Term
| what are causes of infective endocarditis? |
|
Definition
BACTERIAL (staph,strep) Fungi, yeast, virus
Predisposing:
-IV drug abuse
- Rheumatic fever
- Valve replacements
- Congenital heart defects
- Invasive procedures
- Systemic infections
(dental, iv lines) |
|
|
Term
| what mostly causes infection of tricuspid valves? |
|
Definition
|
|
Term
| what is the resulting effect on heart with infective endocarditis? (functional) |
|
Definition
VALVES WONT CLOSE! >>> Valve insufficiency/regurg
valve vegetation
platlets/fibrin lesion and bacteria gather on lesions causing valve insufficiency/regurg |
|
|
Term
What are the S/S of infective endocarditis?
hall mark? |
|
Definition
hallmark= fever/chills (fever associated with night sweat, malaise, fatigue)
Skin- janeway lesions, osler node, roths spots
murmurs in 90% (s3/s4 regurg)
anorexia/weight loss
HF
Petechiae
splinter hemorrhages (distal 1/3)
positive cultures
systemic embolization
heart failure |
|
|
Term
| what type of murmur does infective endocarditis cause? |
|
Definition
|
|
Term
| which heart condition can result in petechiae/splinter hemorrhages on nails? |
|
Definition
|
|
Term
| why does infective endocarditis result in systemic embolization? |
|
Definition
- d/t vegetation
- if on right side of heart--> pulmonary embolism risk
- if on left side of heart--> brain, spleen, kidney, mesenteric, extremeties
* |
|
|
Term
| why do you have to perform neuro checks for infective endocarditis? |
|
Definition
if vegetation on left side of heart embolizes to brain could cause stroke/tia
(1/3 undergo neuro changes)
- confusion
- aphasia
- dysphagia |
|
|
Term
| what would be signs of renal infarct with infective endocarditis? |
|
Definition
flank pain to groin
hematuria and pyuria |
|
|
Term
| what would be sign of splenic infarct with infective endocarditis? |
|
Definition
sudden abdominal pain with radiation to left shoulder
rebound tenderness |
|
|
Term
| what are janeway lesions? |
|
Definition
non painful
flat/red/dark maculae
Feet/hands
infective endocarditis causes |
|
|
Term
|
Definition
painful
red nodes
palms of hands, soles of feet
infective endocarditis causes |
|
|
Term
|
Definition
white retinal spots (d/t hemorrhage)
infective endocarditis causes |
|
|
Term
| what are signs of pulmonary embolism from embolization of vegetation in infective endocarditis on right side of heart? |
|
Definition
pleuritic chest pain
dyspnea
cough |
|
|
Term
| how would you diagnose infective endocarditis? |
|
Definition
echocardiogram
increased wbc
blood culture (2 sets)
new regurg murmur |
|
|
Term
| what are the complications associated with infective endocarditis? which is most common? |
|
Definition
- heart failure (most common)
- embolization (PE, or systemic) |
|
|
Term
| treatment of infective endocarditis |
|
Definition
- intensive antibiotics 4-6 weeks (PICC or central)
- NO ANTICOAGULANTS- doesn't prevent clots
- no floss/irrigation can cause bacteremia
- antibiotic prophylaxis for dental, oral , upper respiratory
- supportive HF therapy
- rest balanced with activity
- tell them to record temp daily for 6 weeks and report: fever, chills, weight loss, malaise, fatigue, weight gain, or dyspnea |
|
|
Term
| what should those with infective endocarditis avoid? what should they report? |
|
Definition
avoid- anticoagulants- wont help clots
avoid flossing/irrigation- bacteremia
report: fever, chills, weight loss, malaise, fatigue, weight gain, dyspnea |
|
|
Term
| what can cause acute pericarditis? |
|
Definition
- infection
- non infectious
- dressler's syndrome (2-11 weeks after mi)
- idiopathic |
|
|
Term
| what can cause chronic pericarditis? |
|
Definition
- ESRD*
- Metastatic cancer*
- TB
- radiation
-trauma |
|
|
Term
| signs and symptoms of acute pericarditis? |
|
Definition
- chest pain radiating to shoulder
- intensified with deep inspiration or supine position or cough/swallow
- substernal, grating, oppressive pain
- pericardial friction rub at left sternal border
- dyspnea
- fever/chills
- could have elevated wbc
- effusion possible |
|
|
Term
| which heart disorder can cause pericardial friction rub? where is this heart |
|
Definition
pericarditis
left sternal border |
|
|
Term
| which heart disorder causes chest pain radiating to shoulder and when is it intensified? |
|
Definition
- pericarditis
- with inspiration or supine |
|
|
Term
| what are the signs and symptoms of CHRONIC pericarditis caused by TB, radiation, trauma, ESRD, or metastatic cancer? |
|
Definition
signs of right sided hf!!
