Inflammation and Valve Disorders

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tiffanydawnn
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134858
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Inflammation and Valve Disorders
Updated:
2012-02-13 00:21:27
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Inflammation Valve Disorders
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Inflammation and Valve Disorders
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  1. rheumatic heart disease
    • rheumatic fever: systemic inflammatory disease caused by abnormal immune response to Group A beta-hemolytic strep
    • inflammatory lesions in heart, joints, skin
    • carditis: inflammation of the heart
    • endocardial inflammation -> fibrous scarring of valves
    • RHD: slowly progressive valvular deformity (usually mitral)
    • rigid, deformed valves cause stenosis or regurgitation
  2. stenosis
    narrowed, fused valve obstructs forward flow
  3. regurgitation
    incompetent valve (fails to close)
  4. RF/RHD manifestations
    • RF: fever, joint pain, skin rash
    • carditis: chest pain, tachycardia, pericardial friction rub, HF s/s, S3, S4, or murmur
  5. RF/RHD dx
    • CBC/ESR - infection and inflammation
    • C-reactive protein - inflammation
    • ASO titer - strep antibodies
    • throat culture - strep
  6. RF/RHD meds
    • ABT (PCN)
    • aspirin/NSAIDs
    • corticosteroids for severe inflammation
  7. infective endocarditis
    • inflammation of the endocardium (lining, valves)
    • risk factors: previous heart damage (congenital, ischemic), IV drug use, invasive catheters, dental procedures
    • usually affects mitral
  8. infective endocarditis patho
    pathogens in blood colonize on valve -> inflammatory mediators -> vegetation enlarges -> scarred/deformed valves
  9. vegetation: debris, fibrin, collagen
    vegetation can embolize -> organ infarction
  10. infective endocarditis manifestations
    • increased temp
    • flu-like symptoms
    • **new or worsened heart murmur**
    • cough
    • SOB
    • joint pain
    • splenomegaly
    • microemboli cause:
    • --petechiae
    • --splinter hemorrhages (in fingernails)
  11. infective endocarditis dx
    • blood cultures
    • echo - visualize vegetations
  12. infective endocarditis tx
    • ABT prophylaxis for dental work
    • ABT for active infection
    • valve replacement (after infection clears)
  13. infective endocarditis nursing
    • risk for imbalanced body temp r/t infection
    • risk for ineffective tissue perfusion r/t embolization of vegetative lesions
    • ineffective health maintenance
  14. pericarditis
    • inflammation of the pericardium
    • primary or secondary to cardiac/systemic disease (MI, infection, uremia, post-cardiac surgery)
    • pericardial tissue damage -> inflammatory response -> vasodilation, erythema, edema -> scarring/adhesions
  15. pericarditis manifestations
    • chest pain with wall movement - sharp, similar to MI (must r/o)
    • pericardial friction rub - leathery, grating sound caused by inflamed pericardium rubbing against chest wall (left lower sternal border)
  16. fever r/t inflammation
    • dyspnea
    • tachycardia
  17. pericarditis complications
    • pericardial effusion
    • cardiac tamponade
    • constrictive pericarditis
  18. pericardial effusion
    • abnormal collection of fluid in pericardial space
    • pus, blood, serum, and/or lymph
    • normal 50mL, can hold up to 2L (gradually)
    • s/s: muffled heart sounds, cough, mild dyspnea
  19. cardiac tamponade
    • rapid fluid build up in pericardial sac that causes compression of the heart
    • caused by pericardial effusion, trauma, cardiac rupture, or hemorrhage
    • interferes with ventricular filling and pumping -> critically reduced cardiac output
    • s/s: paradoxical pulse (diminished during inspiration), muffled heart sounds, dyspnea, tachypnea, tachycardia, narrow pulse pressure, JVD
  20. medical emergency
  21. constrictive pericarditis
    • chronic pericardial inflammation forms scar tissue -> restricted diastolic filling, elevated venous pressure
    • right atrium unable to dilate
    • caused by viral infection, radiation, heart surgery
    • s/s: progressive dyspnea, fatigue, weakness, ascites, peripheral edema, JVD
  22. pericarditis dx
    • CBC/ESR - inflammation
    • cardiac enzymes - slightly elevated (lower than MI)
    • EKG
    • Echo
    • hemodynamic monitoring
    • CXR
    • CT scan
  23. pericarditis meds
    • NSAIDs - inflammation, pain
    • steroids - severe inflammation
  24. pericarditis tx
    • pericardiocentesis - remove fluid from pericardium
    • pericardial window - allows for draining of fluid
  25. valvular heart disease
    • interferes with blood to and from heart
    • RHD most frequent cause, also infective endocarditis, acute MI, congenital
  26. stenosis
    • valve leaflets fuse together
    • unable to fully open or close
    • narrow opening, decreased forward blood flow -> decreased cardiac output
    • some backflow
    • caused by scarring s/t endocarditis or infarction, calcium deposits
  27. regurgitation
    • aka insufficient or incompetent valves
    • valves do not shut completely -> backflow of blood
    • caused by deformity, scarring, cardiac dilation
  28. hemodynamic changes
    • low output in front of valve
    • high pressures behind the valve
    • blood backs up -> s/s similar to CHF
    • leads to heart failure
    • murmur: turbulent flow
  29. mitral valve stenosis/regurgitation
    • blood backs up into LA and lungs -> pulm congestion
    • decreased cardiac output ->
  30. aortic valve stenosis/regurgitation
    • blood backs up into LV/LA -> lungs -> pulm congestion
    • decreased CO -> dizziness, hypotension
  31. tricuspid valve stenosis/regurgitation
    • enlarged RA
    • systemic congestion
    • JVD, peripheral edema
    • decreased blood to lungs
  32. valve disorder dx
    • echo
    • cardiac cath
    • CXR - enlargement
    • EKG changes
  33. valve disorder meds
    • ACE inhibitors
    • digoxin
    • diuretics
    • vasodilators
    • antidysrhythmics
    • anticoags
    • antibiotics (prophylaxis)
  34. valve disorder tx
    • percutaneous balloon valvuloplasty
    • open commissurotomy - cut open leaflets
    • valvuloplasty
    • annuloplasty
    • valve replacement
    • --biomechanical - lasts longer, on Coumadin for life r/t increased risk of clots
    • --tissue - only lasts 10-15 years
  35. valve disorder nursing dx
    • decreased CO
    • activity intolerance
    • risk for infection
    • ineffective protection r/t anticoagulants
    • risk for fluid volume excess

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