ncm 106 cardiac disorders

8/10/2019 NCM 106 Cardiac Disorders

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CARDIAC DISORDERSMs Hassen Zabala, RN, MAN

July 22, 2013


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HEART FAILURE

Definition

Heart failure is a condition in whichthe heart can no longer pump

enough blood to the rest of thebody.


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Causes, incidence, and risk factors

Heart failure is present when: Your heart muscle cannot pump (eject) the blood out of the heart

very well. This is called systolic heart failure.

Your heart muscles are stiff and do not fill up with blood easily. Thisis called diastolic heart failure.

As the heart's pumping action is lost, blood may back up inother areas of the body.

The most common cause of heart failure is coronary artery

disease (CAD), a narrowing of the small blood vessels thatsupply blood and oxygen to the heart.

Heart failure can also occur when an infection weakens theheart muscle. This condition is called cardiomyopathy.


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Other heart problems

that may cause heart

failure are:

Congenital heart disease

Heart attack

Heart valve disease

Some types of abnormal

heart rhythms

(arrhythmias)

Other diseases that can

cause or contribute to

heart failure:

Emphysema

Overactive thyroid

Severe anemia

Underactive thyroid


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Structure of the Heart


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Circulation of the Heart


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Symptoms

Cough

Fatigue, weakness,faintness

Loss of appetite

Need to urinate at night

Pulse that feels fast orirregular, or palpitations

Shortness of breathwhen active or afterlying down

Swollen (enlarged) liveror abdomen

Swollen feet and ankles

Weight gain


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Signs and tests

Signs of heart failure:

Fast or difficult breathing

Irregular or fast heartbeat and abnormal heart sounds

Leg swelling (edema)

Neck veins that stick out (are distended)

Sounds ("crackles") from fluid buildup in the lungs, heardthrough a stethoscope

Swelling of the liver or abdomen


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An echocardiogram (echo) is often the best testto diagnose, learn the cause of, and monitor

heart failure.

Other imaging tests are:

Cardiac stress tests

Heart catheterization

MRI of the heart

Nuclear heart scans


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Echocardiogram Cardiac stress test


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Cardiac catheterization MRI of heart


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Nuclear heart scans


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Lab tests:

Check how well kidneys are working (BUN,

creatinine, creatinine clearance, urinalysis)

Look for a low blood count or anemia -- completeblood count (CBC)

Test for brain natriuretic peptide (BNP)

Watch sodium and potassium levels in blood


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Treatment

These medicines:

Help the heart muscle pump better

Keep blood from clotting

Lower cholesterol levels

Open up blood vessels or slow heart rate

Replace potassium

Rid body of excess fluid and salt (sodium)


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The following surgeries and devices may berecommended for certain patients with heart

failure:

Coronary bypass surgery (CABG) and angioplasty mayhelp improve blood flow to the damaged or weakenedheart muscle.

Heart valve surgery may be done if changes in a heartvalve are causing your heart failure.

A pacemaker can help treat slow heart rates or helpboth sides of your heart contract at the same time.

A defibrillator sends an electrical pulse to stop life-

threatening abnormal heart rhythms.


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END-STAGEHEART FAILURE

Severe heartfailure occurswhen treatments

no longer work. Intra-aortic

balloon pump(IABP)

Left ventricularassist device(LVAD)


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VALVULAR HEART DISEASE

Definition

Heart valve disease occurswhen your heart's valves do

not work the way they should.


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What Are the Types of Valve Disease?

Valvular stenosis. This occurs when a valveopening is smaller than normal due to stiff orfused leaflets. The narrowed opening may

make the heart work very hard to pump bloodthrough it. This can lead to heart failure andother symptoms (see below). All four valvescan be stenotic (hardened, restricting blood

flow); the conditions are called tricuspidstenosis, pulmonic stenosis, mitral stenosis oraortic stenosis


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Valvular insufficiency. Also called

regurgitation, incompetence or "leaky valve",this occurs when a valve does not close tightly.If the valves do not seal, some blood will leakbackwards across the valve. As the leak

worsens, the heart has to work harder tomake up for the leaky valve, and less bloodmay flow to the rest of the body. Dependingon which valve is affected, the conditioned is

called tricuspid regurgitation, pulmonaryregurgitation, mitral regurgitation or aorticregurgitation.


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What Causes Valvular Heart Disease?