- elevated systemic venous pressure
- jugular distention
- hepatic enlargement
- dependent edema
- exertional fatigue/dyspnea
- thickening of pericardium seen on echo |
|
|
Term
| what are the two major complications of pericarditis? |
|
Definition
- atrial fibrillation/dysrhythmias
- cardiac tamponade d/t effusion |
|
|
Term
| what are the signs of cardiac tamponade |
|
Definition
- JVD* with clear lungs
- increased HR
- dyspnea, fatigue
- muffled heart sound*
- hypotension
- decreased CO
- paradoxical pulse* (bp 10 mmhg lower on inspo)
- decreased CO*
- circulatory collapse* |
|
|
Term
| what disorder causes an ST elevation in all 12 leads? |
|
Definition
|
|
Term
| what would an echo of pericarditis determine? |
|
Definition
|
|
Term
| what might we treat pericarditis with until we diagnose tamponade? |
|
Definition
|
|
Term
| what would hemodynamic monitoring show when too little fluid is there to visualize cardiac tamponade? |
|
Definition
| elevated right atrial, pulmonary artery, and wedge pressures |
|
|
Term
| what are our treatment options for cardiac tamponade? |
|
Definition
1. fluid volume (while waiting to diagnose)
2. pericardiocentesis- with echo or fluoroscopic guidance and hemodynamic monitor
3. pericardial drain
4. pericardectomy (full or partial)
5. pericardial window- permits drainage into pleural space |
|
|
Term
| how do we treat pericarditis? |
|
Definition
- nsaid for pain
- anti inflammatory should decrease pain within 48 hrs!
- position by sitting up and forward
- oxygen
- colchicine- prevents reoccurrence- take for 6 months
-antibiotics if bactieral along with pericardial drain
- for chronic- chemo, radiation, hemodialysis, or pericardectomy to remove pericardium (only for chronic) |
|
|
Term
| colchicine is used to treat what |
|
Definition
| pericarditis- take for 6 months- stops reoccurence |
|
|
Term
| which heart disorder causes inflammation in all layers of the heart? |
|
Definition
|
|
Term
| what is the functional affect on heart with rheumatic endocarditis? |
|
Definition
impaired contractile function of myocardium
thickening of pericardium
valvular damage |
|
|
Term
which disorder causes the following 3 things:
1. impaired contractile function of myocardium
2. thickening of pericardium
3. damage to valves/endocardium and leaflets |
|
Definition
rheumatic endocarditis
(AFFECTS ALL LAYERS) |
|
|
Term
| what are the signs and symptoms of endocarditis? |
|
Definition
-tachycardia
-cardiomegaly
-new or changed murmur
-pericardial friction rub
- pericardial pain
- ecg- prolonged PR interval
- HF indications
- evidence of existin strep |
|
|
Term
| which heart issue/infection can cause PROLONGED PR INTERVALS |
|
Definition
|
|
Term
| which heart issue/infection can result in cardiomegaly? |
|
Definition
|
|
Term
| which heart issue causes precordial pain (left side of chest muscle pain)? |
|
Definition
|
|
Term
ashcough bodies
what are they
when are they seen? |
|
Definition
nodules in myocardium of heart replaced with scar tissue - EFFECTS CONTRACTILITY
seen in rheumatic endocarditis |
|
|
Term
| does rheumatic endocarditis cause tachycardia or bradycardia? |
|
Definition
|
|
Term
| how do we treat rheumatic carditis? |
|
Definition
- penicillin immediately for full 10 days and rest
- antibiotic prophylaxis needed for rest of life to prevent infective endocarditis! |
|
|
Term
|
Definition
invasion of organisms into myocardial wall resulting from inflammatory disorder of myocardial
- IDIOPATHIC
- autoimmune
- alcohol, age, radiation
- vital, bacterial |
|
|
Term
| which heart issue can be caused by alcohol? |
|
Definition
|
|
Term
| what functional result on heart does rheumatic carditis cause? |
|
Definition
| stenosis or regurg of mitral and aortic valves |
|
|
Term
| cellular infiltrate perfusion is the reason for HF indications in what heart issue? |
|
Definition
|
|
Term
| what layer of heart has exudate in rheumatic carditis? what can this cause |
|
Definition
pericardium
can result in serosanguineous pleural effusion |
|
|
Term
| pericarditis causes pericardial friction rub/pain but what ELSE causes this? |
|
Definition
rheumatic carditis!!!
