cardiac disorders

cardiomyopathy is a disease of the heart muscle causing...

-impaired CO

-decreased SV

-decreased EF

-increased systemic resistance

-increased sodium and fluid retention

-increased workload

dilated cardiomyopathy (DCM)

-most common

-heart muscle dilates, stretches, and becomes thin

-LV enlarges

DCM causes a weak LV which causes...

impaired contractility

hypertrophic cardiomyopathy

-genetic disorder that leads to increased heart muscle size

-thickened heart muscle causes impaired pumping

hypertrophic cardiomyopathy is the leading cause of death in...

adolescents and athletes

restrictive cardiomyopathy

-least common

-ventricular walls become rigid which impacts the filing of the heart

objective assessment of cardiomyopathy

-VS

-pulse pressure

-weight status

-murmurs

-abnormal heart sounds

-abnormal breath sounds

-JVD

-edema

subjective assessment of cardiomyopathy

-chest pain

-orthopnea

-PM coughing

-syncope

-fatigue

-early satiety

when is cardiomyopathy frequently first diagnosed?

when the patient presents with s/s of HF

what is the most helpful diagnostic tool for cardiomyopathy?

echocardiogram

complications of cardiomyopathy

-HF

-valvular dysfunction

-pulmonary edema

teach the pt to know s/s of arrhythmia formation, like...

-lightheadedness

-dizziness

-orthostatic hypotension

-racing heartbeat

-diaphoresis

-confusion

tell pt. to report immediately to provider or clinic if pt. experiencing..

-gain 2-3 lbs in 1 day

-gain 5 lbs in 1 week

-unusual SOB with activity/rest

-increased peripheral swelling

-persistent cough

-loss of appetite

-restless sleep

-increase # of pillows to sleep

-profound fatigue

diet changes for cardiomyopathy

-avoid tobacco and alcohol

-check sodium content per serving

-avoid canned/processed foods

-avoid salt use

-avoid excess eating/drinking

heart failure

heart is unable to pump enough blood to meet the bodys metabolic demands

left sided HF

-LV can't fill efficiently fill or eject sufficient blood into circulation

-blood backs up into right side (pulmonary side) of the heart leading to pulmonary symptoms and pulmonary congestions

right sided HF

-RV becomes weaker and can no longer fill or eject blood

-causes a backup of blood into the systemic venous circulation causing JVD and peripheral edema

risk factors of HF

-ethnicity

-advanced age (60+)

-hx of CVD

-smoking

-diabetes

-increased BMI

what is a primary cause of HF?

atherosclerosis of coronary arteries

DOE

dyspnea on exertion

clinical manifestations of left sided HF

-pulmonary congestion

-crackles

-DOE

-hypoxia

-cough

-oliguria

-S3 heart sound

clinical manifestations of right sided HF

-viscera and peripheral congestion

-JVD

-dependent edema

-hepatomegaly

-ascites

-weight gain

what are the cardinal manifestations of HF?

-dyspnea

-fatigue

-fluid retention

echocardiogram

-determines EF

-identifies structure abnormalities and valve malfunction

normal EF value

55-65%

exercise is good for the heart but for patients wit HF....

activity limitations may be needed

HF is a condition that is managed with...

-lifestyle changes

-medications

HF complications

-pulmonary edema

-hypotension

-arrhythmias

-thromboembolism

-pericardial effusion

-cardiogenic shock

types of valvular disorders

-regurgitation

-stenosis

-prolapse

regurgitation

valve does not close properly, leading to a backflow of blood through the valve

stenosis

the valve does not open completely, leading to reduced blood flow through the valve

prolapse

the stretching of the valve leaflet into atrium during the systolic phase of the cardiac cycle

mitral valve prolapse is a deformity that usually....

produces no symptoms

valvular disorders predispose the patient to...

