Week 6 valve disorders and heart disorders

Infective endocarditis (IE) is an infection and inflammation of the endocardium (innermost layer of the heart). Most often cause is ___ drug use and _____ valve. Infective endocarditis occurs when blood flow allows organisms to contact and infect previously ______ heart valves or other endothelial surfaces.

A: IV, prosthetic, damaged

The main risk factors for IE includes history of of IE, ___ drug use, having a ____ valve, health care associated infection of an intravascular device, and renal _____.

A: IV, prosthetic, dialysis

_____ the primary lesions of IE are microbes that ____ to the valve surface or endocardium. When these lesion get broken or lost in the blood stream they can result in a ___ ____.

A: vegetation, stick, blood clot

General manifestations of IE include a ____, _____, and weakness. Vascular signs include ______ ______ (black longitudinal streaks in nails beds), _____ on face or extremities. _____ ______ (painful tender red or purple pea size lesions on fingertips or toes), ___ ____ (flat painless small red spots) and ____ ____ (hemorrhagic retinal lesions).

A: fever, chills, splinter hemorrhages, petechiae, Osler's node, Janeway lesions, Roth's spot

Patient presents with fever, black longitudinal streaks in nails beds and flat painless small red spots on palms and soles of feet what do you suspect?

A: IE

Treatment for IE includes finding causative organism of which _____ are prescribed for based on ____ ____ results. You need ___ sets of blood cultures every 24 - 48 hours until infection is cleared then you follow up with an ______ every 1, 3, 6, and 12 months. For FUNGAL IE and PVE you would get an _____ _____ ______ followed by 4 - 6 weeks of antibiotics.

A: antibiotics, blood culture, 2, echocardiogram, early valve replacement

In order to prevent endocarditis you would give antibiotic prophylaxis before dental work to people with ___ ___ ___ and ___ ___ ___.

A: congenital heart disease, prosthetic heart valve

If blood culture results for a patient with diagnosed IE show that the organisms is not susceptible to the ordered antibiotic you should immediately ___ ___ __.

A: notify the HCP

For an IE if the patient who is receiving antibiotic treatment has a persistent temperature elevation then this may mean the antibiotics are _____.

A: ineffective

In ambulatory care for IE to prevent problems related to decreased mobility you would have patient wear elastic ____ ______, perform ROM exercises, _______ _____and _____ every 2 hours.

A: compression stockings, deep breathe and cough

Pericarditis is a condition caused by inflammation of the pericardial sac often with fluid accumulation. Most often the cause is idiopathic but can be caused due to _____, acute MI, cancers, aneurysm, renal failure, ____, ____ _____, rheumatic diseases and drug reactions. There are 3 types acute, subacute, and chronic. ___ develops rapidly and causes pericardial sac to become inflamed and leak fluid. ____ is when the pericarditis occurs weeks to months after an event. _____ is if pericarditis lasts more than 6 months.

A: infection, trauma, Dressler syndrome, acute, subacute, chronic

Symptoms for acute pericarditis include ____ ___ chest pain worse with _____ and ___ ____, it is relieved by ___ ___ and ____ ____. The pain may radiate to neck, arms, and shoulder and distinctly it can be felt in the ___ ___. The HALLMARK finding is a ___ ___ ____ which is a scratching high pitched sound in the lower left sternal border with patient leaning forward, to distinguish is from pleural friction rub tell patient to ___ breath (if still heard then its cardio).

A: severe, sharp, inspiration, lying down, sitting up, leaning forward, trapezius muscle, pericardial friction rub, hold

Major complications for pericarditis is ___ ___ and ___ ___. The former is a build up of fluid in the pericardium and the latter is when the former gets worse and ends up compressing the heart with fluid volume.

A: pericardial effusion, cardiac tamponade

The __ is useful is diagnosing acute pericarditis and an ____ is useful in detecting pericardial effusion and cardiac tamponade.

ECG, echocardiogram

Treatment for pericarditis depends on the cause (antibiotics for infection etc), ____ are used for pain control, ______ are used if it is caused by lupus. ____ may be used with patient who has pericarditis for more than 10 days or has recurrent pericarditis. _____ is usually done for pericardial effusion and cardiac tamponade. With this procedure you should stop any _____ therapy, and it involves a needle going inside pericardial space to remove fluid or heart pressure. A ___ ___ is a surgical procedure for diagnosis or drainage of excess fluid and involves cutting a window in pericardium.

