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Flashcards by brittny beauford, updated more than 1 year ago
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Created by brittny beauford
about 8 years ago
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| Question | Answer |
| These are also knows as REGULATORS. They work by opening, closing or partially obstructing various passageways. | Valve |
| VASCULAR HEART DISEASE IS DEFINED BY WHAT? What are the problems this causes? | defined by valve(s) affected STENOSIS vs REGURGITAITON vs PROLAPSE |
| A narrowing | STENOSIS |
| backward flow into the heart or between heart chambers | REGURGITAITON |
| to “fall out of place” | PROLAPSE |
| between the LEFT ATRIUM AND THE LEFT VENTRICLE | Mitral valve |
| _________ receives oxygenated blood from the pulmonary veins on the way to systemic circulation | Left atrium |
| the GOLD STANDARD for evaluating the severity of mitral stenosis | TRANS-MITRAL GRADIENT MEASURED BY ECHO |
| Majority of adult cases of mitral stenosis are caused by | RHEUMATIC HEART DISESE Takes on a fish mouth shape because of thickening/shortening/scarring of the valve structures |
| The 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 |
| Clinical manifestations of mitral valve stenosis | EXXERTIONAL DYSPNEA (CAN BE ACCOMPANIED WITH HEMOPTYSIS) Palpitations (atrial fibrillation) Fatigue Accentuated first heart sound Murmur – low rumbling Chest pain, seizures, stroke |
| Causes of mitral valve regurgitation | MI Chronic rheumatic heart disease MV prolapse IE (Infective Endocarditis) |
| clinical manifestations in ACUTE MITRAL VALVE REGURGITATION | thready peripheral pulses cool, clammy extremities low CO NEW SYSTOLIC HEART MURMUR could lead to cariogenic shock |
| clinical manifestations in CHRONIC MITRAL VALVE REGURGITATION | may be asymptomatic for years |
| Structural abnormality of MV that allow leaflet to prolapse into left atrium during systole | MITRAL VALVE PROLAPSE |
| CAUSE of mitral valve prolapse | UNKNOWN USUALLY BENIGN, but serious complications can occur, including death |
| EKGs and mitral valve prolapse | MOST PATIENTS ARE ASYMPTOMATIC FOR LIFE Murmur and clicks Dysrhythmias: Paroxysmal supraventricular tachycardia (PSVT) VENTRICULAR TACHYCARDIA (V TACH) |
| Mitral 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 |
| Aortic valve dysfunction Where is it? | AORTIC VALVE IS BETWEEN THE LEFT VENTRICLE AND AORTA which carries oxygenated blood to the body |
| OBSTRUCTION OF FLOW FROM THE LEFT VENTRICLE TO THE AORTA DURING SYSTOLE | Aortic valve stenosis |
| The 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 |
| clinical manifestations of aortic valve stenosis | 1. ANGINA 2. SYNCOPE 3. EXERTIONAL DYSPNEA **This triad= chest pain, dizziness and sob with activity *If Symptoms and obstruction are not relieved=POOR PROGNOSIS |
| Nitro and aortic valve stenosis | reduces preload that is necessary to help open the stiff valve |
| ______ aortic valve regurgitation is a LIFE THREATENING EMERGENCY What does is cause? | ACUTE IE (infective endocarditis) Trauma Aortic Dissection |
| Aortic regurgitation WHAT HAPPENS? | Blood flows from ascending aorta backs to left ventricle |
| ACUTE PHASE CLINICAL MANIFESTATIONS OF AORTIC REGURGITATION | CARDIOVASCULAR COLLAPSE ABRUPT ONSET OF PROFOUND DYSPNEA CHEST PAIN HYPOTENSION LEFT VENTRICULAR FAILURE CARDIOGENIC SHOCK |
| Where is the tricuspid valve | BETWEEN THE RIGHT ATRIUM AND RIGHT VENTRICLE *The right atrium gets its unoxygenated blood from the great veins (superior and inferior vena cava). |
| Tricuspid 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 |
| WHICH 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) |
| clinical manifestations of tricuspid valve stenosis | Peripheral edema Ascites Hepatomegaly Diastolic murmur What do these symptoms sound like? |
| Where is the pulmonic valve | BETWEEN THE RIGHT VENTRICLE AND THE PULMONARY ARTERY |