(pericardium thickening with exudate in rheumatic carditis)
OR
myocarditis |
|
|
Term
|
Definition
|
|
Term
| which heart issue can cause flu like symptoms with fever? |
|
Definition
|
|
Term
| myocarditis can cause what symptoms |
|
Definition
- acute HF signs (fatigue, dyspnea)
- palpitations
- pericardial friction rub
- flu like symptoms with fever |
|
|
Term
| how do we diagnose myocarditis? |
|
Definition
biopsy to snip piece of myocardium for tissue sample
endomyocardial biopsy TO CONFIRM necrosis |
|
|
Term
| what are complications associated with myocarditis? |
|
Definition
- Heart failure
- cardiac tamponade/pericardial friction
- might not recover- transplant list |
|
|
Term
| which issue might result in transplant list? |
|
Definition
|
|
Term
| how do we diagnose myocarditis? |
|
Definition
endomyocardial biopsy to confirm necrosis
chest x ray
echocardiogram |
|
|
Term
| treatment for myocarditis |
|
Definition
- IV antibiotics
- NSAIDS
- immunosuppressants
- supportive HF therapy
- oxygen
- rest balanced w activity
- repair= pericardiocentesis, pericardial window, valve repair or replacement |
|
|
Term
| remind patients with myocarditis what |
|
Definition
to remind all hcp about prophylactic antibiotics (dental, oral)
take temp 6 weeks- report fever, chills, malaise, weight loss, fatigue, weight gain, dyspnea |
|
|
Term
| which disorders do we teach patients to take temp for 6 weeks and report fever, chills, malaise, weight loss, fatigue, weight gain, dyspnea |
|
Definition
myocarditis
infective endocarditis |
|
|
Term
| who do we teach to ask for antibiotic prophylaxis? |
|
Definition
myocarditis
infective endocarditis
rheumatic carditis |
|
|
Term
| what do you NOT give someone with pericarditis? |
|
Definition
| NO aspirin or anticoagulants!!! risk for tamponade |
|
|
Term
| what disorder results in thickened mitral valve due to fusion of valave leaflets or chordae tendinae shortening >>>>> unable to open valve>>>>obstructs flow into left ventricle>>>>left atrium dilates>>>>pulmonary artery pressure increase>>>>> right ventricular hyperteophy |
|
Definition
|
|
Term
| mitral stenosis results in what functional changes of heart |
|
Definition
1. obstruction of flow into left ventricle
2. left atrium dilates from pressure
3. right ventricle hypertrophies |
|
|
Term
| what can cause mitral stenosis? |
|
Definition
- rheumatic carditis
- congenital
- more often in women |
|
|
Term
| process of mitral stenosis? |
|
Definition
1. left atrial dilation
2. pulmonary congestion
3. left ventricle receives inadequate blood volume
4. decreased preload
5. decreased cardiac output |
|
|
Term
| pulmonary pressure rise from mitral stenosis results in? |
|
Definition
- dyspnea on exertion*
- dry cough*
- orthopnea
- paroxysmal nocturnal dyspnea
- heart palpitations
- hemoptysis
- pulmonary edema |
|
|
Term
| eventual right sided heart failure from mitral stenosis occurring after pulmonary pressure increase after left atrium dilation/pressure increase has what symptoms? |
|
Definition
- hepatomegaly
- neck vein distention
- pitting dependent edema |
|
|
Term
| why does decrease preload and decreased cardiac output result from mitral stenosis? |
|
Definition
| blood not getting to ventricle due to stenosis of mitral valve |
|
|
Term
| what is heard in mitral stenosis? |
|
Definition
loud s1 at apex
(rumbling apical diastolic murmur) |
|
|
Term
| when do we hear loud s1 at apex? |
|
Definition
|
|
Term
| what is a complication of mitral stenosis? |
|
Definition
atrial fibrillation!!
