cardiac dysrythmias

Etiology and Risk Factors for inflammatory heart disorders

…Rheumatic fever

…Endocarditis

…Myocardial infarction

…Autoimmune disorders- Lupus

…Cardiomyopathy

…IV drug abuse

…Marfan’s syndrome

most common S/S of stenosis or prolapse

murmur

Clinical Manifestations of inflammatory heart disorders

…Murmurs

…Dyspnea on exertion

…Palpitations

…Chest pain 

…Hemoptysis

…Syncope or orthopnea

…Pulmonary edema

…Fatigue

meds to Optimize cardiac output & prevent heart failure

Diuretics- ex. Furosemide

afterload reducing medications- ex. ACEI, BB, CCB

inotropic medications- ex. Digoxin

Balloon Valvuloplasty

used for stenotic valve

Performed in cath lab

Balloon inflated to widen opening & split leaflets apart

Complication: regurgitation

Good for older adults and poor surgical candidates

Mechanical valve replacement

…Client’s < 65 y/o

…Thrombus common-need anticoagulants

…Click auscultated

…Last longer

ÒBiological  or tissue valve replacement

…Less durable

…Client’s > 65 y/o

…No anticoagulants

…Porcine (pig), Bovine (cow), Cadaver (human tissue)

…No click

endocarditis

-Damage to endothelial layer of heart

-Cause- bacterial, fungi, virus

…Infected central lines, IV drug abuse

-Infection causes- vegetations on valve leaflets

…Fibrin, leukocytes, platelets, microbes

-Diagnostic- blood cultures, 2D echo or TEE

Treatment- antibiotics, anticoagulants

Left side heart emboli

Òbrain, limbs, kidney, liver, spleen

…BEFAST

Right side heart emboli

lungs

Pericarditis

Acute or chronic inflammation of pericardial sac

Can be dry or exudative

Causes- viral, bacterial or autoimmune, post MI

Increased fluid in pericardial sac - Results in cardiac tamponade and restricts heart function

Clinical Manifestations of pericarditis

Pain - Sharp chest pain worse when laying flat

Referred pain to upper back, shoulder

dyspnea

Pericardial friction rub

Complications for pericarditis

Fluid accumulates in pericardial sac

S/Sx- Tamponade (emergency)

Anxiety, restlessness, chest pain

Muffled heart sounds

Hypotension (obstructive shock)

Tachycardia and tachypnea

JVD

tx for percarditis

EKG and echo

Relieve pain- Aspirin, NSAIDS

Determine cause

Patient education about medication management

…Compliance with antibiotics

HOB elevated, pain relieved when sitting up and forward

Pericardiocentesis

taking fluid out of pericardial sack

Myocarditis

Viral, fungal, bacterial or autoimmune

Clinical manifestations

…Tachycardia

…Murmur

…Friction rub

…Cardiomegaly

…Chest pain

Dysrhythmia

Rheumatic Heart disease

Endocarditis from rheumatic fever- group A strep infection

Clinical manifestations

…Lesions in the heart especially on valve leaflets

…Fever

…Chest pain

…Joint pain

…Murmur

Friction rub

Management

Blood cultures

CBC, Cardiac Enzymes, ESR and CRP

ECG

Balance rest and activity

Antibiotics

Amphotericin B- anti-fungal infection

…Monitor liver and kidney function

NSAIDS

Glucocorticosteroids- treats inflammation