valvular heart disease/myopathy/aneurysm. valvular heart disease heartpoint: heartpoint gallery ...
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Valvular Heart Disease/Myopathy/Aneury
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Valvular Heart Disease
HeartPoint: HeartPoint Gallery
http://www.heartcenteronline.com/myheartdr/common/articles.cfm?ARTID=187
Risk FactorsRheumatic Heart Disease MICongenital Heart DefectsAgingCHF
PathophysiologyStenosis- narrowed valve, increases afterloadRegurgitation or insufficiency- increases preload. The heart has to pump same blood**Blood volume and pressures are reduced in front of the affected valve and increased behind the affected valve.This results in heart failureAll valvular diseases have a characteristic murmur murmurs
Mitral Valve Stenosis
Mitral StenosisDec. flow into LVLA hypertrophyPulmonary pressures increasePulmonary hypertensionDec. CO* early symptom is DOELater get symptoms of R heart failureA fib is common- anticoagulantsUsually secondary to rheumatic fever
Mitral RegurgitationRegurg of blood into LA during systoleLA dilation and hypertrophyPulmonary congestionRV failureLV dilation and hypertrophy-to accommodate inc. preload and dec CO
Mitral Valve ProlapseA type of mitral insufficiencyUsually asymptomaticMay get atypical chest pain related to fatigueTachydysrhythmias may developRisk for endocarditis is increased and need prophylactic antibiotics
A&P 1 Heart part 1
Aortic StenosisIncrease in afterloadReduced COLV hypertrophyIncomplete emptying of LAPulmonary congestionRV strain
Symptoms
Syncope
Angina
Dyspnea
Aortic StenosisMay be asymptomatic for many years due to compensationDOE, angina, and exertional syncope are classic symptomsLater get signs of R heart failureUntreated-poor prognosis- 10-20%sudden cardiac death
Aortic RegurgitationGet increased preoad- 60% of SV can be regurgitatedCharacteristic water hammer pulseRegurgitation of blood into the LVLV dilation and hypertrophyDec. CO
Water Hammer pulse
Pulse, water hammer: A jerky pulse that is full and then collapses because of aortic insufficiency (when blood ejected into the aorta regurgitates back through the aortic valve into the left ventricle ).
Also called a Corrigan pulse or a cannonball, collapsing, pistol-shot, or trip-hammer pulse.
Tricuspid and Pulmonic Valve Disorders
Result in R side heart failure
Diagnostic TestsEcho- assess valve motion and chamber sizeCXREKGCardiac cath- get pressures
MedicationsLike Heart Failure
ACE, DigDiureticsVasodilatorsBeta blockersAnticoagulants*Prophylactic antibiotics
Medical/ Surgical Treatment
Percutaneous balloon valvuloplastySurgery
Open commissurotomy- open stenotic valvesAnnuloplasty- can be used for bothValve Replacement
Mechanical-need anticoagulantBiologic-only last about 15 yearsRoss Procedure
Ross Procedure
Nursing DiagnosesDecreased Cardiac OutputActivity IntoleranceRisk for InfectionIneffective Protection
Case study
http://edcenter.med.cornell.edu/Pathophysiology_Cases/96-97_Pathophysiology_Cases/96-97Case_04.html
CardiomyopathyPrimary-idiopathicSecondary
Ischemiainfectious diseaseexposure to toxinsMetabolic disordersNutritional deficiencies
PathophysiologyDilated
Most commonCocaine and alcohol abuseChemotherapy pregnancyHypertensionGenetic* Heart chamber dilate and contraction is impaired and get dec. EF%*Dysrhythmias are common- SVT Afib and VTPrognosis poor-need transplant
Pathophysiology Hypertrophic
GeneticAlso known as IHSS or HOCMGet hypertrophy of the ventricular mass and impairs ventricular filling and COSymptoms develop during or after physical activitySudden cardiac death may be first symptomSymptoms are dyspnea, angina and syncope
PathophysiologyRestrictive
Least commonRigid ventricular walls that impair fillingContraction and EF normalPrognosis-poor
DiagnosticsEcho-wall motion and EFEKGCXRHemodynamicsPerfusion scanCardiac cathMyocardial biopsy
MedicationsSame as for heart failure except for hypertrophic
TreatmentSurgery
Vad-bridge to transplantHeart TransplantMyoloplastyICD- antiarrhythmics are negative inotropesDual chamber pacemakerHypertrophic- excision of ventricular septum
Heart transplant
virtual transplant
Nursing DiagnosesDecreased Cardiac OutputFatigueIneffective Breathing PatternFearIneffective Role PerformanceAnticipatory grieving
Aortic Aneurysms
DefinitionAbnormal dilation of a blood vessel at a site of weakness or a tear in the vessel wall. Usually secondary to atherosclerosis.
Most commonly affect the aorta
Layers of an artery
AAA
Aneurysms location
Saccular
Fusiform
Most are fusiform and 98% are below the renal artery
False or Pseudo
A pseudoaneurysm is actually a disruption in the intima and media of the
aorta, and only the adventitia/surrounding tissue retains
blood within the aortic cavity.
Ex. A hemotoma after a heart cath
DissectingBlood invades or dissects the layers of the vessel wall
Aortic dissection occurs when blood enters the wall of aorta, separating its layers, and creating a blood filled cavity.
Thoracic Aortic AneurysmFrequently asymptomaticMay have substernal, neck or back painOther symptoms depend on location and structures they compress
Abdominal AorticPulsating mass in mid and upper abdomen and bruit over the massPain intensity correlates to size and severityMay have thrombiIt can rupture causing shock and death in 50% of rupture cases
Aortic dissectionLife threatening emergencyHappens when the intima tears and causes hemorrhage into the mediaHypertension is main cause*Primary symptom is excruciating painMay get syncope,dyspnea and weaknessPeripheral pulses are absent
Diagnostic Tests for Aneuysms
Most are diagnosed on routine work-upCXRAbd. UltrasoundTEECT or MRIAngiography
MedicationsAnti-hypertensives
Beta blockers, VasodilatorsCalcium channel blockersNipride
SedativesNiacin, mevocor, statinsPost-op anti-coagulants
SurgeryUsually repaired if >5cmOpen procedure- abd incision, cross clamp aorta,aneuysm opened and plaque removed, then graft sutured in place
Pre-op assess all peripheral pulsesPost-op-check urine output and peripheral pulses hourly for 24 hours- (when to call Dr.)
Endovascular stents- placed through femoral artery
Nursing AssessmentPain- chest, abd or back painHypertension(other vital signs)Peripheral pulsesPulsation in upper abdomenSOB
Nursing DiagnosesRisk for Ineffective Tissue PerfusionRisk for InjuryAnxietyPainKnowledge Deficit
PreventionPrevent atherosclerosisTreat and control hypertensionDiet- low cholesterol, low sodium and no stimulantsCareful follow-up if less than 5cm. It can grow .5cm /year
ComplicationsRupture
Back painHypotensionPulsating mass
ThrombiRenal Failure
Rupture Triad
Back pain
HypotensionPulsating hematoma
http://www.cotc.edu/vstone/wk3.htm
http://www.medi-smart.com/cardce5.htm