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Pt Management & Problems of the CV System - Part 4 Cheat Sheet by

Adult Health 2

Valvular Heart Disease

Mitral 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 Disease

Mitral Valve Prolapse

First Symptom: pts often SOB

Aortic Stenosis

Aortic Regurg­itation

Pharma­col­ogical Interv­entions

Cardiac Glygosides
Beta-B­lockers
Calcium Channel Blockers
Anti-C­oag­ulants
Antibi­otics

Surgical Management

Baloon 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 Types

Pt 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
 

Analysis

Activity Intole­rance (original intent is r/t cardiac issues (CV))
Dec. CO

Transa­ortic Valve Replac­ement (TAVR)

Layers of the Heart Wall

 

Inflam­matory Diseases

Myocar­ditis
Rheumatic Carditis
Endoca­rditis
Perica­rditis
Cardio­myo­pathy

Myocar­ditis

Myoc­ard­itis: 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 Carditis

Endoca­rditis, 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

Endoca­rditis

Infe­ctive 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

Perica­rditis

Usually 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)

Cardio­myo­pathy

Heart 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 Cardio­myo­pathy

Symp­toms: dyspnea, fatigues, signs & symptoms of HF
Expanded damage to fibers
Expanded ventricles
EF < 49%

Restri­ctive Cardio­myo­pathy

Less common
Something restricts filling of ventri­cles, walls become stiff but not necess­arily thickened

Hypert­rophic Cardio­myo­pathy

Symp­toms: palpi­tat­ions, dyspnea on exertion
Massive hypert­rophy of ventricle

Heart Transp­lan­tation

1967 in South Afica by Dr. Chrisitan Barnard
Completed heart transp­lants
Survival rates
Cause of death
Criteria
Procedure
Ventri­cular assist devices
L. VAD?
               

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