Inflammatory Heart Disorders- Unit 2

Front 1

Inflammatory heart disorders

Back 1

Valvular heart disease, RHD,

Front 2

Causes of Valvular heart disease

Back 2

RHD, MI, Congenital defect, Aging

Front 3

RHD-Rheumatic Heart disease

Back 3

FROM STREP INFECTIONS-vegetation grows on the valves (endocarditis) can be embolic so you can get strokes- take care of your teeth and don't smoke- need antibiotics for endocarditis

Front 4

MI

Back 4

DAMAGE TO STRUCTURES AROUND THE HEART IF THERE IS DEATH IN THE TISSUES

Front 5

WITH AGING- WHAT SIDE OF THE HEART GIVES AWAY FIRST-

Back 5

THE LEFT SIDE

Front 6

with aging which valves give away first

Back 6

mitral and aoritc

Front 7

Stenosis

Back 7

stickiness, valve is sticky and doesn't open very well - THey can go in and do a valvularplasty balloon and open up the valve. Then you may get regurgitation

Front 8

Regurgitation

Back 8

Leaky valves- incompetent valves- valves doesn't close tight so it is leaky

Front 9

when the atrium gets big we get problems

Back 9

with afib

Front 10

Treatment of valve problems

Back 10

either replace the valve or treat the symptoms- symptoms and tx are going to be the same as heart failure

Front 11

Symptoms of valve problems

Back 11

Crackles SOB and PND

Front 12

When the blood backs up from valve problem where does it go and what does it do?

Back 12

backs up into atrium

Front 13

Heart failure meds

Back 13

ARB, ACE inhibitors, lasix (po or drip), spironolactone ( k sparing diuretic), beta blockers, adjust heparin based on APTT

Front 14

Hemoptysis

Back 14

coughing up blood

Front 15

Hemolysis

Back 15

breaking of blood cells

Front 16

Collaborative care for patients with valve problems- diagnostic tests

Back 16

ECHO- looking at structure and function of the valves

Front 17

Medications of valve problems

Back 17

digoxin, diuretics, vasodilators, anticoagulants, antibiotics

Front 18

Digoxin

Back 18

to much dig makes heart rate go down

Front 19

Diuretics

Back 19

get rid of failure, lasix- check K

Front 20

Vasodilators (ace inhibitors)

Back 20

pril's, gold standard for failure, they may cause a bad cough so then they will go on ARB's

Front 21

Anticoagulants

Back 21

must be on these if they have a mechanical valve- heparin then coumadin, may bridge to coumadin w/dalteparin.

Front 22

may bridge coumadin with

Back 22

dalteparin

Front 23

Antidote for Heparin

Back 23

protamine sulfate

Front 24

antidote for coumadin

Back 24

Vit K and fresh frozen plasma

Front 25

Antibiotics

Back 25

for patients that have mechanical valves or surgery, dental work or lots of previous endocarditis issues we talk about SBE (subacute bacterial endocarditis) we want to prevent them from getting an infection in the valves. Sometimes they have to be on antibiotics before procedures. PATIENTS WITH STENOSIS OR REGURGITATION WILL ALSO NEED THIS

Front 26

MECHANICAL VALVE

Back 26

DURABLE! must be on Coumadin the rest of your life, noisy and more susceptible to infections. Antibiotics don't work well with mechanical valves. BAD FOR CLOTS

Front 27

Biological Tissue valves

Back 27

don't last as long, may need to get replaced every 15 years, pig or cow, no rejection meds, tissue valves are better if patient gets infections often. Don't need long term anticoagulant.

Less durable

Better for clotting

Front 28

Coumadin teaching

Back 28

green leafy veggies- take the same amount each day. Don't take aspirin for pain because it makes their platelets less sticky- have to have PT/INR labs drawn

Front 29

Reconstructive valve treatments

Back 29

Percutaneous balloon valvularplasty, open commissurotomy, valvularplasty, annuloplasty

Front 30

Percutaneous balloon valvularplasty

Back 30

a balloon catheter similar to that used in coronary angioplasty procedure is inserted into the femoral vein or artery, The balloon is inflated for 90 seconds to divide the fused leaflets and enlarge the valve orifice

Front 31

Open commissurotomy

Back 31

surgical division of fused valve leaflets, is done to open stenotic valves

Front 32

Valvularplasty

Back 32

reconstruction or repair of heart valve

Front 33

Annuloplasty

Back 33

repairs a narrowed or an enlarged or dilated valve annulus, the supporting ring of the valve.

