Valvular Disorders #3 Cardiac

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Tissue Paper My Assets

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Tricuspid
Pulmonic
Mitral
Aortic

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Types of valvular disorders:
What is regurgitation:

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the valve does not close properly and blood back-flows through the valve
Incompetent valve

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What is stenosis:

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the valve does not open completely and blood flow through the valve is reduced
Narrowing tightening

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What is valve prolapse

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the stretching of an atrioventricular valve leaflet into the atrium during diastole
Al leaflet is flapping back a little bit

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Mitral valve prolapse in not what?

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the end of the world

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Incompetent valves:

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Mitral stenosis: thickening and fusing (RHEUMATIC HEART DISEASE)
Mitral reguritation :numerous causes
Mitral valve prolapse: most common

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What is very important teaching in regards to valve disorders?

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Nicotine & caffeine can cause palpitations. Also dental procedures need antibiotics due to risk of infection

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More Incompetent valves:

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Aortic stenosis: congenital (newborns) or rheumatic fever. Aortic stenosis puts major pressure on an adults valve, while baby will not be at nearly the risk.
Aortic regurgitation: in drug abusers
Tricuspid valve disease: not too much
Pulmonic valve disease: not too much

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Assessment for incompetent valves:

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Echocardiogram
TEE: Transesophageal Echocardiogram (full view, down esophagus no obstruction! Great test!!The best way to monitor the opening and closing of the valves
Conservative therapy: percutaneopus transluminal ballon valvuloplasty (PTBV) : catheter in can help with stenosis...thickening and fusing!(risk of breaking up!)
Surgical therapy Prosthetic valves: mechanical and bigological (replacement of valve)

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Surgical therapy:

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There are many ways to repair the heart:
Valvuloplasty
Valve replacement

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If a person has a mechanical valve replacement you will here what?

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clicking, like a clock

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Types of replacement valves:
Mechanical valves:

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Do not deteriorate easily or become infected easily, but ARE THROMBOGENIC AND REQUIRE LIFELONG ANTICOAGULATION THERAPY!!

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TISSUE VALVES:

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Tissue (bilogic) valves
Xenograft (heterograft): pig or cow valves(BOVINE)
Homograft (allograft) human valve
Autograft: pt's own valves

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There are religions that would what?

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never allow a tissue valve replacement (Hacidic jews)

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Mechanical valves are:

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rougher than a normal valve. Therefore there is alot of risk for clots, damage

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A young woman with any type of cardiac issues probably should not get what type of valve replacement?

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Mechanical
A young woman with mechanical valve replacement will be on Coumadin for life (anticoagulant), which is contraindicated for preganancy. NOT GOOD!!

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What is the only valve that can be
relocated?

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Pulmonic valves

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Patient teaching in regards to valves:

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help the pt. select an appropriate type of valve. A young hockey player with a mechanical valve is very contraindicated. Hockey players are injured frequently and would bleed out due to anticoagulants.
Airplane pilot on Coumadin? Not good either due to changes in altitude.

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What is cardiomyopathy?

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a series of PROGRESSIVE events that culminates in impaired cardiac output and can lead to heart failure, sudden death, or dysrhythmias.

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Types of cardiomyopathy:
TEST!
What is dilated cardiomyopathy?

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An enlarged heart with decreased muscle

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Types of cardiomyopathy:
TEST!
What is hypertrophic cardiomyopathy?

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HUGE MUSCLE (ARNOLD SCWARZENNIEGER) less volume in ventricles:tiny cardiac output
NOT GOOD!

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Types of cardiomyopathy:
TEST!
What is restrictive cardiomyopathy?

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some thickening, tight, stiff, cannot contract...decreased cardiac output

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Essentially cardiomyopathy results in what?

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Decerased respiratory, difficulty breathing, fatigue, decreased cardiac output

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Cardiomyopathy is most common in who?

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90% African Males

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What is the diagnostic test for cardiomyopathy?

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TEES
Transesophageal Echocardiogram!!

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What are the manifestation of cardiomyopathy?

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CHF
Due to backing up of the blood
This person WILL NOT be able to tolerate an increase in myocardial oxygen demand
WET LUNG SOUNDS
Jugular vein distention if it backs up all the way to the right atrium and superior vena cava.
Dyspnea
SOB

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What are the four characteristics of hypertrophic cardiomyopathy?
Pathophysiology:
TEST

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thickening of septum
decreased chamber size
aobstruction of aortic output

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What are the four characteristics of restrictive cardiomyopthay?
TEST!!

