Cardiac Valvular and Inflammatory Disease - Student

8/3/2019 Cardiac Valvular and Inflammatory Disease - Student

1/42

CARDIAC VALVULARANDINFLAMMATORY DISORDERS

NU 331


2/42

VALVULAR DISORDERS


3/42

VALVULAR HEART DISEASE

Heart contains

Two artrioventricular valves: mitral & tricuspid

Two semilunar valves: aortic & pulmonic

Valvular Heart Disease defined according to: Valve or valves affected

Two types of functional alterations

Stenosis

Regurgitation


4/42

HEART VALVES


5/42

STENOSIS & REGURGITATION


6/42

MITRAL VALVE STENOSIS

Majority of adult cases result from rheumatic heartdisease

Valve assumes funnel shape because of thickening& shortening of structures

Exertional dyspnea is primary symptom


7/42

MITRAL VALVE STENOSIS


8/42

MITRAL VALVE REGURGITATION

Numerous causes Most caused by MI, chronic RHD, mitral valve prolapse, ischemic

papillary muscle dysfunction, & IE

Clinical course determined by nature of onset Acute - Thready, peripheral pulses & cool, clammy extremities

Chronic Weakness, fatigue, palpitations & dyspnea


9/42

MITRAL VALVE PROLAPSE

Structural abnormality of the valve leaflets thatallows them to prolapse or buckle back into the leftatrium during systole

Etiology unknown

Usually benign, but serious complications can occur Most patients asymptomatic


10/42

Mitral ValveProlapse


11/42

AORTIC VALVE STENOSIS

Etiology

Congenital

Rheumatic fever or senile fibrocalcific degeneration

Results in obstruction of flow from left ventricle toaorta during systole

Causes left ventricular hypertrophy & increasemyocardial oxygen consumption


12/42

AORTIC VALVE STENOSIS


13/42

AORTIC VALVE REGURGITATION

Caused by

IE, trauma or aortic dissection

Acute form constitutes a life-threatening emergency

Consequence is retrograde blood flow from theascending aorta into the left ventricle resulting involume overload


14/42

CLINICAL MANIFESTATIONS

Acute

Sudden manifestations of cardiovascular collapse

Weakness, severe dyspnea, & hypotension

Chronic

Asymptomatic for years

Exertional dyspnea, orthopnea, & paroxysmal nocturnaldyspnea


15/42

COLLABORATIVE CARE

Non-Surgical

Prophylactic antibiotic therapy

Rheumatic fever infective endocarditis

Sodium restriction Medications to treat/control HF

Anticoagulant agents

Antiarryhthmic drugs

PTBV


16/42

COLLABORATIVE CARE

Surgical Therapy

Decision for surgical intervention based on clinical stateof patient

Type of surgery depends on

Valves involved

Valvular pathololgy

Severity of disease

Patients clinical condition

All types of surgery are palliative, not curative


17/42

COLLABORATIVE CARE

Surgical Therapy

Valve repair (valvuloplasty)

Commissurotomy (valvulotomy)

Annuloplasty Valve replacement

Mechanical

Biologic


18/42

PROSTHETIC HEART

VALVES


19/42

INFLAMMATORY DISORDERS


20/42

CARDIAC INFLAMMATORY DISORDERS

Rheumatic Heart Disease

Pericarditis

Endocarditis


21/42

RHEUMATIC HEART DISEASE

Rheumatic Fever is an inflammatory disease of theheart involving one or all three layers.

Rheumatic Heart Disease is a chronic condition asa result of rheumatic fever characterized bydeformity of the heart valves.


22/42


Rheumatic fever is a complication of a group Astrep -hemolytic streptococci post an URI, usuallyfrom an abnormal immunologic response.

Cardiac changes include: Vegetations occur withswelling and erosion of the valve leaflets of theheart form deposits of fibrin and blood cells in areasof erosion- becoming thickened, calcified withstenosis, leading to regurgitation. Aschoff bodiesform

Extracardiac lesions involve connective tissueincluding joints, skin and CNS.

Subsequent infections cause recurrent andincreasing damage


23/42


24/42


25/42


Cardiac Changes:

1. Organic heart murmur

(mitral or aorticregurgitation or mitralstenosis)

2. Cardiac enlargementand potentially HFsymptoms

3. Pericarditis withmuffled heart sounds,Chest Pain, andpericardial friction rub

Systemic Changes:

1. Mono or polyarthritis

(Joint pain, swelling andtenderness)

2. Chorea (CNSmanifestation ofinvoluntary movementsand weakness)

3. Erythema marginatum(skin changes/lesionsSubcutaneous nodules)

Rheumatic feverassessment findings:


26/42

CLINICAL MANIFESTATIONS


27/42


Complication can be chronic rheumatic carditis-changes in valvular structure over time.