-dysrhythmias

-future HF

mitral regurgitation

edges of mitral valve does not close completely during systole because valve has thickened and become fibrotic

mitral regurgitation s/s

-palpitations

-DOE

-cough

-strong, blowing systolic murmur

mitral stenosis s/s

-DOE

-dry cough

-wheezing

-low pitched, rumbling, diastolic murmur

when do mitral stenosis symptoms start to occur?

valve opening is reduced to 1/3-1/2 of normal opening

an enlarged left atrium, from dilation and hypertrophy...

may create pressure on left bronchial tree, causing wheezing or dry cough

mitral prolapse

-typically asymptomatic

-may have mitral click or murmur present

aortic regurgitation (insufficiency) s/s

-subjective pounding heartbeat in head/neck

-visible/palpable arterial pulsations in carotid/temporal arteries

-s/s of HF

-high pitched, blowing, diastolic murmur

aortic stenosis s/s

-DOE

-loud, harsh, systolic murmur

-possible S4 sound

s/s of valvular disorders

-fatigue

-SOB

-cough

-pulmonary congestion

-dizziness

-syncope

-chest pain

-palpitations

-weakness

valvular disorder diagnostic testing

-echocardiogram

-12 lead EKG

-cardiac MRI

-cardiac catheterization

complications of valvular disorders

-HF

-arrhythmias

-dizziness, syncope

-angina

mitral stenosis may require...

antiocoagulants to prevent atrial thrombi

biologic (tissue) valves

-lower risk of thromboembolism

-lasts shorter than mechanical valve

patients with biologic valves and atrial fibrillation must be on...

long term anticoagulation

mechanical valves

-longer lasting than biological valves

-used in younger pts

-higher risk of thromboembolism

-requires long term anticoagulation

infective endocarditis

-microbial infection of the endothelial surface of the heart

-typically bacterial

infective endocarditis risk factors

-prosthetic heart valves

-structural cardiac defects

-IV drug users

-prolonged IV therapy

-hemodialysis

-indwelling catheters

myocarditis

-inflammatory process of myocardium that causes heart dilation, thrombi of heart wall, and muscle fiber degeneration

-typically viral

myocarditis risk factors

-HIV

-flu A

-immune disorders

-rheumatic fever

-infections

pericarditis

-inflammation of the pericardium

-can be acute, chronic, or recurrent

pericarditis can cause...

pericardial effusion or cardiac tamponade

pericarditis risk factors

-recent cardiac surgery

-MI

-infections

-medication reactions

-autoimmune disorders

-cancer

-chest trauma

infective endocarditis s/s

-fever

-heart murmur

-petechiae

-skin changes

-splinter hemorrhages in nailbeds

what is one of the main symptoms of infective endocarditis?

fever!

myocarditis s/s

-flu like symptoms

-fatigue

-dyspnea

-syncope

-palpitations

-EKG changes

what is one of the main symptoms of myocarditis?

flu like symptoms!

myocarditis can be...

asymptomatic

pericarditis s/s

-chest pain

-pericardial friction rube

-dyspnea

-infection symptoms

what is one of the main symptoms of pericarditis?

pericardial friction rub!

management of infective endocarditis

-2 to 6 weeks of antibiotics

-surgery if complications or infection does not resolve with antibiotics

management of myocarditis

-determine and treat underlying cause

-bedrest to decrease cardiac workload

-slow reintroduction of activity

-management of HF/arrhythmias if develop

-avoid NSAIDs

management of pericarditis

-determine and treat underlying cause

-treat symptoms

-pericardiocentesis to remove pericardial fluid if needed

prevention of inflammatory heart disorders

-antibiotics PRN for certain procedures

-oral hygiene

-catheter care (remove ASAP)

-immunizations

-substance abuse counseling

complications of infective endocarditis

-HF

-intracardiac abscess

-valvular dysfunction

complications of myocarditis

-HF

-arrhythmias

-sudden cardiac death

complications of pericarditis

-cardiac tamponade

-EKG changes

-arrhythmias