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stretched out heart, decreased cardiac output....TEES
Outcome: sudden cardiac death
Treatment: Heart transplant

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What is a cardiomyopathy crack heart?

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Tachyarrhythmia: COCAINE
too much catecholamines...epinephrine, norepinephrine, dopamine
decreased output due to decreaed ventricular filling

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Cardiomyopathy tachyarrhythmia can lead to what?

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Ventricular tachycardia.....VERY QUICKLY!!

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Care of a pt. with cardiomyopathy:

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assessment: in addition to heart sounds LISTEN TO LUNG SOUNDS!!
Extra heart sounds
s/s CHF

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Care of pt. with cardiomyopathy:
Nursing Diagnosis:

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Decreased cardiac output
Decreased tissue perfusion
Impaired gas exchange
Activity intolerance
Noncompliance
Knowledge deficit

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Care of pt. with cardiomyopathy:
Planning/Goals:

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Improve or maintain current cardiac output
Helping pt. adjust to the massive changes in their life, morning naps. etc.

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Care of pt. with cardiomyopathy:
Nursing Interventions:

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Meds
ELEVATE HOB WITH LEGS IN DEPENDENT POSITION (decrease blood flow to the heart, decreasing pre-load, which decreases cardiac workload
Diuretics
Low Na diet
Decerase anxiety

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Infectious Disease of the Heart

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Any of the heart may be affected
Disease named by the layer of the heart that is affected
Diagnosis made by patient symptoms and echocardiogram
Blood cultures may be used to identify infectious agent and to monitor therapy
Treatment is with appropriate antimicrobial therapy. Patients need to be instructed to complete the course of appropriate antimicrobial therapy, and require teaching about infection prevention and health promotion

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Infectious Disease of the Heart:

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Rheumatic Endocarditis
Infective Endocarditis
Pericardits

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Rheumatic Endocarditis:

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Occurs most often in school-age children, after group A beta-hemolytic streptococcal pharyngitis
Injury to heart tissue is caused by inflammatory sensitivity reaction to the streptococci
Myocardial and pericardial tissue is affected, but ENDOCARDITIS RESULTS IN PERMANENT CHANGES IN THE VALVES
NEED TO PROMPTLY RECOGNIZE AND TREAT "STREP THROAT" TO PREVENT RHEUMATIC FEVERE
FEVER>101-104, SUDDEN SORE THROAT, FLAME RED BY THE SECOND DAY

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What is the rapid stress test?

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Stopping the progression of the disease before it can do serious damage
BRILLIANT BRIGHT RED STREP THROAT

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People who are socioeconomically compromised are what?

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more likely to acquire rheumatic endocarditis because not everyone that acquires strep throat has access to antibiotics.
Rheumatic heart disease, permanently changes the valves. They will not ever heal. So valve replacement will come up for sure in 10-15 years.

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What is infective endocarditis?

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A microbial infection of the endothelial surface of the heart. Vegetative growths occur and may embolize to tissues throughout the body.
VEGIE VALVES!!
Usually develops in people with prosthetic heart valves or structural cardiac defects. Also occurs in patients who are IV drug abusers and in those with debilitating diseases, indwelling catheters, or PROLONGED IV THERAPY!
Bacteria loves warm, dark, moist, sugar=HEART
Infective endocarditis is brought on by unclean injections, not by the drug itself. Nurse's beware

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Who is at risk for infective endocarditis?

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heavy drug users, hospitalized pt.'s receiving I.V. drug therapy. Nurse's incompetence can cause infective endocarditis

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Pericarditis
(Inflammation of the pericardium)
Many causes usually secondary to open heart surgery. Nursing Diagnosis is what?

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PAIN!!

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Potential complications of Pericarditis?

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Pericardial effusion: irritation results in effuse: fluid the heart puts in the pericardial sca
Cardiac tamponade: Pressure on heart from effusion (fluid) or blood. Decreased cardiac output. Squeezing the heart. similiar to hemothorax

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Important:
ANTIBIOTIC PROPHYLAXIS:

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Mechanical valve replacements including Annuloplasty or other prosthetic material
Valvular defects including mitral click, and murmur or mitral regurgitation, mitrral Stenosis, aortic Stenosis, and aoritc regurgitation
A history of rheumatic heart disease, Endocarditis, or myocarditis
ANTIBIOTIC PROPHYLAXIS IS REQUIRED FOR DENTAL PROCEDURES AND SURGICAL INTERVENTIONS, INCLUDING GU AND GI PROCEDURES, TO PREVENT ENDOCARDITIS
EBP: SAYS TAKE THE ANTIBIOTICS!!!!!