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Med/Surg 374 Test 1 2

Terms

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Rheumatic Heart Disease (RHD)
Definition:
inflammatory disease potentially involving all layers; Damage results in chronic condition; Involves primarily scarring and deformity of the heart valves
Rheumatic Heart Disease (RHD)
Risk/ Etiology
􀂃 Occurs 5-15 years old from URI
􀂃 Delayed response (2-3 weeks) to group A beta-hemolytic strep infection of the pharynx. The delayed response is the inflam. response
􀂃 Socioeconomic factors
􀂃 Genetic predisposition
􀂃 Decreased immune response
􀂃 Reoccurrence--can get it again.
Rheumatic Heart Disease (RHD)
Patho:
inflammatory process, abnormal immune response to streptococcal cells antigens bind to receptors on the organs
Rheumatic Heart Disease (RHD)
Cardiac Involvement
1. Cardiac Involvement: All Cardiac Layers
􀂃 Endocardium: Swelling or erosion of valve leaflets (mitral & aortic most common)--now a concern for LS of heart-- called(Vegetations-size of pin heads) 􀃎 causing:
o Scarring>stenosis
o Shortens flaps> regurgitation, incompetent valve now
􀂃 Myocardial: Aschoff’s bodies=nodules􀃎fibrin deposits & scar tissue
􀂃 Pericarditis: Effusion & adhesions:
Rheumatic Heart Disease (RHD)
doesn't affect just the heart. It is also found in:
2. Extra cardiac lesion
􀂃 Joint-- polyarthritis
􀂃 Skin-- sub Q nodules
􀂃 CNS-- chorea--
Rheumatic Heart Disease (RHD)
s/sx
􀂃 Polyarthritis
􀂃 Carditis
􀂃 Chorea
􀂃 SQ nodules
􀂃 Erythema maginatium
􀂃 Other
Rheumatic Heart Disease (RHD)
Dx tests
Throat cultures, WBC, ESR
Rheumatic Heart Disease (RHD)
Treatment
􀂃 Eradicate infection
􀂃 Penicillin
􀂃 Corticosteroids
􀂃 ASA
􀂃 Bed rest
Rheumatic Heart Disease (RHD)
Nursing
1. Primary: early detection
2. Secondary
–Identify at risk
–Prophylactic
–At risk for bacterial endocarditis
Infectious Endocarditis (bacterial endocarditis):Definition
Infection of the endocardium; usually involves valves
Infectious Endocarditis (bacterial endocarditis):
Etiology & Risk factors
􀂃 Infectious agent: Bacterial-staph, strep,
􀂃 Gram negative-klebsiella
􀂃 Fungi-candida
􀂃 Introduced by procedures
o Oral: dental, URI
o Direct: surgical, IV injections, cardiac surgery
Infectious Endocarditis (bacterial endocarditis):
s/sx
No universal s/s
1. nonspecific (infection): fever, malaise, fatigue, joint pain
CHF: dyspnea, edema, cough; heart murmur
2. Secondary to embolism (30%)
􀂃 CVA-TIA, AMI, PE
􀂃 Petechiae
􀂃 Janeways lesions
􀂃 Osler’s nodes
􀂃 Splinter hemorrhages
􀂃 anemia
Infectious Endocarditis (bacterial endocarditis):
Dx tests
􀂃 History: dental, urological, gynecological, skin, respiratory, UTI;
􀂃 History of heart disease
􀂃 Blood cultures
􀂃 Anemia, chest x-ray (CHF), echo (valve diseases)
􀂃 Positive DX:
Infectious Endocarditis (bacterial endocarditis): TX
􀂃 Antibiotics
o Prophylaxis: penicillin with procedures
􀂃 Treat
o Penicillin G/ streptomycin: strep or staph, 4-6 weeks IV
o Aminoglycocydes: gram negative
o Amphotericin: fungal
􀂃 Assessment of heart sounds; fever; nutrition; s/s of cx
􀂃 Sx: valve replacement
Infectious Endocarditis (bacterial endocarditis):
Nursing considerations
􀂃 Prevention: know history
􀂃 Self care
Myocarditis: Definition
Inflammation of the heart muscle; usually both ventricles
Myocarditis: etiology/risks
􀂃 May be alone or with an inflammatory disease; RH; collagen diseases; hypersensitivity immune reaction
􀂃 Usually viral (Coxsackie’s A&B): Mumps, flue, rubella
􀂃 Radiation, toxic agents: Lead, lithium & cocaine
Myocarditis: s/sx/dx tests
􀂃 Nonspecific: Fever, fatigue, dyspnea, CHF
􀂃 Dysrhythmias; conduction disturbances
􀂃 Chest pain, friction rub, palpitations
􀂃 X-ray, echo EKG
Myocarditis: tx
􀂃 Underlying disease
􀂃 CHF
Prognosis: self-limiting; Recovers spontaneously
Pericarditis:definiton
inflammation of the parietal and visceral pericardium sac. Can take up to 2L of fluid..takes a while...then trauma happens and you die quickly. Lining is dry or fluid filled.
Pericarditis:Etiology/Risk factors
􀂊Any injury: Infection, myocardial disease, collagen diseases, drug hypersensitivity, radiation therapy, metabolic, neoplastic disease
Pericarditis:Signs & Symptoms/Diagnostic Tests
1. Chest pain: sudden, severe, sharp, aggravated with inspiration and movement; Radiates to L shoulder; Decreases if sitting up and leaning forward
2. Friction rub: short, scratchy or grating; synchronized with heart beat; transient; L middle to lower sternal border