| This is VERY RARE and includes any condition that affects the ______ valve can lead to stenosis or regurgitation | pulmonary PULMONIC VAVLE DISEASE |
| This valvular heart disease is ALMOST ALWAYS CONGENITAL AND MAY GO UNNOTICED FOR YEARS IF MILD | PULMONIC VAVLVE STENOSIS |
| Pulmonic valve disease is results in what? | BACKWARD FLOW OF BLOOD FROM THE RIGHT VENTRICLE |
| CAUSES of pulmonic valve stenosis | Right ventricular HTN Hypertrophy |
| in pulmonic valve stenosis PATIENTS PRESENT WITH | Fatigue Cyanosis JVD Loud mid-systolic murmur |
| WHAT IS INFECTIVE ENDOCARDITIS (IE) | INFECTION OF THE ENDOCARDIUM USUALLY IMPACTS CARDIAC VALVES PREVIOUSLY FATAL UNTILL DISCOVERY OF PCN |
| Who is at risk for IE | Prior IE Prosthetic valves Valve Disease Pacemakers Cardiac lesions Hospital acquired bacteremia Intravenous drug abuse Intravascular devices |
| Primary lesions of IE | Vegetations: could be Fibrin, leukocytes, platelets, microbes adhere to valve or endocardium. Embolization of portions of vegetation get into circulation= INFARCTION! |
| When do vegetations occur? | when blood flow turbulence within the heart allows the organism to infect (embolize) |
| 2 TYPES OF IE | SUB-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 |
| CLINICAL MANIFESTATIONS OF IE | NON SPECIFIC-SX ARE FLU LKE= FEVER in >90% of pt’s Chills, weakness, malaise fatigue, anorexia NEW OR CHANGING MURMUR Sick! Sick! Sick! |
| SUB-ACUTE IE HAS MORE SYMPTOMS What are they? | Wt loss, headache, clubbing fingers, back pains, body aches, abdominal discomfort |
| common HISTORY seen with IE | Any 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) |
| Diagnostics for IE | CBC with differential Blood cultures, both aerobic and anaerobic Electrolytes Trops Coags 12-lead ECG CXR – look for cardiomegaly Echocardiogram |
| The pericardium is the fibrous sac surrounding the heart What is the inflammation of this sac called? | PERICARDITIS |
| CAUSES of pericarditis | INFECTIOUS 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, |
| HALLMARK FINDING FOR PERICARDITIS | PERICARDIAL FRICTION RUB Severe CP, sharp and pleuritic in nature Worse with deep breathing Relieved by sitting and leaning forward |
| 2 MAJOR COMPLICATIONS OF PERICARDITIS | PERICARDIAL EFFUSTION- accumulation of excess fluid in the pericardium. Can be rapid or slow. CARDIAC TAMPONADE-effusion increases in volume, compresses the heart. |
| Diagnostic Studies to help r/o Pericarditis | ECG-abnl in 90% of cases (ST up) CXR- look for cardiomegaly Echo CT/MRI CBC with differential CRP/ESR Troponins, coags, etc! Pericardiocentesis |
| VITAL SIGNS WITH PERICARDITIS | Diastolic higher tachycardia with narrowed pulse pressure (diastolic and systolic being closer together) |
| Nursing management of pericarditis depends on likely cause | Directed towards identification and tx Based on causative factors: Antibiotics, NSAIDs, Corticosteroids Sometimes colchicine Pericardiocentesis Hemodynamic support – fluids, inotropic agents Surgical intervention – last ditch |
| Inflammation of the myocardium- heart muscle. Can cause cellular damage and necrosis | MYOCARDITIS |
| Causes of myocarditis | Virus Bacteria Fungi Radiation therapy Pharmacologic and chemical factors |
| Diagnosis of myocarditis | endomyocardial biopsy |
| CLINICAL MANIFESTATIONS OF MYOCARDITIS | Big 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 |
| Diagnostic Studies of Myocarditis | ECG CBC with differential ESR & CRP Troponins Viral titers (tissue and fluid samples) Biopsy Echo MRI |
| Nursing management of myocarditis | Digoxin – use with caution, ACE inhibitor, Beta blockers, Diuretics, Inotropes Afterload reducers – nitroprusside, inocar, milrinone Oxygen, bedrest, restricted activity If severe: consider IABP |
| WHAT IS THE BEST WAY TO EVALUATION VALVE FUNCTION OR DYSFUNCTION? | ECHO |
| KNOW WHERE THE HEART SOUNDS ARE FOR THE EXAM | .... |
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