Valve disease can develop before birth(congenital) or can be acquired sometime duringone's lifetime.

Congenital valve disease. Most often affects theaortic or pulmonic valve.

Bicuspid aortic valve disease is a congenital valvedisease that affects the aortic valve. Instead ofthe normal three leaflets or cusps, the bicuspid

aortic valve has only two.


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Acquired valve disease. Rheumatic fever is caused by an untreated bacterial infection

(usually strep. throat). The heart valves become inflamed, theleaflets stick together and become scarred, rigid, thickened

and shortened. This leads to mitral regurgitation. Endocarditis occurs when germs, especially bacteria, enter the

bloodstream and attack the heart valves, causing growths andholes in the valves and scarring. This can lead to leaky valves.

Mitral valve prolapse (MVP) is a very common condition,causes the leaflets of the mitral valve to flop back into theleft atrium during the heart's contraction.

Other causes of valve disease include: coronary arterydisease, heart attack, cardiomyopathy (heart muscledisease), syphilis (a sexually transmitted disease),hypertension, aortic aneurysms, and connective tissuediseases.


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What Are the Symptoms of Valve

Disease?

Shortness of breath and/or difficulty catchingyour breath.

Weakness or dizziness.

Discomfort in your chest. You may feel a pressureor weight in your chest with activity or whengoing out in cold air.

Palpitations.

Swelling of your ankles, feet or abdomen.

Rapid weight gain. A weight gain of two or threepounds in one day is possible.


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How Are Valve Diseases Diagnosed?

After the physical exam, the doctor may order

diagnostic tests. These may include:

Echocardiography

Transesophageal echocardiography

Cardiac catheterization (also called an angiogram)

Radionuclide scans

Magnetic resonance imaging (MRI)


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How Is Heart Valve Disease Treated?

Medications Diuretics ("water pills")

Antiarrhythmic medications. Control the heart's rhythm

Vasodilators. Lessen the heart's work; encourages bloodto flow in a forward direction, rather than backwardsthrough a leaky valve.

ACE inhibitors. A type of vasodilator used to treat highblood pressure and heart failure

Beta blockers. Treat high blood pressure and lessen theheart's work by helping the heart beat slower and lessforcefully. Used to decrease palpitations in some patients.

Anticoagulants ("blood thinners")


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Surgeries

heart valve repair orreplacement.

percutaneous balloon

valvotomy.


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Dilated cardiomyopathy


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Hypertrophic cardiomyopathy


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Symptoms

Some people who develop cardiomyopathyhave no signs and symptoms during the earlystages of the disease. Cardiomyopathysymptoms may include:

Breathlessness with exertion or even at rest Swelling of the legs, ankles and feet

Bloating of the abdomen due to fluid buildup

Fatigue

Irregular heartbeats that feel rapid, pounding orfluttering

Dizziness, lightheadedness and fainting


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Causes Long-term high blood

pressure

Heart valve problems

Heart tissue damage from aprevious heart attack

Chronic rapid heart rate Metabolic disorders

Nutritional deficiencies ofessential vitamins or

minerals, such as thiamin(vitamin B-1), selenium,calcium and magnesium

Pregnancy

Excessive use of alcoholover many years

Abuse of cocaine orantidepressantmedications, such as

tricyclic antidepressants Use of some chemotherapy

drugs to treat cancer

Certain viral infections,which may injure the heart

and trigger cardiomyopathy Iron buildup in your heart

muscle (hemochromatosis)

Genetic conditions


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Types of cardiomyopathy

1. Dilated cardiomyopathy.

This is the most common type ofcardiomyopathy

the pumping ability of your heart's mainpumping chamberthe left ventriclebecomes less forceful; becomes enlarged

(dilated) and can't effectively pump blood outof the heart

occurs most often in middle-aged people andis more likely to affect men


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2. Hypertrophic cardiomyopathy.

involves abnormal growth or thickening ofyour heart muscle, particularly affecting the

muscle of your heart's main pumping

chamber. the heart tends to stiffen and the size of the

pumping chamber may shrink, interfering with

your heart's ability to deliver blood to your

body.

tends to be more severe during childhood.


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3. Restrictive cardiomyopathy

heart muscle becomes rigid and less elastic,meaning the heart can't properly expand and

fill with blood between heartbeats.

most often tends to affect older people.

least common type and can occur for no

known reason (idiopathic). The condition may

also be caused by diseases elsewhere in thebody that affect the heart.