3. Fever, chills, malaise
4. EKG changes (􀃇 ST in I, II, aVf, V4-V6): brady, afib
Pericarditis:TX
􀂃 Rest
􀂃 Pain relief: ASA, NSAID
􀂃 Watch complication
o Pericardial effusion
o Cardiac tamponade
Pericardial Effusion:definition
escape of fluid into pericardial sac
Pericardial Effusion: s/sx
Muffled heart sounds--sound distant (w/fluid in sac)
􀂃 Pulses paradoxus--amplitude changes
􀂃 Flatness to percussion
􀂃 Pt complains of Fullness in chest
Pericardial Effusion: TX
Pericardiocentesis
Cardiac Tamponade:def
a life threatening complication caused by accumulation of fluid in the pericardium: Can be blood, pus, or air.(trauma, bullet wound, open heart surgery)
􀂃 Accumulates fast enough and in a sufficient quantity to compress the heart and restrict blood flow in and out of the ventricles.
Cardiac Tamponade:Signs & Symptoms
􀂃 Elevated venous pressure
􀂃 Distended neck veins
􀂃 Hypotension--narrowing pulse pressure 120/80 then to 100/80
􀂃 Narrowed pulse pressure plus a dropping pressure
􀂃 Restlessness, anxiety
Cardiac Tamponade:Tx
Pericardiocentesis
􀂃 Fluid or air is aspirated from the pericardial sac. Sx are gone immediately.
Cardiomyopathies:
any disease of the muscle or any part of the muscle. These are the heart transplant people.
Cardiomyopathies:etiology
Primary: unknown etiology
􀂃 Secondary: known disease from outside the heart: arteriosclerosis; malnutrition, viruses, toxic chemicals, alcohol
Cardiomyopathies:Signs & Symptoms/Diagnostic Tests
CHF: heart failure
ECHO< ECG, X-ray
Cardiomyopathies:TX
CHF treatment
􀂃 Preload--volume, fluid
􀂃 Afterload--resistance, BP
􀂃 Contractility--how well it contracts
Cardiac transplants--good candidates for this
Types of Cardiomyopathy:Dilated (Congestive) cardiomyopathy:
Most common; Both ventricles dilated; Fibrotic tissue replaces healthy tissue 􀃆 contractility; pooling & clots
Signs & Symptoms: Gradual: fatigue, weakness, arrhythmias
Treatment:dopamine drip!
–Inotropics to increase contractility--digoxin only works w/healthy tissue
–Nitroglycerin to decrease pre & after load to decrease pressure to lessen workload
Types of Cardiomyopathy:Hypertrophic Cardiomyopathy:
disproportionate thickening of septum wall--grows inside the heart
􀂃 Genetic (50%); L wall encroaches on L ventricle -->small and congested
Signs & Symptoms: SCD
􀂃 CHF:
􀂃 Arrhythmias: Tx is slowing it down -->b-blockers are bad SE
􀂃 Death>>football players dropping dead
Treatment
􀂃 Decrease ventricular contractility and Relieve outflow obstruction; Beta adrenergic
Types of Cardiomyopathy:Restrictive Cardiomyopathy:
Least common; Excessively rigid ventricular walls; Can no longer stretch;
􀂃 Caused by infiltrative process ei amyloidosis
Signs & Symptoms
􀂃 Dysrhythmias
Tx of choice: heart transplant!
3 types of cardiomyopathies
Dilated (Congestive) cardiomyopathy, Hypertrophic Cardiomyopathy,Restrictive Cardiomyopathy
Valvular Disorders:Functional Murmurs
Stenosis: orifice is restricted, fused/thick
􀂃 Impedes forward flow--vents pump fine
ô€‚ƒ í¯€increases afterload --pressure problem(resistance)
Valvular Disorders:Regurgitation: incompetence, insufficiency
leaflets don’t close
􀂃 Allow back flow
􀂃 increases preload (volume) volume coming back in
Valvular Disorders:
Characteristics of Murmurs
􀂃 Location
􀂃 Loudness--scale of 1-6, should hear >3
􀂃 Pitch
􀂃 Place and duration
􀂃 Quality
􀂃 Radiation
􀂃 Timing
􀂃 Variations
Mitral Valve Diseases:Mitral Stenosis (MS):
MS):RHD, endocarditis, Ca+ deposits
S/S: murmur, diastolic

LA dilation--L pulmonary--CHF--SOB
Mitral Valve Diseases: Mitral Regurgitation (MR, MI)
RHD, MVP, after an MI
S/S: murmur, systolic

LV hypertrophy--LA dilation--LV failure--CHF
Mitral Valve Diseases:Aortic Stenosis
Congenital, RHD, Calcifications
S/S: murmur, systolic

LVH, LVD --LV failure --CHF --Syncope and/or angina
Mitral Valve Diseases:Aortic Regurgitation (AR):
: RHD, syphilis, connective tissue diseases, HTN
S/S: murmur diastolic

LVH, LVD--LV failure--CHF --syncope, angina
Treatment for Valvular Disorders
Conservative: Treat CHF
Surgery: palliativ--valve replacement
􀂃 Open or closed mitral commissurotomy; Split fused leaflets
􀂃 Prosthetic/artificial valves: mechanical or tissue
o Tolerance to anticoagulation
o Durability of valve
􀂃 Mechanical Valves(lasts forever but predisposed to emboli) and Tissue Valves (best, but shorter lives)

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