Valvular Heart DiseaseMitral Stenosis | Aortic Stenosis | Mitral Regurgitation | Aortic Regurgitation | Mitral Prolapse |
* Hear murmurs!
Stenosis: valve doesn't open all the way, not enough blood passes through
Regurgitation: valve dosn't close all the way so blood leaks backward Mitral Valve ProlapseFirst Symptom: pts often SOB Pharmacological InterventionsCardiac Glygosides | Beta-Blockers | Calcium Channel Blockers | Anti-Coagulants | Antibiotics |
Surgical ManagementBaloon Valvuloplasty: repair of cardiac valve; open heart; no long-term anti-coagulation therapy | Direct or Open Commissurotomy: cut leaflets apart if fused together | Mitral Annuloplasty: fix valve (e.g. regurgitation) so blood moving in the right direction | Replacement Procedures |
Valve TypesPt must be aware of the type!
Ball valve: more durable than tissue valve
Mechanical valve: inc. clot risk lifelong Coumadin; used w/ younger pts b/c it lasts longer
Tissue valve: inc. infection risk prophylactic antibiotics for invasive procedures
Porcine = pig / Bovine = cow
Homographs = cadaver/organ donor | | AnalysisActivity Intolerance (original intent is r/t cardiac issues (CV)) | Dec. CO |
Transaortic Valve Replacement (TAVR)
| | Inflammatory DiseasesMyocarditis | Rheumatic Carditis | Endocarditis | Pericarditis | Cardiomyopathy |
MyocarditisMyocarditis: inflammation of the heart muscle | Usually also have pericarditis | Symptoms: fever, tachycardic (out of proportion for fever), c/o HA, fatigue, flu-like symptoms | HF w/ severe myocarditis | Treatment: largely supportive, treat symptoms |
Rheumatic CarditisEndocarditis, myocarditis, pericarditis, pancarditis | Associated w/ upper resp. Strep. infection
- 40% of people w/ Strep = rheumatic carditis | Most of damage done to endocardium - damages valves | Assessment: tachypnea, cardiomegaly (CXR), murmurs, pericardial friction rub, prolonged PR interval | Treatment: + Strep. = rheumatic heart disease treat infecton & control symptoms |
EndocarditisInfective Endocarditis: microbial infection of endocardium | Common in IV drug abusers, valve replacement, DM, immunosuppressed, burns | Vegetative lesions form | Assessment: sunconjunctival hemorrhages, varying murmurs, conduction disorders, hematuria, Osler's nodes, petechial rash, cerebral emboli, Roth's spots in fundi, petechial hemorrhages on mucus membranes & fundi, poor dentition, splenomegaly, systemic emboli, digital clubbing, splinter hemorrheages, loss of (distal) pulses | Treatment |
PericarditisUsually caused by viruses (also bacteria, MI, radiation) | Acute: fever, leukocytosis, ST segment change
Chronic: signs & symptoms of R-sided HF | Assessment: leaning on table (taking pressure off sac removes pain | Treatment: NSAIDs (dec. inflammation), steroids (if NSAIDs don't work), antibiotics (if caused by bacteria) |
CardiomyopathyHeart muscle disease (usually unknown cause) | Classified in 3 Categories:
- Dilated
- Restrictive
- Hypertrophic | Treatment:
- Medical: diuresis, digoxin
- Surgical: ventricular septal myomectomy (remove septum = 1 ventricle), heart transplant (palliative treatment until then) |
Dilated CardiomyopathySymptoms: dyspnea, fatigues, signs & symptoms of HF
Expanded damage to fibers
Expanded ventricles
EF < 49% Restrictive CardiomyopathyLess common
Something restricts filling of ventricles, walls become stiff but not necessarily thickened Hypertrophic CardiomyopathySymptoms: palpitations, dyspnea on exertion
Massive hypertrophy of ventricle Heart Transplantation1967 in South Afica by Dr. Chrisitan Barnard | Completed heart transplants | Survival rates | Cause of death | Criteria | Procedure | Ventricular assist devices |
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