurgitation -severe MR is uncommon though Dysrhythmias can cause -palpitations -light headedness -syncope IE chest pain unresponsive to nitrates
30
How to treat MVP
beta blockers help with chest pain and palpitations valve surgery if severe MR
31
Patient teaching for MVP
-antibiotic prophylaxis if MR present -take your meds -healthy diet --> avoid caffeine -avoid OTC stimulants -exercise -know when to call HCP or EMS
32
Aortic valve stenosis: child vs adult
Congenital aortic stenosis (AS) usually found in childhood or adolescence In adults, its usually a result of rheumatic fever or degeneration
33
What is AVS?
obstruction of blood flow from left ventricle to aorta -causes left ventricular hypertrophy and increased myocardial oxygen consumption -decreased CO leads to decreased tissue perfusion, pulmonary hypertension, and HF **poor prognosis if untreated
34
clinical manifestations of AVS
angina syncope exertional dyspnea
35
Ausculatory findings in AVS
Normal to soft S1 Decreased or absent S2 Systolic murmur with radiation to carotids Prominent S4
36
Treatment of AVS
poor prognosis if symptomatic and not corrected Use nitroglycerin cautiously -reduces preload and BP -can worsen chest pain though
37
Aortic Valve Regurgitation: acute vs chronic
Acute AR - from trauma, IE, or aortic dissection -LIFE THREATENING EMERGENCY Chronic -rheumatic heart disease, congenital bicuspid aortic valve, syphilis, CT prob, or post-surgical issue
38
What is AVR?
Backward blood flow from ascending aorta into left ventricle with chronic AR, LV dilation and hypertrophy occur Decrease in myocardial contractility Pulmonary htn and RV failure
39
Clinical manifestations of acute AR
-severe dypnea -chest pain -hypotension -cardiogenic shock -life-threatening emergency
40
Clinical manifestation of chronic AR
may be asymptomatic for years -exertional dyspnea, orthopnea, paroxysmal dyspnea -angina -"water-hammer" pulse if severe -soft or absent S1 -S3 or S4 -Murmur
41
Tricuspid valve stenosis
Almost always caused by rheumatic fever Manifests -fluttering discomfort in neck -fatigue -RUQ pain
42
Pulmonic valve stenosis
-Almost always congenital -Causes RV htn and hypertrophy Manifestations -syncope -dyspnea -angina
43
Diagnostic studies for valvular heart diseases
Patient history/ physical Echo and TEE Chest xray ECG (hr and hypertrophy) Heart catheterization (pressure and valve size)
44
Conservative therapy for valvular heart disease
-Dependent on valve invovled and disease severity -prevent exacerbations of HF, pulmonary edema, thromboembolism, and recurrent RF and IE Prophylactic antibiotics to prevent recurrent RF and IE Drugs for HF -vasodilators (nitrats, ACE-is) -positive inotropes (dioxin) -diuretics -B-blockers No sodium, anticoagulation, anti-dysrhythmic drugs
45
Vavlular heart disease: Percutaneous transluminal balloon valvuloplasty
-split open the fused commissures -treats stenosis for all valves -balloon-tipped catheter inserted via femoral artery -inflated to separate the valve leaflets
46
Surgical therapy for valvular heart disease: valve repair
Valve repair -preferred surgical procedure -lower operative mortality rate than valve replacement -might not restore total func Types: 1. Commissurotomy (valvulotomy) -closed or open (open is common) 2. Valvuloplasty -open, minimally invasive -usually for MR or TR 3. Annuloplasty
47
Surgical therapy for valvular heart disease: Valve replacement
1. Mechanical -more durable -lasts longer -higher risk of thromboembolism -requires long-term anticoagulation 2.Biologic (tissue) -bovine, porcine, and human -better blood flow -less durable
48
Transcatheter aortic valve replacement
For severe AS -transfemoral approach 1. Edwards Sapien 3 valve 2. CoreValve transcatheter aortic valve
49
Health promotion for Valvular disorders
Early treatment of strep Prophylactic antibiotics for those with history -teach patients symptoms to report
50
Acute and ambulatory care for valvular disorders
Individualize rest and exercise avoid strenuous activity discourage tobacco ongoing cardiac assessments to make sure drugs are working Monitor INR for patient on anticoagulants
51
Patient teaching: valvular disorders
-drug actions and side effects -importance of prophylactic antibiotics -info related to anticoagulation therapy -when to seek medical care
52
Follow up care for valvular disorders
Notify HCP for -signs of infection, HF, or bleeding -planned invasive or dental work Medical-alert device or bracelet

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