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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
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stenosis
narrowed, fused valve obstructs forward flow
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regurgitation
incompetent valve (fails to close)
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RF/RHD manifestations
- RF: fever, joint pain, skin rash
- carditis: chest pain, tachycardia, pericardial friction rub, HF s/s, S3, S4, or murmur
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RF/RHD dx
- CBC/ESR - infection and inflammation
- C-reactive protein - inflammation
- ASO titer - strep antibodies
- throat culture - strep
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RF/RHD meds
- ABT (PCN)
- aspirin/NSAIDs
- corticosteroids for severe inflammation
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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
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infective endocarditis patho
pathogens in blood colonize on valve -> inflammatory mediators -> vegetation enlarges -> scarred/deformed valves
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vegetation: debris, fibrin, collagen
vegetation can embolize -> organ infarction
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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)
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infective endocarditis dx
- blood cultures
- echo - visualize vegetations
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infective endocarditis tx
- ABT prophylaxis for dental work
- ABT for active infection
- valve replacement (after infection clears)
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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
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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
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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)
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pericarditis complications
- pericardial effusion
- cardiac tamponade
- constrictive pericarditis
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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
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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
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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
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pericarditis dx
- CBC/ESR - inflammation
- cardiac enzymes - slightly elevated (lower than MI)
- EKG
- Echo
- hemodynamic monitoring
- CXR
- CT scan
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pericarditis meds
- NSAIDs - inflammation, pain
- steroids - severe inflammation
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pericarditis tx
- pericardiocentesis - remove fluid from pericardium
- pericardial window - allows for draining of fluid
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valvular heart disease
- interferes with blood to and from heart
- RHD most frequent cause, also infective endocarditis, acute MI, congenital
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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
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regurgitation
- aka insufficient or incompetent valves
- valves do not shut completely -> backflow of blood
- caused by deformity, scarring, cardiac dilation
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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
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mitral valve stenosis/regurgitation
- blood backs up into LA and lungs -> pulm congestion
- decreased cardiac output ->
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aortic valve stenosis/regurgitation
- blood backs up into LV/LA -> lungs -> pulm congestion
- decreased CO -> dizziness, hypotension
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tricuspid valve stenosis/regurgitation
- enlarged RA
- systemic congestion
- JVD, peripheral edema
- decreased blood to lungs
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valve disorder dx
- echo
- cardiac cath
- CXR - enlargement
- EKG changes
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valve disorder meds
- ACE inhibitors
- digoxin
- diuretics
- vasodilators
- antidysrhythmics
- anticoags
- antibiotics (prophylaxis)
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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
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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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