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Nursing 2005: Clinical Pathophysiology > Nursing 2005: Cardiovascular Disorders (Part 2) Disorders of the Heart Wall > Flashcards

Nursing 2005: Cardiovascular Disorders (Part 2) Disorders of the Heart Wall Flashcards

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1
Q

Pericardium

A
  • double walled membranous sac that
    encloses heart
  • Layers separated by a clear serous fluid
  • 30cc
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2
Q

Myocardium

A
  • cardiac muscle
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3
Q

Endocardium

A
  • internal lining

- composed of connective tissue and squamous cells

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4
Q

Disorders of Pericardium

  1. Acute Pericarditis
A
  • acute (short term problem) inflammation of pericardium

- etiology unknown or infection

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5
Q

What is the pathophysiology of pericarditis?

A
  • membrane becomes inflamed
  • roughened
  • exudate may form = fluid becomes thick, cloudy, bloody
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6
Q

What are the clinical manisfestations of acute pericarditis?

A

a. chest pain
- d/t inflam
- sharp, abrupt, and radiates
- pain worsens with breathing and laying down
- leaning forward = takes pressure of lungs and is somewhat helpful

b. restlessness, anxiety

c. low grade fever
- d/t inflam

d. friction rub
- heard w/ stethoscope over heart
- sounds like sandpaper

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7
Q

What are the 2 complications of acute pericarditis?

A

a. pericardial effusion

b. cardiac tamponade

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8
Q

a. Pericardial effusion

A
  • excess pericardial fluid
  • increase in fluid = pressure =
    • SOB
    • cough
    • inc resp rate
    • heart can’t beat as strongly
  • Can compress adjoining structures - pulmonary tissues
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9
Q

b. Cardiac tamponade

A
  • effusion inc in size or occurs rapidly
    • a lot of fluid at one time
  • Fluid and pressure compromises heart’s ability to fill and empty
  • dec filling of heart, can’t expand
  • dec cardiac output

** dec R atrial filing -> dec ventricular filing -> dec stroke vol and cardiac output**

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10
Q

What are the s/s of acute pericarditis?

A
  1. pulses paradoxus
    - exaggeration of a normal due in systolic bp in inspiration
  2. muffled heart sounds
  3. poorly palpable pulses
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11
Q

What are the diagnostic tests for acute pericarditis? What are the results?

A
  1. EKG
    - P and R changes
  2. Echocardiogram
    - ultrasound of the heart
    - shows pericardial sac
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12
Q

What are the types of treatment for acute pericarditis?

A

a. treat cause
- it’s acute

b. pain meds
- aspirin or antibiotics

c. pericardiocentesis
- if a lot of excess fluid
- stick needle in pericardial sac to take out fluid

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13
Q

What is constrictive pericarditis?

A
  • chronic inflammation of pericardium
  • develops slowly
  • starts acutely, maybe from pericarditis
  • etiology unknown
    • associated with radiation, cancer, rheumatoid arthritis
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14
Q

What is the pathophysiology of constrictive pericarditis?

A
  • fibrous scarring
  • pericardial layers adhere.
    • no more fluid so it sticks together
  • Encases heart in rigid shell
    • cardiac output dec
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15
Q

What are clinical manifestations of constrictive pericarditis?

A
  • same s/s of heart failure
    a. fatigue, weakness
    b. SOB on exertion
    c. exercise intolerance

d. edema (fluid)
- kidneys can’t filer blood which causes fluid retention

e. distention of jugular vein

f. hepatic congestion​
- in liver

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16
Q

What are the diagnostic tests for constrictive pericarditis?

A

a. EKG
- inflam in heart
- t wave inversions
- a fib

b. Echocardiogram
- no fluid
- layers stick together

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17
Q

What are the types of treatment for constrictive pericarditis?

A

a. digoxin
- positive inotropic agent that inc contractility
- slows down HR
- inc filing of heart to inc cardiac output

b. diuretics
- inc urine output to dec fluid
- less preload on heart

c. Na restrictions
- dec water/fluid retention

d. surgery
- cut out part of pericardium to inc more during HR

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17
Q

What are some additional facts about cardiomyopathy?

A
  • inherited
  • dominant gene in men
  • diagnosed in young adulthood
  • usually in active, athletic people
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18
Q

What is the pathophysiology of dilated cardiomyopathy?

A
  • unknown

** heart chambers dilate= impaired pumping func = dec cardio output

  1. inflam and degenerarion of myocardial fibers that dec contraction func
  2. inc blood vol
  3. dec left ven ejection
  4. dec CO
    ex: pregnancy, alcohol abuse
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19
Q

What are the clinical manifestations of dilated cardiomyopathy?

