Inflammatory cardiac disorders

Inflammatory cardiac disorder

Acquired Valvular disorders

1. Mitral valve prolapse

2. Mitral regurgitation

3. Mitral stenosis

4. Aortic regurgitation

5. Aortic stenosis

Mitral valve prolaps

Mitral valve prolaps

• Clinical manifestation: can result in death, it is inherited connective disorders. Fatigue, SOB, syncope, dizziness and palpitation.

• assessment and diagnostic finding: extra heart sound, murmur, doppler echocardioraphy is used to diagnose.

• Medical and nursing management:

Mitral valve prolaps

• Medical and nursing management: medical : controlling the symptoms, eliminate caffeine and alcohol, nitrate or calcium channel blockers or Mitral valve repair.

• Nursing management: teach about the causes first degree relatives, oral hygiene, dental care, avoid body pirecing, and not use sharop objects for mouth cleaning, 2

Mitral regurgitation

Mitral regurgitation

• It is back flow of blood from left ventricle to left atrium because it does not close properly.

• Because it is thickeneyggd and fibrosed. because of rheumtatic heart disease.

• Clinical manifestation: asymptomatic, cause congestive heart failure, dyspnea on exertion, fatigue, weakness and cough

Mitral regurgitation

• Diagnostic finding: irregular pulse or regular, doppler is used to diagnose it, TEE (transesophageal echocarrdiography) provides best images.

• Medical and nursing management: decrease after load, treatment ACE inhibitors, angiotension receptor blockers, beta blockers, restrict activity and valve replacement.

Mitral stenosis

• It is obstruction of blood flow from left atrium into left ventricle because of rheumatic endocarditis which cause thicken mitral valve.

• Clinical manifestation: ,dyspnea, on exertion from pulmonary venous hypertension, fatigue, enlarged left atrium, palpitation, orthopnea, repeated respiratory infections and proxismal nocturnal dyspnea (PND).

Mitral stenosis

• assessment and diagnostic finding: atrial fibrillation (irregular and weak pulse), diastolic murmur, atrium dilates, hypertrophies,

• Medical management: anticoagulants, avoid strenuous exercises, pulmonary pressure pressure increase and surgery is valve replacement may be performed.

Aortic regurgitation

Aortic regurgitation

• Clinical manifestation: forceful heart beat in neck, marked arterial pulsation in carotid or temporal arteries, exert ional dyspnea and fatigue.

• Assessment and diagnostic finding: high pitch sound in 3 or 4 space, widen pulse pressure, water hammer (Corrigan’s pulse), use Doppler, ECG, MRI to diagnose it.

Aortic regurgitation

• Medical management: avoid physical exertion or competitive sports, vasodilator medication, aortic valve replacement before left ventricular failure.

Aortic stenosis

Aortic stenosis

• Clinical manifestation: Is asymptomatic, then exertional dyspnea form pulmonary venous pressure from LVF, orthopnea, pulmonary edema, dizziness and syncope from low blood to brain, low BP, low pulse pressure and angina pectoris.

Aortic stenosis

• Assessment and diagnostic finding: murmur (blood flow in narrow area), S4, vibration may be felt if examiner put hand over heart base, doppler is used to diagnose it, left ventricular hypertrophied seen in ECG, left side catheterization to evaluate the arteries.

• Medical management: medication for dysrhythmia, or LVF, surgical replacement or balloon percutaneous valvuplasty procedure if not surgical candidate.

Cardiomyopathies

1. Dilated

2. Hypertrophic

3. Restrictive

4. Arrhythmoenic right ventricular

5. Unclassified.

Cardiomyopathies: Dilated

Cardiomyopathies: Dilated

• Is the most common type• It is dilation of ventricles with out

hypertrophy (increase muscle wall thickness), makes amount of blood ejected from ventricles with systole is less, and more blood remains in heart so thrombus occur

• caused by: pregnancy, chemotherapeutic medication, or idiopathic (not known)

Cardiomyopathies: Hypertrophic

Cardiomyopathies: Hypertrophic

• Heart muscle increase in size especially in septum

• It reduce the space in the ventricle so it takes time to relax after systole and more time to fill during diastole.

• This cause dysrrthmias or fibrillation because cells are disorganized to contract properly.

Cardiomyopathies: Restrictive

Cardiomyopathies: Restrictive

• Has rigid ventricular walls causing dysfunctional diastolic filling.

• Caused by protein substance deposited within cells with unknown cause.

• Clinical manifestation: dyspnea, nonproductive cough, and chest pain.

• ECG and pulmonary artery systolic pressure could diagnose it.

Clinical manifestation of myopathy

• Might be a symptomatic• S&S of heart failure: dyspnea on exertion,

orthopnea, cough, fluid retention, peripheral edema, nausea as low perfusion to GI tract. Chest pain, palpitation, dizziness and death.

• Assessment and diagnostic finding: ECG, MRI, chest x-ray, cardiac catheterization, endomyocardial biopsy to analyze heart cells.