A: NSAIDs, corticosteroids, colchine, pericardiocentesis, anticoagulant, pericardial window

Patient has pericarditis and cardiac tamponade what procedure is most likely for doctor to want to do?

A: pericardiocentesis

For Pericarditis pain is usually felt in the ____ or the ___ trapezius region and has a ___ quality and relieved when ___ ___ and ___ ___. Tell these patients to avoid ______ (drink).

A: pericardium, left, sharp, sitting up, leaning forward, alcohol

Chronic constrictive pericarditis is a condition which rigidity of pericardium result in decreased pericardial elasticity and restricted valvular filling. Most PROMINENT finding is ____ ___ ___, and treatment of choice is _______.

A: jugular vein distention, pericardiectomy

Rheumatic fever is an acute inflammatory disease that can involve all heart layers. Rheumatic heart disease is chronic scarring and deformity of the heart valves resulting from rheumatic fever (RF). RF is a complication 2 - 3 weeks after a _____ __ ______ _____. RHD is the result of valve damage form an abnormal immune response to _______.

A: group a streptococcal pharyngitis, streptococcus

To diagnose RF you need presence of 2 major criteria, or 1 major and 2 minor plus evidence of preceding group A streptococcal infection. ____ is most IMPORTANT manifestation of RF. It results in 3 signs 1) heart murmur 2) heart enlargement 3) muffled heart sounds. ____ or ______ is the MOST COMMON finding in RF. ____ ____ is the MAJOR CNS manifestation, it is characterized by involuntary movements, especially of the face and limbs, muscle weakness and gait problems. ___ ____ lesions are less common but still a feature of RF and are bright pink, maplike macular lesions occurring on trunk and proximal extremities. ___ ___are also a manifestation and are small hard painless swelling found over extensor joints.

A: carditis, monoarthritis, polyarthritis, Sydenham's chorea, erythema marginatum, subcutaneous nodules

Patients presents with heart enlargement, muffled heart sounds and has involuntary movements of the face and limbs, what do you suspect?

A: Rheumatic Fever

Treatment for RF includes drug therapy and supportive measures. _____ (for eliminating residual group A streptococci in tonsils and pharynx and stopping spread of organisms. ____, N ____, and c ________, are the 3 inflammatory agents used to control fever and joint manifestations.

A: antibiotics, salicylates, NSAIDs, corticosteroids

Treatment with an initial dose of IM ___ ___ _ is the most widely used antibiotic to treat RHD.

A: Benzathine Penicillin G

Patients with ___ __ _ and ____ __ ___ need lifelong prophylaxis.

A: rhematic carditis, residual heart disease

mitral valve stenosis causes mitral valve to take on a ___ __ shape because of thickening and shortening of the mitral valve structures. These deformities block the blood flow and create pressure difference between left atrium and left ventricular during _____. MAIN SYMPTOM is _____ _____, heart sounds include a loud ____ heart sound and ___ pitch ____ murmur, and h_____.

A: fish mouth, diastole, exertional dyspnea, 1st, low, diastolic, hemoptysis

A defect in any of the mitral structures can cause ______ _________. This allows for blood to flow backward from left ventricle to left atrium. In acute MR there is a _____ peripheral pulse and ____ and ____ extremities, They need rapid heart cath and get a ___ ___ or _____.

A: mitral regurgitation, thready, cold, clammy, valve repair, replacement

Mitral valve prolapse is an abnormality of the mitral valve that allows the leaflets to prolapse back into the left atrium during systole. A characteristic of MVP is a _____ ___ that is louder during _____. There could be chest pain that appears in _____ and during periods of ____. MVP related chest pain does not respond to ______, instead use ___ ___.

A: regurgitation murmur, systole, clusters, stress, nitrates, beta blockers

In aortic valve stenosis there is classic triad of symptoms of _____, _____ , and ____ ____, reflecting left ventricle failure. Auscultation may find a crescendo decrecendo holosystolic murmur that may radiate to _____. ALSO USE _____ WITH CAUTION as it may cause significant ______, and worsen chest pain.

A: syncope, angina, exertional dyspnea, carotids, nitroglycerin, hypotension

Aortic regurgitation causes backward blood flow form ascending aorta into left ventricle during diastole which result in volume overload. Patients with acute version have sudden ___ ____ and ___ ___ and _____. IN chronic version that develop a ___ __ pulse (strong, quick beat that collapse immediately).

A: severe dyspnea, chest pain, hypotension, water hammer

Tricuspid stenosis has signs of ___ ___ in the neck, and possible ____ ___ ___ ____.