(ineffective atrial contraction, and decreased CO) |
|
|
Term
| what do people with mitral stenosis eventually develop in the end? |
|
Definition
| right sided hf (resulting from initial left sided) |
|
|
Term
| what would you see on x ray for mitral stenosis? |
|
Definition
- atrial enlargement
- prominent pulmonary arteries
- enlarged R ventricle |
|
|
Term
| how do we treat mitral stenosis? |
|
Definition
vasodilator/calcium channel blocker
to reduce regurg flow |
|
|
Term
| why do we give a calcium channel blockers/vasodilator with mitral stenosis? |
|
Definition
|
|
Term
| what would you give to treat A fib in mitral stenosis complication? |
|
Definition
- IV diltiazem or amiodarone
- cardioversion if rapid or worsening |
|
|
Term
| what happens in mitral regurgitation? |
|
Definition
mitral valve cant close during systole
backflow occurs into left atrium
During diastole regurg and normal blood flow go to left ventricle
increased volume in left ventricle to be ejected
results in:
left atrium and left ventricle dilation and hypertrophy |
|
|
Term
| why does mitral regurgitation result in both left atrium and left ventricular dilation and hypertrophy? |
|
Definition
| because during systole valve cant close- blood flow back into atria- then that extra blood in atria gets pushed into ventricle during diastole in addition to normal blood flow and increases volume in left ventricle- so both atria and ventricle working harder- dilation and hypertrophy occur |
|
|
Term
| what is a complication of mitral regurg? |
|
Definition
|
|
Term
| what causes mitral regurg? |
|
Definition
degenerative/aging
infective endocarditis
congential anomalies
CAD
rheumatic heart disease
women more
mitral valve prolapse |
|
|
Term
| which stenosis/regurg is caused by rheumatic fever? |
|
Definition
1. mitral stenosis
2. mitral regurg
3. aortic stenosis
* so its the stenosis ones mostly
- remember that mitral regurg involves some mitral stenosis as well- SO ALL STENOSIS- plus mitral regurg due to this |
|
|
Term
| which two regurg/stenosis can be caused by infective endocarditis? |
|
Definition
mitral regurg
aortic regurg |
|
|
Term
| which stenosis/regurg is seen due to "wear and tear"? |
|
Definition
|
|
Term
| marfans causes which stenosis/regurg? |
|
Definition
mitral valve prolapse
aortic regurgitation |
|
|
Term
| what is heard in mitral regurg? |
|
Definition
murmur in mitral area
(high pitched systolic as apex S3) |
|
|
Term
| which regurg/stenosis has palpable thrill? |
|
Definition
|
|
Term
| what are the signs of acute mitral regurg vs chronic mitral regurg? |
|
Definition
acute= pulmonary edema, decreased CO, shock
chronic= asymptomatic then symptoms of left ventricle failing- fatigue, dyspnea on exertion*, orthopnea, chest pain, palpitations*, atrial fib* palpable thrill*murmur over mitral*
Eventually in chronic- right sided hf signs- neck veins, liver, pitting edema |
|
|
Term
| when would you see increased cardiac shadow/ left ventricular and left atrial enlargement on xray? |
|
Definition
|
|
Term
| when would you see left atrial enlargement, prominent pulmonary arteries, and enlarged R ventricle on x ray? |
|
Definition
|
|
Term
| what regurg/stenosis are we going to see a fib in? |
|
Definition
- mitral stenosis
- mitral regurg
- possibly aortic stenosis (d/t atrial dilation) |
|
|
Term
| what are the causes of mitral valve prolapse? |
|
Definition
- women
- familial
- congenital
- marfans |
|
|
Term
| what occurs in mitral valve prolapse? |
|
Definition
- valvular leaftlets enlarge and prolapse into left atrium during systole
