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54 Cards in this Set

  • Front
  • Back
Inflammation of the pericardium which may be chronic or acute
Causes of Pericarditis
Signs and Symptoms of Pericarditis
- Pain – may be similar to MI, may be relieved by sitting up or sitting forward
--Labs/tests that can rule out MI
--- EKG, cardiac enzymes, ECHO

- Dyspnea

- Pericardial friction rub
-- Most notable sign of a myocardial infarction
-- Caused when pericardium and myocardium rub and irritate each other
--- Sounds like sand paper rubbing on each other

- Pulses Paradox
-- Difference of pt’s blood pressure
-- 10mg difference between pt’s inspiration and expiration

- Temperature

- Elevated WBC

- Symptoms of CHF
Complications of Pericarditis
- Pericardial effusion - build up of fluid which restricts cardiac function
- Prevents the ventricles the way they are supposed to, leading to
- Cardiac tamponade – fluid which builds up in the pericardial sac that restricts ventricular filling
Diagnostic tests for Pericarditis
-- Tells us about chambers and walls of heart
--More definitive test for heart problems as opposed to EKG and CE


- Cardiac enzymes (CE)
Interventions for Pericarditis
- Acute
- Treat underlying cause
- Antibiotics
- Steroids
- Pericardiocentesis - Sticks a needle into the pericardium and removes blood
- Pericardial window – creates slit in pericardium and releases pressure in pericardium
Nursing care for Pericarditis
- Bedrest
- Oxygen
- Assess for complications
Definition of Myocarditis
Inflammation of the myocardium
Causes of myocarditis
- Cause may be unknown

- Lyme disease

- Infection

- Drugs
-- Adriamycin

- Chemicals

- Radiation


- “crack heart”

- Secondary to another inflammatory heart disorder
Signs and Symptoms of Myocarditis
- Flulike symptoms
- Dyspnea
- Palpitations
- Chest pain over the pericardium with pericardial friction rub
- Syncope
- Pericardial effusion
Complications of Pericarditis
- Pericardial effusion - build up of fluid which restricts cardiac function
-- Prevents the ventricles the way they are supposed to, leading to
- Cardiac tamponade – fluid which builds up in the pericardial sac that restricts ventricular filling
Diagnostic tests for Pericarditis
-- Tells us about chambers and walls of heart
-- More definitive test for heart problems as opposed to EKG and CE
- Cardiac enzymes (CE)
Interventions for Myocarditis
- Bedrest
- Treat underlying problem
- Steroids
- Digoxin
- Correction of dsyrhythmias
Diagnostic tests for Myocarditis
- EKG changes
- Endomyocardial biopsy
-- Definitive test for myocarditis
Significance of Digoxin
- Digoxin is given to pt’s to increase force of contraction (a positive inotropic reaction)

-Also a negative chronotropic agent to slow down heart rate and gives left ventricle more time to fill

- Must check apical heart rate before giving digoxin

- Do not give digoxin if heart rate is below 60

- Patient may become toxic when given digoxin
Definition of Endocarditis
Infection of the endocardium in which the valves of the heart are most often affected
Causes of Acute Endocarditis
Caused by a staph infection and may cause rapid destruction of the tissue resulting in death in days to weeks if left untreated
Subacute bacterial endocarditis (SBE)
Less virulent form of endocarditis which usually affects persons with pre-existing valvular problems. The most common causative agent is hemolytic streptococci. These patients usually respond well to treatment
Persons at risk for Endocarditis
- Patients with rheumatic valvular disease, congential heart disease or degenerative heart disease

- Patients who have had a valve replacement

- Immunosuppressed patients
Infectious Endocarditis
- May be preceded by dental procedures, minor surgery, open heart surgery, invasive procedures IV drug users.

- Occurs when bacteria in the blood becomes lodged on the valve resulting in infectious growth or “vegetation”. Vegetation can break off and form an emboli.
Signs and Symptoms of endocarditis
- Fever/chills

- Fatigue

- Anemia

- Anorexia

- Weight loss

- Murmur

- Heart failure

- Petechiae

- Osler’s nodes - small, raised, tender, bluish areas on the fingers and toes
Diagnostic tests for Endocarditis
- Blood cultures


-- Tells how heart works

- Cardiac cath
Treatment for Endocarditis
- ID the infecting organism
- Antibiotic therapy
- Surgical valve replacement
Nursing Care for Endocarditis
- ID patients at risk

- Notify all MDs, including

- Good oral hygiene

- Assess for S/S of endocarditis
Definition of Rheumatic Fever
- A systemic inflammatory disease that can involve the heart, kidneys, CNS, skin and connective tissue
- Mitral and aortic valve may become scarred and do not function properly
Cause of Rheumatic Fever
- May occur after untreated strep tonsillitis or strep throat due to Group A beta hemolytic strep
Definition of Rheumatic Heart Disease
– Damage to the heart as a result of rheumatic fever. It is a chronic condition that is characterized by scarring and deformity of the heart valves, most often the mitral and aortic valves
- Important to ask patients about childhood diseases because rheumatic heart disease may not develop for many years after rheumatic fever
Diagnostic tests for Rheumatic Heart Disease
- ASO titer

- ESR and C-reactive protein



Treatment for mitral stenosis
- Supportive

- Low sodium diet

- Diuretics

- Digoxin

- May need surgical replacement
Interventions for Rheumatic Heart Disease
- Supportive

- Large doses of Aspirin

- Steroids

- Penicillin
Prevention of Rheumatic Heart Disease
- Encourage throat cultures

- Entire course of antibiotic therapy

- PCN prophylactically
Anatomy and Physiology of Valves
- Tricuspid valve – separates the right atrium from the right ventricle

- Mitral valve – separates the left atrium from the left ventricle

- Pulmonic valve – separates the right ventricle from the pulmonary circulation

- Aortic valve-separates the left ventricle from the aorta

- Valves keep blood moving forward
Problems with diseased valves
- Stenosis - the orifice is restricted and forward blood flow is restricted. An increased pressure is needed to push the blood through the valve.