28/42

RHEUMATIC FEVERAND RHEUMATICHEART DISEASE

Care and Nursing Management: Obtain a heath history and physical exam

Recent strep infection Previous rheumatic fever Physical symptoms to match criteria- skin, joints, heart, neuro

muscular

Treat with antibiotics, salicylates, anti-inflammatory agents,NSAIDS and corticosteroids. Antibiotics will NOT modify the acute disease, or development of

carditis, but will prevent spread Salicylates, NSAIDS and anti-inflammatory to control synovialjoint involvement Corticosteriods if severe carditis Antibiotics, to control and erradicate organism and prevent

complications

Bedrest


29/42

RHEUMATIC FEVERAND RHEUMATICHEART DISEASE

Nursing Diagnoses:

Activity Intolerance r/t arthralgia from joint pain

Fatigue

Pain

Decreased cardiac output r/t valve dysfunction (andpotential HF)

Knowledge deficit r/t long term needs for prophylaticantibiotic use


30/42

PERICARDITIS

Acute Pericarditis pathophysiology:

Inflammation of the pericardium (fibrous sacsurrounding the heart)

Is usually acute in nature

May be idiopathic

Identified causes include-bacterial, fungal or viralinfection

Coxsackievirus B is most common viral cause


31/42

PERICARDITIS

Acute Pericarditis assessment findings: Inflammatory response is the characteristic. *Sharp, sudden pain over heart, radiating to the

neck and left scapular region.Pain may worsen with breathing or movement.Pain may lessen if siting or leaning forward

*Pericardial friction rub Dyspnea from decreased CO and orthopnea Tachycardia Distant heart sounds Increased cardiac dullness on percussion Absent apical impulse EKG changes demonstrate a decreased

amplitude of the QRS


32/42


33/42

PERICARDITIS

Acute Pericarditis diagnostics:

May have elevated WBC and ESR (erythrocytesedimentation rate)

Pericardiocentesis reveals positive culture

EKG changes are possible


34/42

PERICARDITIS

Complications of pericarditis:

Pericardial effusion

Build up of fluid in pericardium causing compression ofsurrounding tissues and structures

May see pulmonary tissue compression, phrenic nervecompression or laryngeal nerve compression

Cardiac Tamponade

As pericardial effusion builds up- it causes pressure on the

heart- which leads to this disorder Symptoms include Becks triad


35/42

PERICARDITIS

Acute Pericarditis nursing management:

Pain relief

Analgesics (ASA versus NSAIDs)

Narcotics

Positioning- upright and forward Bedrest

Monitor for complication of Cardiac Tamponade

Prepare for possible pericardiocentesis

Treat underlying cause


36/42

ENDOCARDITIS

Infective Endocarditis Pathophysiology:

infection of the endocardium or heart valves resulting frominvasion of bacteria or other organisms

Organism travels through blood stream deposited on heart

valves or endocardium. Triggers fibrin and platelet aggregation, engulfs organism

forming vegetations, form usually on valves- which can causeulceration and necrosis- leading to deformity and dysfunctionon valve.


37/42

ENDOCARDITIS


38/42

ENDOCARDITIS

Aging b/c of calcifiedvalvular stenosis

IVDU

Prosthetic valves

Indwelling andprolonged IV deviceuse (often with TPN)

renal dialysis

h/o vavular heartdisease

h/o endocarditis

Congenital heartmalformations

recent dental surgery

Infective Endocarditis MainPredisposing factors:


39/42

ENDOCARDITIS

Infective Endocarditis Assessment Findings:

Weakness and fatigue- nonspecific

Weight loss/anorexia

Fever, chills and diaphoresis- may be low grade

Cough

Arthralgia/myalgia

Splenomegaly

Petechiae of the anterior trunk, conjunctivae and

mucosa Splinter hemorrhage in nail beds

New heart murmur or change in existing murmur


40/42

VASCULAR MANIFESTATIONS

Splinter Hemorrhages

Clusters of petechiae

Janeways LesionsOslers Nodes

Roth spots


41/42

ENDOCARDITIS

Infective Endocarditis Diagnostics:

Get a health history: Recent h/o procedure (dental, urologic,surgical or gyn) or h/o IVDU/IVDA

Cultures: Positive blood cultures (minimum x2, 30 minutes

apart) WBC with diff: Elevated WBC, possible elevated ESR and

CRP

CBC: Potential anemia

Echocardiogram: may show valvular damage

Urinalysis: r/o other causes


42/42

ENDOCARDITIS

Administer prescribedmedications Insure that the antibiotics

cover the infection Antipyretics

Provide on goingassessment to include: VS, temperature, serial

blood cultures, S/S CHF,Cardiovascular andcerebrovascularcomplications, andvalvular regurgitation.

Bedrest

Repeat cultures

Prepare patient for thepotential for valve

replacement and for longterm prophylactic use

Arthralgia is common

treat for joint tenderness,

ROM and muscle tenderness Monitor for petechiae

changes and monitor forembolic complications

Infective EndocarditisNursing Management:

Documents

Cardiac Valvular and Inflammatory Disease - Student