(leaflets don't fit together) |
|
|
Term
| what signs and symptoms occur in mitral valve prolapse? |
|
Definition
- this is most asymptomatic one
- palpitations*
- dizziness*
- syncope/blackouts*
- chest pain*
aarrhythmias *
- midsystolic click and late systolic murmur at apex of heart* |
|
|
Term
| what to avoid with mitral valve prolapse? |
|
Definition
| caffeine, ephedrine, anything g that ups hr |
|
|
Term
| what are the causes of aortic stenosis |
|
Definition
"wear and tear" age 60-70
congenital bicuspid or unicuspid valves
rheumatic disease
atherosclerosis and degen calcification |
|
|
Term
| what is the process of aortic stenosis |
|
Definition
1. aortic valve opening narrows
2. obstruction of left ventricle outflow
3. left ventricle hypertrophy or dilation
4. increased left atrial pressure/dilation
5. blood to lungs
First fixed cardiac output and cant meet bodys needs DURING EXERTION
THEN
left ventricular failure leads to marked fatigue and backup to left atrium and lungs/pulmonary congestion |
|
|
Term
| what are the initial signs and symptoms or aortic stenosis when there is a fixed cardiac output? |
|
Definition
- exertional dyspnea
- angina
- syncope on exertion |
|
|
Term
| when aortic stenosis eventually leads to left ventricular failure and back up of blood to left atrium and lungs/pulmonary congestion (after the fixed co stage) what symptoms occur? |
|
Definition
- marked fatigue
- narrow pulse pressure
- peripheral cyanosis
- orthopnea
- paroxysmal nocturnal dyspnea |
|
|
Term
| what sound is heard with aortic stenosis? |
|
Definition
systolic murmur
(harsh, systolic murmur, crescendodecrescendo murmur) |
|
|
Term
| what complication can occur with aortic stenosis? |
|
Definition
| atrial fibrillation possible d/t left atrial dilation |
|
|
Term
| what can treat aortic stenosis? |
|
Definition
vasodilators/caldcium blockers may reduce regurg blood flow
SURGERY IS ONLY DEFINITIVE TREATMENT- recommended when angina, syncope, dyspnea on exertion occur- urgent surgery needed when surface of valve becomes 1 cm or less |
|
|
Term
| which regurg/stenosis results in narrow pulse pressure? |
|
Definition
|
|
Term
| which regurg/stenosis results in widened pulse pressure? |
|
Definition
| aortic regurg (elecated systolic, lowered diastolic) |
|
|
Term
| what causes acute aortic regurg? |
|
Definition
|
|
Term
| what causes chronic aortic regurg? |
|
Definition
infective endocarditis
congenital malformation
hypertension
CT disorders like marfans |
|
|
Term
| what happens in aortic regurg? |
|
Definition
aortic valve leaflets don't close properly during systole (annulus may be dilated, loose or deformed)
---- causes backflow from aorta to left ventricle- left ventricle dilates 1st and eventually hypertophies |
|
|
Term
| which regurg/stenosis can be caused by dilated, loose, or deformed annulus? |
|
Definition
|
|
Term
| aortic dissection can cause |
|
Definition
|
|
Term
| what are the signs of chronic aortic regurg? |
|
Definition
- exertional dyspnea
- orthopnea
- fatigue
-palpitations ESPECIALLY LAYING ON LEFT SIDE
- nocturnal angina
- bounding pulse
- widened pulse pressure (elevated systolic, lowered diastolic)
- high pitched blowing decrescendo DIASTOLIC MURMUR
- paroxysmal nocturnal dyspnea |
|
|
Term
| what are the signs of acute aortic regurg? |
|
Definition
- pulmonary congestion
- edema |
|
|
Term
| does dilation or hypertrophy of ventricle occur first in aortic regurg? |
|
Definition
| dilation, then hypertrophy to push extra blood out |
|
|
Term