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Complications

Heart failure.

Blood clots. Valve problems.

Cardiac arrest and suddendeath.


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Tests and Diagnosis

Chest X-ray

Echocardiogram.

Electrocardiogram (ECG).

Cardiac catheterization and biopsy.

Cardiac magnetic resonance imaging (MRI).

Blood tests. One blood test can measure B-type natriuretic peptide (BNP), a protein

produced in your heart.


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Treatment

Dilated cardiomyopathy ACE inhibitors to improve your heart's pumping

capability, such as enalapril (Vasotec), ramipril

(Altace) and captopril (Capoten).

Angiotensin receptor blockers (ARBs) for those

who can't take ACE inhibitors, such as losartan

(Cozaar) and valsartan (Diovan).

Beta blockers to improve heart function, such as

carvedilol (Coreg) and metoprolol (Lopressor,

Toprol-XL).


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Digoxin (Lanoxin). Increases the strength of heart

muscle contractions; tends to slow the heartbeat. Diuretics. Make you urinate more frequently and

keep fluid from collecting in your body.

Commonly prescribed diuretics for heart failure

include bumetanide (Bumex) and furosemide

(Lasix). One diuretic, spironolactone (Aldactone),

may also be helpful in treating scarring of your

heart tissue. ICD


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Septal ablation.Also called septalalcohol ablation,this is a treatmentin which a smallportion of the

thickened heartmuscle isdestroyed byinjecting alcohol

through a catheterinto the arterysupplying blood toit.


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Pacemaker implantation ICD


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Restrictive cardiomyopathy

Treatment focuses on improvingsymptoms.

salt and water intake monitoring and

weight monitoring

diuretics for sodium and water retention

medications to lower blood pressure andcontrol fast or irregular heart rhythms.


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Heart transplant & Ventricular assistive

devices (VADs)


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Stress Cardiomyopathy

Broken heart syndrome

S/sx: Chest pain

Shortness of breath

An irregular heartbeat

A generalized weakness

Cx: Death

Disruptions in your heartbeat

A fast or slow heartbeat

Backup of fluid into your lungs (pulmonary edema)


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Test & diagnosis:

Personal history and physical exam

Electrocardiogram (ECG)

Chest X-ray

Echocardiogram Blood tests

Treatment

angiotensin-converting enzyme (ACE) inhibitors beta blockers

diuretics


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What is pericarditis?

Definition

The hearts sits in the center of the chest and issurrounded by a sac called the pericardium.

This sac has two layers, one that fits tightlyonto the heart muscle and another looserlayer surrounding the inner layer.Inflammation of these tissue layers

surrounding the heart is referred to aspericarditis.


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What causes pericarditis? Idiopathic

Mechanical injury to theheart Heart attack and Dressler's

syndrome

Heart surgery and postpericardiotomy syndrome

Infection Bacterial

Viral Fungal

HIV

Tumors or cancer

Connective Tissue Disease Rheumatoid arthritis

SLE

Sarcoidosis

Metabolic diseases Uremia (kidney failure)

Hypothyroidism

Medication Reactions Side effects of phenytoin

(Dilantin), hydralazine(Apresoline) andprocainamide (Pronestyl,Procan-SR, Procanbid).


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How is pericarditis diagnosed?

Physical Evaluation

Diagnostic Testing

Electrocardiogram

Chest x-ray

Echocardiography

Blood testing


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What is the treatment for pericarditis?

Medicines Nonsteroidal anti-

inflammatory drugs(ibuprofen)

Narcotic pain medication

[codeine, hydrocodone(Vicodin) or oxycodone(OxyContin, Roxicodone)]

Corticosteroids

Surgery Pericardiocentesis (a thin

needle is inserted throughthe chest wall into thepericardial sac)


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Pericardotomy (cutting a hole inthe pericardial sac)

Pericardectomy (removing the sac

completely)


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Myocarditis

Definition

inflammation of heart muscle.

Causes

Viruses

Sarcoidosis

immune diseases (such as systemic lupus, etc.)

Pregnancy

Others


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Symptoms

pain in the chest

weakening of the heart muscle

heart failure symptoms

shortness of breath

Fatigue

fluid accumulation in the lungs

Etc

heart rhythm irregularities from inflammationand/or scarring of the electrical system of theheart.


