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Karteikarten

452: Test 2 Valvular Heart Disease

brittny beauford Englisch 60 Karten

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  1. 1These are also knows as REGULATORS. They work by opening, closing or partially obstructing various passageways.Valve
  2. 2VASCULAR HEART DISEASE IS DEFINED BY WHAT? What are the problems this causes?defined by valve(s) affected
    STENOSIS vs REGURGITAITON vs PROLAPSE
  3. 3A narrowingSTENOSIS
  4. 4backward flow into the heart or between heart chambersREGURGITAITON
  5. 5to “fall out of place”PROLAPSE
  6. 6between the LEFT ATRIUM AND THE LEFT VENTRICLEMitral valve
  7. 7_________ receives oxygenated blood from the pulmonary veins on the way to systemic circulationLeft atrium
  8. 8the GOLD STANDARD for evaluating the severity of mitral stenosisTRANS-MITRAL GRADIENT
    MEASURED BY ECHO
  9. 9Majority of adult cases of mitral stenosis are caused byRHEUMATIC HEART DISESE
    Takes on a fish mouth shape because of thickening/shortening/scarring of the valve structures
  10. 10The structural deformities of mitral valve stenosis include (3)1. Obstruction of blood flow
    2. increased pulmonary vasculature
    pressure (pulmonary HTN)
    3. hypertrophy of the pulmonary
    vessels
  11. 11Clinical manifestations of mitral valve stenosisEXXERTIONAL DYSPNEA (CAN BE ACCOMPANIED WITH HEMOPTYSIS)
    Palpitations (atrial fibrillation)
    Fatigue
    Accentuated first heart sound
    Murmur – low rumbling
    Chest pain, seizures, stroke
  12. 12Causes of mitral valve regurgitationMI
    Chronic rheumatic heart disease
    MV prolapse
    IE (Infective Endocarditis)
  13. 13clinical manifestations in ACUTE MITRAL VALVE REGURGITATIONthready peripheral pulses
    cool, clammy extremities
    low CO
    NEW SYSTOLIC HEART MURMUR
    could lead to cariogenic shock
  14. 14clinical manifestations in CHRONIC MITRAL VALVE REGURGITATIONmay be asymptomatic for years
  15. 15Structural abnormality of MV that allow leaflet to prolapse into left atrium during systoleMITRAL VALVE PROLAPSE
  16. 16CAUSE of mitral valve prolapseUNKNOWN
    USUALLY BENIGN, but serious complications can occur, including death
  17. 17EKGs and mitral valve prolapseMOST PATIENTS ARE ASYMPTOMATIC FOR LIFE
    Murmur and clicks
    Dysrhythmias:
    Paroxysmal supraventricular tachycardia (PSVT)
    VENTRICULAR TACHYCARDIA (V TACH)
  18. 18Mitral Valve Prolapse May or may not be present with CP what to do if PAIN occurs?Episodes occur in clusters, especially during stress
    Pain may be accompanied by dyspnea, palpitations, and syncope
    DOES NOT RESPOND TO ANTI-ANGINA TREATMENT ie. NITRO
  19. 19Aortic valve dysfunction Where is it?AORTIC VALVE IS BETWEEN THE LEFT VENTRICLE AND AORTA which carries oxygenated blood to the body
  20. 20OBSTRUCTION OF FLOW FROM THE LEFT VENTRICLE TO THE AORTA DURING SYSTOLEAortic valve stenosis
  21. 21The effect of aortic valve stenosis is LVH and increased myocardial oxygen consumption. What does this cause?DECREASED CO WHICH LEADS TO PULMONARY HTN AND HF
    **USUALLY DISCOVERED IN CHILDHOOOD, ADOLESCENCE OR YOUNG ADULTS
    If discovered later in life usually from Rheumatic fever
  22. 22clinical manifestations of aortic valve stenosis1. ANGINA
    2. SYNCOPE
    3. EXERTIONAL DYSPNEA
    **This triad= chest pain, dizziness and sob with activity
    *If Symptoms and obstruction are not relieved=POOR PROGNOSIS
  23. 23Nitro and aortic valve stenosisreduces preload that is necessary to help open the stiff valve
  24. 24______ aortic valve regurgitation is a LIFE THREATENING EMERGENCY What does is cause?ACUTE
    IE (infective endocarditis)
    Trauma
    Aortic Dissection
  25. 25Aortic regurgitation WHAT HAPPENS?Blood flows from ascending aorta backs to left ventricle
  26. 26ACUTE PHASE CLINICAL MANIFESTATIONS OF AORTIC REGURGITATIONCARDIOVASCULAR COLLAPSE
    ABRUPT ONSET OF PROFOUND DYSPNEA
    CHEST PAIN
    HYPOTENSION
    LEFT VENTRICULAR FAILURE
    CARDIOGENIC SHOCK
  27. 27Where is the tricuspid valveBETWEEN THE RIGHT ATRIUM AND RIGHT VENTRICLE
    *The right atrium gets its unoxygenated blood from the great veins (superior and inferior vena cava).
