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 Prolapse
First Symptom: pts often SOB
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
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Analysis
Activity Intolerance (original intent is r/t cardiac issues (CV)) |
Dec. CO |
Transaortic Valve Replacement (TAVR)
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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 |
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