- Regurgitation (insufficiency)-the valves fail to close properly and the blood is allowed to flow backwards
Mitral Stenosis
- Most often occurs due to Rheumatic Fever

- Because of the stenotic valve the pressure in the LA increases which causes the LA to dilate. This causes fixed left sided cardiac output which causes an increase in pressure in the pulmonary vascular bed which causes pulmonary congestion which causes right heart failure
Signs and Symptoms of Mitral Stenosis
- Chest X-ray will show enlarged left atrium (LA)

- Symptoms of right sided and left sided heart failure

- Heart sound changes-opening snap with diastolic murmur (DON’T WORRY ABOUT MEMORIZING DIFFERENT TYPES OF MURMURS)
Diagnostic tests for Mitral Stenosis
- Clinical symptoms



- ECHO – Non invasive may be more preferred over cardiac cath

- Cardiac cath

- Once the patient becomes symptomatic they have a life expectancy of 5-10 years unless they have a valve replacement
Interventions for Mitral Stenosis
- Digoxin
- Diuretics
- Low sodium diet
- Try to convert atrial fibrillation
Atrial Fibrillation
- Commonly seen in elderly people

- Biggest problem of atrial fibrillation is when blood pools and starts clotting, causing embolisms which may cause strokes
--Often on anticoagulants to prevent clotting

- AF patients have irregularly irregular pulses
--Listen to apical HR while taking apical pulse
Surgical interventions for Mitral Stenosis
- Mitral commissurotomy - splitting of the fused mitral valve leaflets

- Mitral valve replacement - replacement of the valve with either an artificial or bioprosthetic valve
Mitral Regurgitation
- The insufficient mitral valve allows blood from the LV to re-enter the LA during systole which causes the LA to dilate. The LV has to hypertrophy to maintain the cardiac output and eventually heart failure occurs
Causes of Mitral Regurgitation
- Rheumatic fever

- Ruptured papillary muscle
Signs and Symptoms of Mitral Regurgitation
- Signs and symptoms of right and left sided heart failure
Diagnostic tests for mitral regurgitation
- Clinical symptoms

- Blowing, high pitched systolic murmur


- Chest X-Rays



- Cardiac cath
Mitral Valve Prolapse
- One or both of the leaflets may be floppy and “prolapse” back into the atria during systole.

- Common in women

- May also have mitral regurgitation
Signs and Symptoms of mitral valve prolapse
- Asymptomatic

- Atypical chest pain

- Palpitations

- Fatigue

- Dizziness

- Dyspnea

- Anxiety
Definition of Aortic Stenosis
As the left ventricle tries to push blood through the stenotic aortic valve there is an increase in LV systolic pressure which eventually leads to LV failure. Eventually the patient will develop heart failure as the LV can not push blood forward.

- Kidneys start holding onto fluid compounding problems
Signs and Symptoms of aortic stenosis (Classic symptoms of aortic stenosis)
- Angina – due to the fact that the oxygen demands of the myocardium are not being met

- Syncope – due to the fact that the brain is not getting the blood supply that it needs
- Dyspnea – due to the development of pulmonary congestion because the LA can not completely empty.

- All happen because the left ventricle is not able to pump out to the coronary artieries and no oxygen is supplied to the myocardium
Later Signs and Symptoms of Aortic Stenosis
- Fatigue

- Weakness

- Orthopnea – Difficulty breathing

- PND Parsoxysmal Nocturnal Dsypnea
-- Difficulty breathing at night due to excess fluid from lower extremities flowing into upper extremities (chest) causing shortness of breath

- Peripheral edema


- ascites
Diagnostic Tests for Aortic Stenosis
- Harsh, rough, mid-systolic murmur
- Cardiac cath
Interventions for Aortic Stenosis
- Digoxin

- Low sodium diet

- Diuretics

- Nitro for angina

- May need valve replacement
Definition of Aortic Regurgitation
Because the aortic valve does not close completely there is a backflow of blood from the aorta to the LV during diastole. This causes the LV to dilate and then hypertrophy develops as the heart tries to compensate with a more forceful and rapid ejection of blood
Signs and Symptoms of Aortic Regurgitation
- May take many years to develop

- Widened pulse pressure

- Other symptoms similar to other valve problems
Diagnostic tests for Aortic Regurgitation
- Soft, blowing, aortic diastolic murmur


- Cardiac cath


- Angiography
Types of Heart Surgery for Heart problems
- Coronary Artery By Pass Graft (CABG)-the most common reason for cardiac surgery.

- Used for occlusion of one or more of the coronary arteries. Graft allows blood flow to bypass the area of occlusion

- Surgery isconsidered “closed”

- May be done with or without cold cardioplegia or with or without bypass machine.
Nursing care for cardiac surgery
- Preoperative education

- Postoperative care

- Need frequent cardiovascular, respiratory, neurologic, GI, urinary and F and E monitoring

- Promote comfort

- Observe for complications

- Discharge teaching