  28. 28Tricuspid valve stenosis: Right atrial output becomes obstructed. Increases the blood volume in the right atrium What happens to the right atrium?RIGHT ATRIAL ENLARGMENT AND ELEVATED SYSTEMIC PRESSURE
  29. 29WHICH OCCURS MORE OFTEN STENOSIS OR REGURGITATION?STENOSIS
    ALMOST ALWAYS IN PATIENTS WITH:
    Rheumatic mitral stenosis
    IV drug abusers
    Pt’s treated with a dopamine agonist such as
    (Parkinsons drugs, Pituitary tumor drugs, restless leg syndrome drugs)
  30. 30clinical manifestations of tricuspid valve stenosisPeripheral edema
    Ascites
    Hepatomegaly
    Diastolic murmur
    What do these symptoms sound like?
  31. 31Where is the pulmonic valveBETWEEN THE RIGHT VENTRICLE AND THE PULMONARY ARTERY
  32. 32This is VERY RARE and includes any condition that affects the ______ valve can lead to stenosis or regurgitationpulmonary
    PULMONIC VAVLE DISEASE
  33. 33This valvular heart disease is ALMOST ALWAYS CONGENITAL AND MAY GO UNNOTICED FOR YEARS IF MILDPULMONIC VAVLVE STENOSIS
  34. 34Pulmonic valve disease is results in what?BACKWARD FLOW OF BLOOD FROM THE RIGHT VENTRICLE
  35. 35CAUSES of pulmonic valve stenosisRight ventricular HTN
    Hypertrophy
  36. 36in pulmonic valve stenosis PATIENTS PRESENT WITHFatigue
    Cyanosis
    JVD
    Loud mid-systolic murmur
  37. 37WHAT IS INFECTIVE ENDOCARDITIS (IE)INFECTION OF THE ENDOCARDIUM
    USUALLY IMPACTS CARDIAC VALVES
    PREVIOUSLY FATAL UNTILL DISCOVERY OF PCN
  38. 38Who is at risk for IEPrior IE
    Prosthetic valves
    Valve Disease
    Pacemakers
    Cardiac lesions
    Hospital acquired bacteremia
    Intravenous drug abuse
    Intravascular devices
  39. 39Primary lesions of IEVegetations:
    could be Fibrin, leukocytes, platelets, microbes adhere to valve or endocardium.
    Embolization of portions of vegetation get into circulation= INFARCTION!
  40. 40When do vegetations occur?when blood flow turbulence within the heart allows the organism to infect (embolize)
  41. 412 TYPES OF IESUB-ACUTE: (Longer course, slower onset=enterococci)
    These people usually have previous valve disease
    ACUTE:(shorter course, more rapid onset=strep, staph, viruses, or fungi)
    These people can have healthy valves
  42. 42CLINICAL MANIFESTATIONS OF IENON SPECIFIC-SX ARE FLU LKE=
    FEVER in >90% of pt’s
    Chills, weakness, malaise fatigue, anorexia
    NEW OR CHANGING MURMUR
    Sick! Sick! Sick!