A: fluttering discomfort, upper right quadrant pain

Pulmonary regurgitation may have a _____ ___ ____ present.

A: crescendo decrescendo murmur

Pulmonic stenosis results in RV hypertension and hypertrophy and symptoms do not present until ____.

A: adulthood

Conservative management therapy for valvular heart disease include a _____ restriction, vasodilators, digoxin, diuretics, beta blockers, anticoagulation therapy

A: sodium

An alternative treatment for some valvular heart disease that involves a balloon tipped catheter inserted into femoral artery and inflates to separate valve leaflets is called ___ ___ ___ __.

A: percutaneous transluminal balloon valvuloplasty

Open surgical ____ involves the repair of the valve by suturing torn leaflets and is mainly used to treat mitral or TR.

A: valvuloplasty

____ involves reconstruction of the annulus with or without the aid of prosthetic rings. It can be used for mitral or TR.

A: annuloplasty

Mechanical valves and biologic valves are options in valve replacement, the ____ is more durable and lasts longer but you need lifetime _____ which is not needed in _____ unless they have ___ __ . ____ ___ __ ___ is an option for patients with severe symptomatic atrial stenosis and the 3 commercially available forms are Core Valve, Lotus, and Edwards Sapiens 3. Pregnant patients who cant take anticoagulants have ___ valves as an option.

A: mechanical, anticoagulants, biologic, atrial fibrillation, transcatheter aortic valve replacement, biologic

The person who is on anticoagulants after surgery for valve replacement should have ____ regularly check of which the range is ___ - ____.

A: INR, 2.5 - 3.5

Dilated cardiomyopathy appears with diffuse inflammation and rapid degeneration of heart fibers. Symptoms include decreased ____ ___, _____ ___ ___, a dry cough, and abdominal bloating. Treatment focuses on controlling HF so if patient has stage 4 HF than treatment is more ______ than curative. Drugs that manage HF include nitrates ( _____), diuretics ( ____ ), beta blockers ( ____ ), and aldosterone antagonists ( ___ ). Nondrug therapies include ___ which is a bridge to a heart transplant, a heart transplant, and if they are not a candidate for transplant than they can get ___ ___ which is a permanent VAD.

A: exercise capacity, dyspnea at rest , palliative, nitroglycerin, furosemide, metoprolol, spiralactone, VAD, destination therapy

Hypertrophic cardiomyopathy is a genetic disorder that causes asymmetric left ventricular hypertrophy without ventricular dilation. This most often happens in ____ ____ people. 4 main characteristics are 1) ventricular _____ 2) ___ ____ ___ of left ventricle 3) impaired _____ 4) obstructing aortic outflow. The most common symptom is ____ caused by elevated left ventricular ____ ___. ______ is main diagnostic tool.

A: young athletic, hypertrophy, rapid forceful contraction, diastole, dyspnea, diastolic pressure, echocardiogram

Interprofessional care for Hypertrophic cardiomyopathy is reducing ventricular contractility and relieving left ventricular outflow obstruction. These can be achieved with drugs ____ ___ or ___ ___ __ like ( ___ ). ____ or ____ are effective antidysrhythmic drugs but do not prevent SCD, patients at risk for SCD need cardioverter defibrillator. If unresponsive to drug therapy patients can get a ______ or _____ which involves cutting into thickened septal muscle and removing some of the ventricular muscle. Nonsurgical includes ____ _____ __ ____ ___ which is where they inject alcohol into the first septal artery to cause ischemia and septal wall infarction.

A: beta blockers, calcium channel blockers, vepramil, Amiodarone, sotalol, ventriculomyotomy, myectomy, percutaneous transluminal septal myocardial ablation

Restrictive cardiomyopathy impairs diastolic filling and stretch but systolic function remains unchanged. Symptoms are fatigue, exercise _____, and dyspnea. On chest x ray ______ may be present and the dysrhythmia ______ may be present in ECG. There is no specific treatment but a ___ ___ is an option. Teach them to avoid ___ ___ and ____ (drink __ - ___ glasses a day). If at risk for IE teach them to take ____ ____.

A: intolerance, cardiomegaly, supraventricular (afib), heart transplant, strenuous activity, dehydration, 6 - 8, prophylactic antibiotics

systoic murmur (remember mr (mitral regurgitation) p (physiologic) as (aortic stenosis) mvp (mitral valve prolapse)

diastolic murmur remeber AR (aortic regurgitation) MS (mitral stenosis)