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Diagnosis

Blood tests for heart muscle enzymes(CPK levels) can be elevated

Electrical testing (EKG) can suggest

irritation of heart muscle and

demonstrate irregular beating of the

heart

Nuclear heart scan testing can show

irregular areas of heart muscle.


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Treatment

Treatment measures mainly

involves alleviating heart failure

(salt restriction, water pills, ACEinhibitors, beta blockers, etc.) and

treating as well as monitoringheart rhythm abnormalities.


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Endocarditis

Definition

Endocarditis is a serious infection of one of

the four heart valves.

Cause

Endocarditis is caused by a growth of bacteria

on one of the heart valves, leading to an

infected mass called a "vegetation".


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What are the symptoms?

fever,

fatigue,

chills,

weakness

aching joints and muscles, night sweats,

edema in the leg(s), foot (feet), and abdomen,

malaise,

shortness of breath, and

occasionally, scattered small skin lesions.

anemia, blood in urine, elevated white blood cell

count, and a new heart murmur.


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Who is at risk for endocarditis?

People with existing diseases of

the heart valves (aortic stenosis,

mitral stenosis, mitralregurgitation, etc.) and people

who have undergone heart valvereplacements


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How is endocarditis diagnosed?

Transesophageal echocardiography


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How is endocarditis treated?

Aggressive antibiotics, generally givenintravenously, usually for 4-6 weeks.

Amoxicillin

Ampicillin Erythromycin

Gentamicin

Vancomycin

surgical replacement of the valve


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HYPERTENSION

Blood pressure is a measurement of the force againstthe walls of your arteries as your heart pumps bloodthrough your body.

The top number is called the systolic blood pressure,and the bottom number is called the diastolic bloodpressure.

High blood pressure (hypertension) is when your bloodpressure is 140/90 mmHg or above most of the time.

If your blood pressure numbers are 120/80 or higher,but below 140/90, it is called pre-hypertension.


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Essential HPN

no cause of high blood

pressure is found

Secondary HPN

Chronic kidney disease

Disorders of the adrenal gland(pheochromocytoma or Cushingsyndrome)

Pregnancy

Medications such as birth control pills,diet pills, some cold medications, andmigraine medications

Renal artery stenosis

Hyperparathyroidism


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Symptoms

If you have a severe headache, nausea or

vomiting, bad headache, confusion, changes

in your vision, or nosebleeds you may have a

severe and dangerous form of high bloodpressure called malignant hypertension.


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Diagnosis


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Complications


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Treatment

Lifestyle modification

Medications

Diuretics help the body get rid of excess sodium (salt)and water and help control blood pressure

Beta-blockers reduce the heart rate, the heart'sworkload and the heart's output of blood

ACE inhibitors help the body produce less angiotensin,which helps the blood vessels relax and open up

ARBs block the receptors so the angiotensin fails toconstrict the blood vessel

Calcium channel blockers relax and open up narrowedblood vessels

Alpha blockers reduce the arteries' resistance relaxing


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Alpha blockers reduce the arteries resistance, relaxingthe muscle tone of the vascular walls

Alpha 2 receptor agonist decreases the activity of the

sympathetic (adrenaline-producing) portion of theinvoluntary nervous system

Combined alpha and beta-blockers areused as an IV dripfor those patients experiencing a hypertensive crisis

Central agonists also help decrease the blood vessels'ability to tense up or contract

Peripheral adrenergic inhibitors reduce blood pressureby blocking neurotransmitters in the brain. This blocksthe smooth muscles from getting the "message" toconstrict.

Blood vessel dilators, or vasodilators, can cause themuscle in the walls of the blood vessels (especially thearterioles) to relax, allowing the vessel to dilate (widen)


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ANEURYSM

Definition

An aneurysm is an

abnormal widening

or ballooning of aportion of an artery

due to weakness in

the wall of theblood vessel.


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Symptoms

The symptoms depend on the location of theaneurysm. If the aneurysm occurs near thebody's surface, pain and swelling with athrobbing mass is often seen.

Aneurysms within the body or brain often causeno symptoms.

If an aneurysm ruptures, pain, low bloodpressure, a rapid heart rate, and lightheadednessmay occur. The risk of death after a rupture ishigh.

Si d t t


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Signs and tests

physical exam.

CT scan

Ultrasound

Treatment

Surgery endovascular stent repair

Endovascular embolization.