  43. 43SUB-ACUTE IE HAS MORE SYMPTOMS What are they?Wt loss, headache, clubbing fingers, back pains, body aches, abdominal discomfort
  44. 44common HISTORY seen with IEAny HX within the past 3-6 months of:
    IV DRUG USE
    Dental, surgical, or GYN procedures
    including OB delivery
    heart cath or surgery
    dialysis
    infections (skin, resp, or UTI)
  45. 45Diagnostics for IECBC with differential
    Blood cultures, both aerobic and anaerobic
    Electrolytes
    Trops
    Coags
    12-lead ECG
    CXR – look for cardiomegaly
    Echocardiogram
  46. 46The pericardium is the fibrous sac surrounding the heart What is the inflammation of this sac called?PERICARDITIS
  47. 47CAUSES of pericarditisINFECTIOUS such as bacteria, virus (coxsackie B), TB, fungal infections
    NON-INFECTIONS: such as CANCER, MI, trauma, uremia
    AUTOIMMUNE OR HYPERSENSITIVITY such as rheumatic fever, drug reactions, RA, Lupus,
  48. 48HALLMARK FINDING FOR PERICARDITISPERICARDIAL FRICTION RUB
    Severe CP, sharp and pleuritic in nature
    Worse with deep breathing
    Relieved by sitting and leaning forward
  49. 492 MAJOR COMPLICATIONS OF PERICARDITISPERICARDIAL EFFUSTION- accumulation of excess fluid in the pericardium. Can be rapid or slow.
    CARDIAC TAMPONADE-effusion increases in volume, compresses the heart.
  50. 50Diagnostic Studies to help r/o PericarditisECG-abnl in 90% of cases (ST up)
    CXR- look for cardiomegaly
    Echo
    CT/MRI
    CBC with differential
    CRP/ESR Troponins, coags, etc!
    Pericardiocentesis
  51. 51VITAL SIGNS WITH PERICARDITISDiastolic higher
    tachycardia with narrowed pulse pressure (diastolic and systolic being closer together)
  52. 52Nursing management of pericarditis depends on likely causeDirected towards identification and tx
    Based on causative factors:
    Antibiotics, NSAIDs, Corticosteroids
    Sometimes colchicine
    Pericardiocentesis
    Hemodynamic support – fluids, inotropic agents
    Surgical intervention – last ditch
  53. 53Inflammation of the myocardium- heart muscle. Can cause cellular damage and necrosisMYOCARDITIS
  54. 54Causes of myocarditisVirus
    Bacteria
    Fungi
    Radiation therapy
    Pharmacologic and chemical factors
  55. 55Diagnosis of myocarditisendomyocardial biopsy
  56. 56CLINICAL MANIFESTATIONS OF MYOCARDITISBig range of symptoms
    Vague to severe with HF or sudden cardiac death
    Flu-like sx
    THE PATIENT CAN HAVE FRICTION RUB AND PERICARDITIS ALONG WITH MYOCARDITIS
  57. 57Diagnostic Studies of MyocarditisECG
    CBC with differential
    ESR & CRP
    Troponins
    Viral titers (tissue and fluid samples)
    Biopsy
    Echo
    MRI
  58. 58Nursing management of myocarditisDigoxin – use with caution, ACE inhibitor,
    Beta blockers, Diuretics, Inotropes
    Afterload reducers – nitroprusside, inocar, milrinone
    Oxygen, bedrest, restricted activity
    If severe: consider IABP
  59. 59WHAT IS THE BEST WAY TO EVALUATION VALVE FUNCTION OR DYSFUNCTION?ECHO
  60. 60KNOW WHERE THE HEART SOUNDS ARE FOR THE EXAM....

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Karteikarten am 452: Test 2 Valvular Heart Disease, erstellt von brittny beauford am 19/02/2017.
Erstellt von
brittny beauford
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