Valvular Heart Disease/Myopathy/Aneury

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Valvular Heart Disease

HeartPoint: HeartPoint Gallery

http://www.heartcenteronline.com/myheartdr/common/articles.cfm?ARTID=187

Risk FactorsRheumatic Heart Disease MICongenital Heart DefectsAgingCHF

PathophysiologyStenosis- narrowed valve, increases afterloadRegurgitation or insufficiency- increases preload. The heart has to pump same blood**Blood volume and pressures are reduced in front of the affected valve and increased behind the affected valve.This results in heart failureAll valvular diseases have a characteristic murmur murmurs

Mitral Valve Stenosis

Mitral StenosisDec. flow into LVLA hypertrophyPulmonary pressures increasePulmonary hypertensionDec. CO* early symptom is DOELater get symptoms of R heart failureA fib is common- anticoagulantsUsually secondary to rheumatic fever

Mitral RegurgitationRegurg of blood into LA during systoleLA dilation and hypertrophyPulmonary congestionRV failureLV dilation and hypertrophy-to accommodate inc. preload and dec CO

Mitral Valve ProlapseA type of mitral insufficiencyUsually asymptomaticMay get atypical chest pain related to fatigueTachydysrhythmias may developRisk for endocarditis is increased and need prophylactic antibiotics

A&P 1 Heart part 1

Aortic StenosisIncrease in afterloadReduced COLV hypertrophyIncomplete emptying of LAPulmonary congestionRV strain

Symptoms

Syncope

Angina

Dyspnea

Aortic StenosisMay be asymptomatic for many years due to compensationDOE, angina, and exertional syncope are classic symptomsLater get signs of R heart failureUntreated-poor prognosis- 10-20%sudden cardiac death

Aortic RegurgitationGet increased preoad- 60% of SV can be regurgitatedCharacteristic water hammer pulseRegurgitation of blood into the LVLV dilation and hypertrophyDec. CO

Water Hammer pulse

Pulse, water hammer: A jerky pulse that is full and then collapses because of aortic insufficiency (when blood ejected into the aorta regurgitates back through the aortic valve into the left ventricle ).

Also called a Corrigan pulse or a cannonball, collapsing, pistol-shot, or trip-hammer pulse.

Tricuspid and Pulmonic Valve Disorders

Result in R side heart failure

Diagnostic TestsEcho- assess valve motion and chamber sizeCXREKGCardiac cath- get pressures

MedicationsLike Heart Failure

ACE, DigDiureticsVasodilatorsBeta blockersAnticoagulants*Prophylactic antibiotics

Medical/ Surgical Treatment

Percutaneous balloon valvuloplastySurgery

Open commissurotomy- open stenotic valvesAnnuloplasty- can be used for bothValve Replacement

Mechanical-need anticoagulantBiologic-only last about 15 yearsRoss Procedure

Ross Procedure

Nursing DiagnosesDecreased Cardiac OutputActivity IntoleranceRisk for InfectionIneffective Protection

Case study

http://edcenter.med.cornell.edu/Pathophysiology_Cases/96-97_Pathophysiology_Cases/96-97Case_04.html

CardiomyopathyPrimary-idiopathicSecondary

Ischemiainfectious diseaseexposure to toxinsMetabolic disordersNutritional deficiencies

PathophysiologyDilated

Most commonCocaine and alcohol abuseChemotherapy pregnancyHypertensionGenetic* Heart chamber dilate and contraction is impaired and get dec. EF%*Dysrhythmias are common- SVT Afib and VTPrognosis poor-need transplant

Pathophysiology Hypertrophic

GeneticAlso known as IHSS or HOCMGet hypertrophy of the ventricular mass and impairs ventricular filling and COSymptoms develop during or after physical activitySudden cardiac death may be first symptomSymptoms are dyspnea, angina and syncope

PathophysiologyRestrictive

Least commonRigid ventricular walls that impair fillingContraction and EF normalPrognosis-poor

DiagnosticsEcho-wall motion and EFEKGCXRHemodynamicsPerfusion scanCardiac cathMyocardial biopsy

MedicationsSame as for heart failure except for hypertrophic

TreatmentSurgery

Vad-bridge to transplantHeart TransplantMyoloplastyICD- antiarrhythmics are negative inotropesDual chamber pacemakerHypertrophic- excision of ventricular septum

Heart transplant

 

virtual transplant

Nursing DiagnosesDecreased Cardiac OutputFatigueIneffective Breathing PatternFearIneffective Role PerformanceAnticipatory grieving

Aortic Aneurysms

DefinitionAbnormal dilation of a blood vessel at a site of weakness or a tear in the vessel wall. Usually secondary to atherosclerosis.

Most commonly affect the aorta

Layers of an artery

AAA

Aneurysms location

Saccular

Fusiform

Most are fusiform and 98% are below the renal artery

False or Pseudo

A pseudoaneurysm is actually a disruption in the intima and media of the

aorta, and only the adventitia/surrounding tissue retains

blood within the aortic cavity.

Ex. A hemotoma after a heart cath

DissectingBlood invades or dissects the layers of the vessel wall

Aortic dissection occurs when blood enters the wall of aorta, separating its layers, and creating a blood filled cavity.

Thoracic Aortic AneurysmFrequently asymptomaticMay have substernal, neck or back painOther symptoms depend on location and structures they compress

Abdominal AorticPulsating mass in mid and upper abdomen and bruit over the massPain intensity correlates to size and severityMay have thrombiIt can rupture causing shock and death in 50% of rupture cases

Aortic dissectionLife threatening emergencyHappens when the intima tears and causes hemorrhage into the mediaHypertension is main cause*Primary symptom is excruciating painMay get syncope,dyspnea and weaknessPeripheral pulses are absent

Diagnostic Tests for Aneuysms

Most are diagnosed on routine work-upCXRAbd. UltrasoundTEECT or MRIAngiography

MedicationsAnti-hypertensives

Beta blockers, VasodilatorsCalcium channel blockersNipride

SedativesNiacin, mevocor, statinsPost-op anti-coagulants

SurgeryUsually repaired if >5cmOpen procedure- abd incision, cross clamp aorta,aneuysm opened and plaque removed, then graft sutured in place

Pre-op assess all peripheral pulsesPost-op-check urine output and peripheral pulses hourly for 24 hours- (when to call Dr.)

Endovascular stents- placed through femoral artery

Nursing AssessmentPain- chest, abd or back painHypertension(other vital signs)Peripheral pulsesPulsation in upper abdomenSOB

Nursing DiagnosesRisk for Ineffective Tissue PerfusionRisk for InjuryAnxietyPainKnowledge Deficit

PreventionPrevent atherosclerosisTreat and control hypertensionDiet- low cholesterol, low sodium and no stimulantsCareful follow-up if less than 5cm. It can grow .5cm /year

ComplicationsRupture

Back painHypotensionPulsating mass

ThrombiRenal Failure

Rupture Triad

Back pain

HypotensionPulsating hematoma

http://www.cotc.edu/vstone/wk3.htm

http://www.medi-smart.com/cardce5.htm