Inflammatory and Structural Cardiac Disorders

Cardiomyopathy

MAIN GOAL: improve cardiac output

CNS compensation on RAAS causing peripheral resistance, increasing cardiac workload. Eventually leads to HF

Dilated CM

most common cardiomyopathy, heart valves and muscles stretch weakening the left ventricle. pump issue

Hypertrophic CM

genetic disorder increasing heart muscle size. pulmonary backflow, often showing respiratory symptoms and abrupt unexplained death

Restrictive CM

rigid ventricles, decreased filling

Cardiomyopathy Ax

Usually can show as asymptomatic initially; dilated or restricted will usually present with HF sx (DOE, fatigue, paroxysmal dyspnea at night, peripheral edema).

Assess for smoking, BMI, DM, and heart sounds

JVD, peripheral edema

chest pain, orthopnea, syncope

Cardiomyopathy diagnostic

Rule out other causes of HF such as MI and CAD.

Echo, MRI, EKG, xray, genetic testing

Cardiomyopathy management

identify cause and monitor for complications

HF symptom management: exercise, Na+/fluid restriction, rest regimen

Educate on symptom reporting; weight gain 2-3lbs/day

Stress management

see MD for minor illnesses that can worsen CM

Medical:

antiarrhythmic meds, surgical LVAD placement/heart transplant

HCM: do not dehydrate (makes blood thicker, increasing workload) , B-blockers to improve cardiac contractility

DCM: pacemaker device

Untreated Cardiomyopathy

arrhythmias, weight gain 2-3lbs/day, unusual SOB, restless sleep, persistent cough, increased elevation for sleep, fatigue

Heart failure

chronic disease, clinical syndrome (combination of illnesses), heart cannot function properly to meet metabolic demand

GOAL TO manage symptoms, increase output and perfusion

Left sided HF

left ventricle weak, cant fill or eject into circulation

backing up into right side to pulmonary side. pulmonary congestion sx such as congestion, s3, hypoxia, productive cough, crackles

Cough, DOE, congestion, crackles

Right sided HF

RV weak, cant fill or pump

backup into systemic venous circulation. Increased JVD, increased hydrostatic pressure, weight gain

peripheral edema, JVD, dependent edema, hepatomegaly, ascites

HF risk factors

A.A. race, old age, Hx of CV disorders (valvular, rhythm dysfunction), smoking, DM, obesity

DX of HF

Echo, 12 lead, xray,

Labs

• Electrolytes: Na+ (R-HF deceased dilutes) (L-HF increased)

• BUN, Cr increased

• increased liver enzymes

• Increased BNP

• CBC

• Urinalysis

HF planning

promote activity and reduce fatigue

reduce fluid overload

decrease stress and anxiety

education for pt and family

Management of HF

Medical

• diuretics

• ACEi, ARBs, ARNIs

• O2 therapy

Nursing

• activity limitation

• Daily weigh

• I&O

• Fluid and Na restriction

• education

Untreated HF

pulmonary edema

poor perfusion: hypotension, altered mental status

arrhythmias

thromboemboli

pericardial effusion, cardiac tamponade

Mitral regurgitation

backflow of ventricle to atria

palpitations, DOE, strong blowing systolic murmur @ apex

Mitral stenosis

DOE, dry cough, wheezing, low pitch diastolic murmur

Mitral prolapse

usually asymptomatic valvular disorder, can have a mitral click

Aortic regurgitation

subjective pounding in head or neck, arterial pulsations at corotid/temporal arteries s/s of HF

high pitched blowing diastolic murmur @ 3-4th intercostal

Aortic stenosis

DOE, loud, harsh systolic murmur at 2nd intercostal space with possible S4 sound

Ax of Valvular disorders

clinical presentations of fatigue, SOB, pulmonary congestion, syncope, chest pain

heart sounds

potential causes: endocarditis, infections, congenital

Dx of valvular disorders

echo (w/ TEE), 12lead, MRI, cardiac cath

Nursing management of valvular disorders

• v/s

• management of symptoms

• med admin with schedule education

• infection risk, prescribe prophylactic antibiotics

• daily weight

• exercise

Medical management of valvular disoredrs

surgical intervention

• Biologic valve: less need for anticoagulant therapy (Unless a-fib), shorter life then mechanical

• Mechanical valve: lasts long, for young patients, needs lifelong anticoagulant therapy

Medications for HF/arrhythmia: ACE/ARBs, b-blocks, digoxin, CCB

Endocarditis

microbial infection of endothelium, patients with prosthetic heart valves/structural defects, IV drug users, indwelling catheters

Myocarditis

inflammation of the myocardium

usually viral, causes dilation and thrombi

Risks from influenza A, HIV, rheumatic fever (starts as strep throat)

Pericarditis

inflammation of the pericardium

can cause pericardial effusion or tamponade

risks from MI, surgery, infection, med reactions, autoimmune disorder, chest trauma

Ax of endocarditis

fever, murmur, petichiae (due to capillary bursting), spliter hemorrhage, bacterial infection ultimately leaded to sepsis

ax of myocarditis:

flu like symptoms, fatigue, dyspnea, syncope, palpitations, EKG change

ax of pericarditis

CP, pericardial friction rub, HF sx w/ tamponade, dyspnea, infection sx

DX testing for inflammatory disorders

blood culture,

Labs

• CBC

• ESR

• CRP

12 lead, Echo w/ TEE, Cardiac cath, CT scan

Endocarditis management

2-6 wks IV antibiotics

surgery if not resolved

Myocarditis management

treat underlying

bed rest to reduce workload

HF/arrhythmia management

avoid NSAID

Pericarditis management

treat underlying cause

analgesic/corticosteroids or pain

pericardiocentesis for fluid removal

prevention of inflammatory Heart disorders

prophylactic antibiotics

oral hygiene

cath care

immunization

substance counseling

untreated endocarditis

HF, intracardiac abscess, valvular dysfunction

myocarditis untreated

HF, arrhythmia, cardiac death

Pericarditis untreated

tamponade, EKG changes, arrhythmia