Flashcards in Strutural Heart Disorders Deck (25)
Differentiate between Valvular stenosis and Regurgitation.
1) Stenosis occurs when the opening of the valve is narrowed, and the forward flow of blood through the valve is reduced.
2) Regurgitation occurs when valves do not close completely and blood flows backward through the valve.
What are the 2 most significant risk factors for Mitral Stenosis?
1) Rheumatic fever
2) Radiation therapy to the chest
What are the most common symptoms of Mitral Stenosis?
2) Atrial Fibrillation
3) Coughing (sometimes coughing blood)
7) Recurrent respiratory infections
Describe Percutaneous Mitral Valvuloplasty?
Procedure used in patients with Mitral Stenosis. A balloon catheter is placed over a guide wire and positioned with the balloon across the mitral valve. The balloons are hen inflated in order to split the fused valves.
Describe the pathophysiology of Mitral Valve Prolapse?
MVP occurs when one or both of the mitral valve leaflets bulges back into the left atrium during systole.
What are the 2 biggest risk factors for Mitral Valve Prolapse (MVP)?
1) Family history
2) Female gender
Chest pain and SOB are symptoms of MVP, what is the pathophysiology behind this?
Chest pain is not related to activity, it is caused by abnormal stress placed on the chordae tendinae and papillary muscles.
SOB is also not related to activity or pulmonary fxn.
What is the Tx involved for patient with MVP?
1) Asymptomatic MVP requires not treatment.
2) Symptomatic MVP Tx includes:
- BBs to relieve chest pain and palpitations
- Elimination of caffeine and alcohol to reduce symptoms.
Distinguish between Mechanical and Tissue valves.
1) Mechanical Valves - Lasts longer and are therefore used in younger patients. They may also be used in patients with renal failure, endocarditis, or sepsis, as they will not become infected. The disadvantage is that they require life long use of anticoagulants.
2) Tissue Valves - Taken from human (allograft), pigs or cows (xenograft). Are used when anticoagulants are contraindicated (i.e., women of childbearing age, patients older than 70, children and patients who are non-med compliant).
Why is it that Atropine does not increase the heart rate of a transplanted heart?
Transplanted hearts are denervated; it has no nerve connections to the recipient's body and the sympathetic and vagus nerves do not affect the transplanted heart.
What is Endocarditis? What are the 3 major risk factors involved?
Endocarditis is an infection of the Endocardium usually caused by Staphylococci or Streptococci.
Prosthetic heart valves, structural cardiac defects, and IV drug use account for the majority of the infections.
Distinguish between Acute and Subacute Infective Endocarditits.
1) Acute IE - Often caused by Staphylococcus infection and its onset is rapid, occurring within days to weeks.
2) Subacute IE - Usually caused by Streptococcus, occurs more slowly and it's course is prolonged. Systemic emboli occur with left-sided heart IE, while pulmonary emboli can occur when the right heart is infected.
What are the different types of clinical symptoms seen in patients with Infective Endocardidtis?
1) Vague SxS - Anorexia, myalgia, fever & chills, weight loss, back and joint pain, and night sweats.
2) Skin - Osler nodes, Janeway lesions, and Roth spots (caused by microembolization).
3) CNS - Headache, transient cerebral ischemia, and strokes.
4) Organ - Heart murmurs, cardiomegaly, tachycardia, and splenomegaly.
Myocarditis is an inflammation of the heart muscle, commonly resulting from viral infection.
What are the 9 common causes of Pericardidtis?
1) Acute MI
2) Bacterial, viral and fungal infections
3) Chest trauma (injury or surgery)
4) Connective tissue disorders (i.e., lupus, RA, and scleroderma)
5) Disorders of adjacent structures (i.e., dissecting aneurysm).
6) Medications (i.e., Procainamide, hydralazine, and isoniazid)
7) Neoplasms and radiation therapy to the chest
8) Renal failure and uremia
Describe the characteristic chest pain associated with Pericarditits.
The pain is typically persistent, sharp, pleuritic, and usually felt in the mid chest, clavicle, neck, or trapezius area. It is usually aggregated by deep inspiration, coughing, lying down or turning.
It may be relieved by leaning forward or sitting up.
What are the common SxS of Pericarditis?
1) Infection - ⬆WBC, anemia, ⬆ESR and CRP.
2) Cardiac - ST elevation, depressed PR segments, atrial arrhythmias, and pericardial friction rub.
3) Respiratory - Non-productive cough, SOB, dyspnea unrelated to exertion.
What are the two major complications that can occur in a patient with Pericarditis?
1) Pericardial Effusion
2) Cardiac Tamponade - compression of the heart from excessive fluid build up.
What is the medical and nursing management involved for a patient with Pericarditis?
1) NSAIDs and Corticosteroids for pain and inflammation (Boths these meds MUST NOT be used in patients who developed Pericarditis following and acute MI, because they can cause rupture of the infarcted area.
2) Pericardectomy - In cases of restrictive pericarditis.
How might a nurse distinguish between chest pain caused by Pericardidtis and MI?
Pericarditis chest pain intensifies with deep inspiration or coughing.
What are the indications for prophylactic antibiotics in a patient with Infective Endocarditits?
1) Previous IE
2) Prosthetic valves
3) Congenital heart disease with persistent risk of IE
4) Cardiac transplant recipients with valve diseases
What is the hallmark symptom of Myocarditis and Pericarditis?
1) Myocarditis - Cardiac muscle inflammation
2) Pericarditis - Chest pain
(T/F) An Asymptomatic patient with Mitral Regurgitation may continue their regular exercise until mild symptoms occur.
What should the nurse specifically monitor for when giving diuretics to a patient with Cardiomyopathy?