Front 34

Cardiomyopathy

Back 34

same thing as failure- BIG BOGGY HEART

Front 35

Primary causes of Cardiomyopathy

Back 35

we dont know what causes it, patient just kind of gets it

Front 36

Secondary causes of cardiomyopathy

Back 36

we know what causes it- all related to failure-ie infections, metabolic problems, amyloidosis, alcohol, cocaine, IV drugs, Pregnancy, Leukemia, Cancers

Front 37

Amyloidosis

Back 37

protein disorder

Front 38

3 major types of Cardiomyopathies

Back 38

Restrictive, hypertrophic, dilated

Front 39

Restrictive cardiomyopathy

Back 39

when wall of the ventricles become stiff and hardened so we have bad filling times and filling amounts

Front 40

Hypertrophic cardiomyopathy

Back 40

walls are thick and there is little filling space , decreased cardiac output, septal myectomy to take out some of the septal myocardium- HOCM

FOund in younger people/athletes

Causes one to go into VFIB so we SHOCK THEM

Front 41

HOCM

Back 41

stands for hypertrophic cardio myopathy

Front 42

Dilated cardiomyopathy

Back 42

maybe patient had an MI or ischemic heart disease, wall of the heart is dilated out, low ejection fractions

Front 43

Inflammatory Cardiac Disorders

Back 43

rheumatic fever, rheumatic heart disease

Front 44

Rheumatic Fever

Back 44

Inflammatory disease from untreated strep throat. Can damage valves and cause failure

Front 45

Rheumatic Heart Disease R/T rheumatic fever

Back 45

vegetation, worried about embolism and petechiae caused by rheumatic fever

Front 46

Infective Endocarditis

Back 46

CLOT SHOWER

Front 47

Signs/Symptoms of Infective Endocarditis

Back 47

signs of failure (SOB EDEMA ETC), Petechiae, clots, fever , murmur, brain clots

Front 48

Complications of infective Endocarditis

Back 48

HF, embolic complications

Front 49

Medications for infective ENdocarditis

Back 49

Antibiotics, blood cultures to find the best meds to treat bacteria (antibiotics for 4-8 weeks, may put through a PIC line. Treat infection and then replace the valve

Front 50

Surgery for Infective Endocarditis

Back 50

Replacement- any previous heart problems put people at risk for endocarditis-

Front 51

Do we need SBE prophylaxis with pacemakers?

Back 51

NOPE

Front 52

Myocarditis -(RARE)

Back 52

is an inflammation problem so we give NSAIDS (ibuprofen) or steroids but can effect blood sugars and hard on bones, antiinflammatory meds

Front 53

Pericarditis

Back 53

inflammation of sac around the heart

Front 54

Complications of Pericarditis

Back 54

pericardial effusion, cardiac tamponade

Front 55

How to treat Pericardial effusion

Back 55

pigtail catheter to draw out fluid

Front 56

Cardiac Tamponade sx

Back 56

Decreased BP, Decreased CO, distant heart sounds and chest tube drainage STOPS

Front 57

Cardiac Tamponade

Back 57

compression of the heart that occurs when blood or fluid builds up in the space between the myocardium and the pericardium. When fluid builds up in the pericardial sac (quickly) common in cabg or valve surgery. muffled heart sounds, heart doesn't have time to stretch. EMERGENCY CONDITION

Front 58

Collaborative care for Cardiac Tamponade

Back 58

treat the pain, IV push morphine, 2-4 mg over a minute- resp assessment within 5 minutes and then 30 minutes thereafter

Front 59

ESR and SED rate look at

Back 59

inflammatory problem

Front 60

Unstable Angina

Back 60

coronary arteries block w plaque- check CKMB Troponin, IV heparin, MONA, beta blockers

Front 61

MONA

Back 61

Morphine , oxygen Nitro Aspirin

Front 62

Beta Blockers

Back 62

decrease HR and contraction- decreases O2 demand

Front 63

Prinzmetals-

Back 63

SPASMS- syndrome typically consisting of angina- at rest that occurs in cycles. Its is caused by vasospasm, a narrowing of the coronary arteries caused by contraction of the smooth muscle tissue in the vessel walls rather than directly by artherosclerosis. It occurs more in younger women

Front 64

Statins

Back 64

for cholesterol- look at liver enzymes. AST ALT- side effects are muscle aches and pains.

Front 65

Coumadin teaching

Back 65

bleeding - apply pressure

eat green leafy veggies in moderation

no aspirin in high doses for pain- 81mg per day ok

Front 66

What kind of vegetable makes your pee stink

Back 66

asparagus