A

a. fatigue​

b. edema
- peripheral: hands, ankles, feet

c. SOB
- blood isn’t pumping from left side of lungs

d. cough​

e. murmurs
- abnormal heart sounds and rhythms

f. dysrhythmias
- abnormal heart sounds and rhythms

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20
Q

What kind of diagnostic tests are done to check for dilated cardiomyopathy? What are the results?

A
  • CXR
    • shows enlarged heart
  • Echocardiogram
    • can measure the chambers of the heart
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21
Q

What are the types of treatment for dilated cardiomyopathy?

A

a. digoxin
- inc contractility

b. diuretics
- inc urine output to dec preload

c. vasodilators
- dec bp and easy for heart to pump

d. heart transplant
- only chance for cure
- 50% of heart surgeries is for this condition

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23
Q

What is the patho for hypertonic cardiomyopathy?

Study These Flashcards
A
  • myocardial hypertrophy without dilation
  • ** dec vol and obstruction = dec cardiac output
  • inc in myocardial tissue
  • Walls = hypertrophy
  • thick septum = small volumes
  • Hypertrophy also causes impaired relaxation.
  • Possible aortic outflow obstruction
  • strong contraction but dec in blood flow d/t lack of blood
24
Q

What are the clinical manifestations of hypertonic cardiomyopathy?

