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
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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
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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
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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
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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
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􀂃 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
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􀂃 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
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􀂃 Nonspecific: Fever, fatigue, dyspnea, CHF
􀂃 Dysrhythmias; conduction disturbances
􀂃 Chest pain, friction rub, palpitations
􀂃 X-ray, echo EKG - Myocarditis: tx
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􀂃 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
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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
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􀂃 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
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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
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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
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􀂃 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
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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
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Primary: unknown etiology
􀂃 Secondary: known disease from outside the heart: arteriosclerosis; malnutrition, viruses, toxic chemicals, alcohol - Cardiomyopathies:Signs & Symptoms/Diagnostic Tests
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CHF: heart failure
ECHO< ECG, X-ray - Cardiomyopathies:TX
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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:
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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:
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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:
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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
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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
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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):
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MS):RHD, endocarditis, Ca+ deposits
S/S: murmur, diastolic
LA dilation--L pulmonary--CHF--SOB - Mitral Valve Diseases: Mitral Regurgitation (MR, MI)
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RHD, MVP, after an MI
S/S: murmur, systolic
LV hypertrophy--LA dilation--LV failure--CHF - Mitral Valve Diseases:Aortic Stenosis
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Congenital, RHD, Calcifications
S/S: murmur, systolic
LVH, LVD --LV failure --CHF --Syncope and/or angina - Mitral Valve Diseases:Aortic Regurgitation (AR):
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: RHD, syphilis, connective tissue diseases, HTN
S/S: murmur diastolic
LVH, LVD--LV failure--CHF --syncope, angina - Treatment for Valvular Disorders
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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)