Medical management of myopathy

• Correct heart failure with medication

• Low sodium diet, rest, implant device as cardioverter defibrillator, systematic anticoagulant, limit fluid intake, avoid dehydration, put pacemaker,

• Surgery: myectomy (removal of some heart tissue) or heart transplantation.

Infectious diseases of the heart

1. Rheumatic endocarditis

2. Infective endocarditis

3. Myocarditis

4. Pericarditis

Rheumatic endocarditis

Infectious diseases of the heart: Rheumatic endocarditis

• Clinical manifestation: in school children after

GASpharyngitis. • assessment and diagnostic finding: heart

murmur. • Medical and nursing management: antibiotics,

and avoid malnutrition, overcrowds, poor hygiene, low socioeconomic status,,,,,

Infectious diseases of the heart: Infective endocarditis

• Infection of endothelial cells of heart happens with aging or low immunity, IV drug users, catheters, or corticosteroids

• Clinical manifestation: fever and heart murmur. Osler nodes may be present

in ?pads of fingers or toes. Headache, strokes, heart failure. Complication: myocardial damage or regurgitation,

Infectious diseases of the heart: Infective endocarditis

• Causes:• Valvular damage.• Prosthetic valve.• Damage to cardiac structures.• Assessment and diagnostic findings:

take 3 sets of blood cultures before starting antibiotics, high WBCs, positive rheumatoid factor and high ESR, or C-reactive protein.

• Medical management: antibiotic therapy, Penicilline is the choice and periodic blood C/S.

• Surgical management: valve debridment or replacement.

Infectious diseases of the heart: Infective endocarditis

• Nursing management: monitor patient temperature frequently heart sound is assessed, assess for stroke, MI or heart failure, provide long term IV antibiotics, instruct about S&S of infections from wounds,

• Causes: Reduce blood flow, causing necrotic areas of the myocardium, Necrosis maybe patchy or global.Virus.

Infectious diseases of the heart: myocarditis

Infectious diseases of the heart: myocarditis

• Clinical manifestation: fatigue, dyspnea, palpitation, chest and abdomen discomfort and severe congestive heart failure.

• Assessment and Diagnostic finding: MRI, ECG, elevated ESR and WBCs.

• Medical management: penicillin, bed rest not to over load the heart, then increase the activity gradually (schedule nursing interventions is important for rest periods)..

Infectious diseases of the heart: myocarditis

• Nursing management: assess fever, tachycardia, continuous cardiac monitoring, anti-embolism stocking and passive and active exercises to prevent thrombi from bed rest.

Infectious diseases of the heart: pericarditis

• Inflammation of pericardium (membrane sac envelop in the heart following cardiac procedures

• Clinical manifestation: may be a symptomatic, or chest pain, clavicle pain, worsen with inspiration, relieved with sitting, friction rub heard on left lower sternal border (most characteristics), mild fever, high WBCs, high ESR, or C reactive protein,

Infectious diseases of the heart: pericarditis

• Assessment and diagnostic finding: by ECG, CT for size and shape of heart and MRI.

• Medical management: bed rest , analgesics, corticosteroids, pericardial fluid C/S and surgical removal of affected tissues.

Replacement Procedures for valvular disorders

1. Mechanical valves

2. Tissue (biologic valves):

Replacement Procedures for valvular disorders

1. Mechanical valves: it is used for younger individuals, they are ball and cage, more durable than tissue valve. They do not become infected, but its complications are: thromo-embolisim so anticoagulant to be continued.

Replacement Procedures for valvular disorders

2. Tissue (biologic valves): less likely to develop thrombi, no need for anticoagulant, required replacement frequently. It has 3 types: Xenografts, Homografts and Autografts.

a. Xenografts: is hetrografts, for tricuspid valve replacement. Used for women, children and old people more 70years, peptic ulcer because they are at risk for bleeding from long term anticoagulant. it comes from pigs or cows.

Replacement Procedures for valvular disorders

• Homografts: is allograft or human valves: obtained from cadaver donations for aortic and pulmonic valve replacement. Very expensive but last for 10-15 years.

• Autografts: from patient on pulmonic valve, alternative for children, women of child rearing age, young adults and with peptic ulcers.

Valve repair and replacement procedures

• Valvuplasty: is repair of heart and does not need for anticoagulation.

1.Closed commisurtomy: is it is

areas where the leaflets meets

is repaired. And it is to

separate the fused

leaflets. It has two types.

• . Balloon valvuplasty: by small cut in the chest then the surgeon by finger or by balloon to enlarge the valve. It is used for children and old people.

Balloon valvuplasty:

2. Open commisurtomy: it is by direct visualization of heart (it is open heart surgery) and cardio-pulmonary bypas is needed. The thrombus can be removed also.

Annuplasty:

• Annuplasty: is repair of heart annulus is, put annuplasty ring ( the ring is sutured to the ring of the proper size).

• Leaflets repair and Chordoplasty: :

if regurgitation the leaflests should be folded and sutured and if short it should be elongated.

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