Study These Flashcards
A
  • similar to dilated CMP = dec CO

b. syncope
- dizziness d/t dec cardiac output

c. angina
- chest pain d/t thick heart wall = more oxygen by coronary arteries

25
What types of diagnostic tests are done? What are the results?
a. CXR - chest X-ray - wont show diff, just enlarged heart b. echocardiogram - can see thick muscle and small vessels
26
What are the types of treatments?
a. Beta blockers: - meds to dec HR and dec contractility - inc filling of ventricles and dec HR b. antiarrythmics​ - control abnormal HR and rhythm - keeps heart regular c. Surgery - take out part of heart muscle to inc chamber size = inc blood vol
26
What are the patho to restrictive cardiomyopathy?
- stiff muscle fibers - loss of compliance - Ventricles resistant to filling - a lot of pressure to fill ventricles
27
What is additional info to restrictive cardiomyopathy?
- scarring d/t radiation | - systemic coronary disease
29
What are the clinical manifestations to restrictive cardiomyopathy?
- similar to dilated CMP d/t dec CO - exercise intolerance - most common in restrictive because its worse - ventricles won't fill even more
30
What kind of diagnostic tests are done for restrictive cardiomyopathy? What are the test results?
- CXR - enlarged heart - echocardiogram - small or normal sized heart chambers
31
What type of treatment is used for restrictive cardiomyopathy?
- treat the underlying cause - improve diastolic filling a. digoxin - dec HR to improve filing of heart b. meds to dec SVR (systemic vascular resistance) - diuretics - anti hypertensive - heart transplant
32
Disorder of the endocardium A. Infective endocarditis
- infection of endocardium aka bacterial endocarditis – development of lesions filled with microorganisms Ex: staph
33
What is the patho of infective endocarditis?
- endocardium damage exposes basement membrane - prepositions valve issue - attracts platelets = thrombus. - Microorganisms adhere to endocardial surface. - through dental, IV drug use, skin infection - Vegetative lesions form, grow and cause valve dysfunction. Ex: blood clot, debri, "garden in heart" - Lesions can break apart =emboli – get lodged - hemorrhage
34
What are the clinical manifestations of infective endocarditis?
a. fever b. weakness, fatigue - d/t infection and inflam c. arthralgias - back pain - joint pain d. splinter hemorrhages - lodged in fingers - make longitudinal lines in nail bed e. petechiae - red pin point lesions on skin and eyes f. oslers nodes - lesions on fingers and toes - pea sized - r/t micro emboli g. Janeway lesions - red painless lesions on palm of hands and feet h. murmur - damage of valves in chambers - hear turbulence, irregular heart sounds i. systemic embolization in organs​ - emboli can got to diff organs
35
What are the diagnostic tests for infective endocarditis? What are the results?
a. blood cultures b. WBC - inc in WBC c. echocardiogram - see lesions on lining of heart and valves
36
What are the treatments for infective endocarditis?
antibiotics: - long term - by IV for 4-6 weeks - multiple kinds
37
B. Rheumatic fever
– inflammatory disease caused by delayed infection by group A beta-hemolytic strept. - mainly with elderly because it was prevalent in the 60s, now its curable - scarring and deformity of cardiac structures -> RHD. - develop strept throat - not treated with antibiotics= RF = scarring = valve problems
38
What is the patho to rheumatic fever?
- inflam in skin, throat - RF = pharyngeal infection. - Delayed and Abnormal immune response to group A strept cell membrane antigen. - Antigens bind to receptors in heart as well as other parts of the body -> damage valves. - scarring = RH
39
What are the clinical manifestations for rheumatic fever?
a. carditis - inflam of heart - heart murmur - chest pain b. polyarthritis - inflam in joints c. chorea - disorder of CNS - involuntary body movements - fixed with treatment d. erythema marginatum - red rash in abdomen - worse with heat
40
What are the diagnostic tests for RF?
a. throat culture​ - look for strept b. anti-streptolysin O titer - exposure to strept c. WBC - inc d. echocardiogram - to look at valve function - if closing properly
41
What are the types of treatment for RF?
a. antibiotics - to clear stept but damage of RF b. aspirin - dec inflam and clots from developing c. cardiac drugs - improve contractility of heart - depends how severe d. surgical repair of valve - to repair valve if that damaged
42
Valvular Disease - 2 types
- d/t endocarditis and RH - left side of heart = more problems 1. Stenosis - valve opening constricted - narrow valves - hypertrophies - valves gets bigger because pumping blood though little opening 2. Regurgitation: – valve doesn’t close all the way = leaking valve - allows blood to flow in reverse -> inc volume - hypertrophy and dilation of chamber d/t getting more blood to put out and get in
43
Types of vavluar disease: | 1. What is the patho for Aortic Stenosis
- results in obstruction of flow from L ventricle to aorta * L ventricle must pump harder -> hypertrophy -> inc O2 consumption - congenital disorder - found when younger - develops slowly = obstruction of flow from left ventricle - pumps harder to get blood through aortic valve = hypertrophy - inc myocardial oxygen consumption = angina
44
What are the clinical manifestations for aortic stenosis?
1. dec HR - d/t less blood 2. dec SBP - less blood being pumped out 3. dec stroke volume - <70 cc of blood vol - dizziness 4. systolic murmur - can hear a longer or extra sound in heart 5. angina - needs more oxygen
45
2. What is the patho of aortic regurgitation?
- caused by heart disease, HTN, syphilis - valve does not close -> retrograde blood flow from ascending aorta into Left ventricle - Volume overload. - blood from L atrium and aorta - Left ventricle dilation and hypertrophy. - Dec contractility d/t it's getting overworked - blood backs up into pulmonary system = goes into the lungs - Can lead to Right ventricle failure
46
What are the clinical manifestations of aortic regurgitation?
1. inc in stroke volume - early on because blood from both directions - strong, throbbing pulses 2. murmur - from not closed valves 3. S&S of heart failure - d/t blood back up in left ventricles with makes right side work harder
47
3. What is the patho of mitral stenosis
- narrowing and fibrosis of valve – obstruction causes incomplete emptying of L atrium = atrium enlarges - inc L atrial pressure/volume - > pulmonary congestion - CO and stroke volume dec - d/t less filling of left ventricle - L atria hypertrophy - d/t endocarditis, heart disease
48
What are the clinical manifestations of mitral stenosis?
1. pulmonary congestion - d/t blood backup into lungs - SOB 2. palpitations - abnormal heart rate d/t change in size of atria 3. diastolic murmur 4. fatigue, weakness - dec cardiac output
49
4. What is the path of mitral regurgitation?
Ex: RH, congenital, coronary heart disease - backflow of blood from L ventricle into L atria and right side of heart - L atria dilates due to inc volume - L ventricle dilates - hypertrophies to maintain CO - L ventricle fails d/t backup of blood - then right side fails
50
What are the clinical manefestation of mitral regurgitation?
1. fatigue, weakness, palpitations | 2. systolic murmur
51
What re the types of diagnostic tests for mitral regurgitation?
a. CXR​ - can see enlargement of heart and valves b. EKG - look for damage to heart - ischemia c. echocardiogram - see valves - measure it d. cardiac catheterization - insert catheter into femoral artery to measure pressure of heart
52
What are the types of treatment for mitral regurgitation?
a. digoxin - inc contractility to inc cardiac Output b. vasodilators - dec after load c. diuretics - dec vol of blood - dec fluid retention d. anticoagulants - prevent clotting e. antiarrhythmics - to normalize HR F.surgery 1. Balloon valvuloplasty - stretch valves= stenosis - good for elderly 2. Repair placement
53
What is the patho for mitral valve prolapse?
- failure of one or both valves leaflets to fit together - Usually benign - can lead to mitral regurgitation and inc risk of endocarditis
54
Additional info for mitral valve prolapse
- most common valve disorder in women 8x more - can live with it for years w/o problems - dangers = infection d/t damage of valve
55
What are the clinical manifestations for mitral valve prolapse?
- murmur​ | - dysrhythmias
56
What types of treatment is prescribed for mitral valve prolapse?
a. antibiotics prophylactically | b. meds to control palpitations

Nursing 2005: Clinical Pathophysiology (9 decks)

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