E d l t t i


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Endovascular stent repair

THROMBOANGITIS OBLITERANS


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THROMBOANGITIS OBLITERANS

(BUERGERS DSS.)

Definition blood vessels of the hands and feet become blocked.

Cause

Caused by vasculitis (inflammation of the blood vessels).

average age when symptoms begin is around 35 years

history of heavy smoking/chewing tobacco; Raynaud'sdisease.

very uncommon in children unless if with autoimmune

diseases.


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Symptoms Hands or feet may be pale, red, or bluish

Hands or feet may feel cold Pain in the hands and feet

Acute, severe

Burning or tingling

Often occurring at rest Pain in the legs, ankles, or feet when walking

(intermittent claudication) Often located in the arch of the foot

Skin changes or ulcers on hands or feet

Note: Symptoms may worsen with exposure to cold orwith emotional stress. Usually, two or more limbs areaffected.


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Signs & Tests

Angiography/arteriography of

the extremity

Doppler ultrasound of the

extremity


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Treatment There is no cure for thromboangiitis obliterans. The

goal of treatment is to control symptoms.

The patient must stop using tobacco and should avoidcold temperatures and other conditions that reduce

circulation to the hands and feet.

Applying warmth and exercising gently may helpincrease circulation.

Cutting the nerves to the area (surgicalsympathectomy) may help control pain. Aspirin andvasodilators may also used. It may be necessary toamputate the hand or foot if infection or widespread

tissue death occurs.


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RAYNAUDS PHENOMENON

Raynaud's phenomenon (RP) is a condition resulting ina particular series of discolorations of the fingersand/or the toes after exposure to changes intemperature (cold or hot) or emotional events. Skin

discoloration occurs because an abnormal spasm of theblood vessels causes a diminished blood supply to thelocal tissues.

White---blue---red

Affects women between 20-40 When it occurs alone, it is referred to as "Raynaud's

disease" or primary Raynaud's phenomenon. When itaccompanies other diseases, it is called secondary

Raynaud's phenomenon.

h d' h ?


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What causes Raynaud's phenomenon?

The causes of primary and secondary RP are unknown.

What are Raynaud's phenomenon


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What are Raynaud s phenomenon

symptoms and signs?

skin discoloration upon cold exposure

mild tingling and numbness of the involveddigit(s) that will disappear once the color

returns to normal. Ulcerated digits can become infected

Less common areas of the body that can be

affected by RP include the nose, ears, andtongue. While these areas rarely developulcers, they can be associated with a sensationof numbness and pain.

How is Raynaud's phenomenon


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How is Raynaud s phenomenon

diagnosed?

Physical exam No single blood test to help the doctor to confirm

the diagnosis. The doctor can order certain bloodtests (for example, sedimentation rate,

rheumatoid factor, antinuclear antibody, thyroidhormone levels, and protein levels) to excludeassociated rheumatic diseases and thyroiddisorders.

Certain maneuvers with the patient's extremitiesto exclude pinched blood vessels that canproduce symptoms that mimic RP, such as inthoracic outlet syndrome.

What is the treatment for Raynaud's


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What is the treatment for Raynaud s

phenomenon?

Management of Raynaud's phenomenon involves protecting thefingers and the toes from cold, trauma, and infection. Avoiding direct and indirect (passive or secondhand smoke) smoking

Medications that can aggravate blood vessel spasm should beavoided

Medications that dilate the blood vessels can be administered.

Calcium antagonists, such as diltiazem (Cardizem, Dilacor), nicardipine(Cardene), nifedipine (Procardia), and other medicines used in bloodpressure treatment, such as methyldopa (Aldomet) and prazosin(Minipress).

Low doses of aspirin or dipyridamole (Persantine)

Some patients with persistent symptoms can benefit by adding amedication called pentoxifylline (Trental), which makes the red bloodcells more pliable and thereby improving circulation.

Sympathectomy is


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Sympathectomy issometimes considered.In this procedure, toprevent blood-vesselspasm, the nerves thatstimulate theconstriction of thevessels (sympatheticnerves) are surgicallyinterrupted. the tiny

nerves around theblood vessels arestripped away.


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Tests


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Tests

Blood Pressure

Hypertension Tests Blood Pressure

Monitors

Heart Tests

Treatment

Embolectomy Thrombolysis

Bypass surgery

ncm 106 cardiac disorders

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