| why does aortic regurg cause bounding pulse and widened pulse pressure |
|
Definition
bounding pulse because extra blood flow backs into ventricle during systole- then extra CO causes bounding pulse
this increases systolic bp, while diastolic bp is decreased d/t regurg |
|
|
Term
| what sound is heard in aortic regurg |
|
Definition
diastolic murmur
(high pitched, decrescendo blowing diastolic murmur) |
|
|
Term
| which regurg/stenosis results in diastolic murmur |
|
Definition
|
|
Term
| what regurg/stenosis might cause nocturnal angina |
|
Definition
|
|
Term
| what regurg/stenosis causes palpitations esp when laying on left side? |
|
Definition
|
|
Term
| what are the four categories of cardiomyopathy? |
|
Definition
1. dilated cardiomyopathy
2. hypertrophic cardiomyopathy
3. restrictive cardiomyopathy
4.arrhythmogenic right ventricular cardiomyopathiy |
|
|
Term
| What is involved with dilated cardiomyopathy? |
|
Definition
- fibrosis or myocardium and endocardium
- dilates chambers (both right and left, but left is worse)
- ventricular wall THICKNESS is normal |
|
|
Term
| what is prevalent in dilated cardiomyopathy? |
|
Definition
|
|
Term
| which is the most common cardiomyopathy? |
|
Definition
|
|
Term
| what function is effected with dilated cardiomyopathy? |
|
Definition
|
|
Term
| signs and symptoms of dilated cardiomyopathy |
|
Definition
- fatigue and weakness, dyspnea on exertion, decreased exercise capacity** (due to CO reduced)
- palpitations* A fib*
- heart failure (left side)
- dysrhythmias or heart block
- systemic or pulmonary emboli
- s3 and s4 gallops
- moderate to severe cardiomegaly |
|
|
Term
| what can cause dilated cardiomyopathy? |
|
Definition
alcohol
chemo
infection
inflammation
poor nutrition |
|
|
Term
| alcohol, chemo, infection, inflammation, and poor nutrition causes which cardiomyopathy? |
|
Definition
|
|
Term
| what is the treatment of dilated cardiomyopathy? |
|
Definition
- HF symptomatic treatment
- vasodilators, diuretics,digoxin increase CO (this is treating the HF)
- control of dysrhythmias
- heart transplant surgery |
|
|
Term
| what complications can occur with dilated cardiomyopathy? |
|
Definition
- heart failure (left, then right)
- atrial fibrillation |
|
|
Term
| hypertrophy of all walls, hypertrophied septum, and small chamber side occurs in which cardiomyopathy? |
|
Definition
| hypertrophic cardiomyopathy |
|
|
Term
| what problem is caused by hypertrophic cardiomyopathy? |
|
Definition
diastolic dilling problems
- in obstructive, can result in left ventricle outflow problems |
|
|
Term
| what are the signs and symptoms of hypertrophic cardiomyopathy? |
|
Definition
- death with no symptoms
- dyspnea on exertion
- angina
- syncope, dizziness, fatigue
- palpitations
- S4 gallop
- ventricular dysrhythmias
- heart failure
IN OBSTRUCTED:
mitral regurg murmur
atrial fibrillation |
|
|
Term
| what is the treatment for hypertrophic cardiomyopathy? |
|
Definition
- symptomatic treatment
- beta blockers
- conversion of a fib
- ventriculomyotomy or muscle resection and mitral valve replacement
- NO NITRATES OR VASODILATORS IN HYPERTROPHIC CARDIOMYOPATHY THAT IS OBSTRUCTIVE! |
|
|
Term
| what can cause hypertrophic cardiomyopathy? |
|
Definition
| - often genetic (seen in athletes who die suddenly) |
|
|
Term
| which cardiomyopathy is often result of athletes dying suddenly? |
|
Definition
hypertrophic cardiomyopathy
(due to high incidence of ventricular dysrhythmias) |
|
|
Term
| which type of cardiomyopathy do we avoid vasodilators and nitrates in? |
|
Definition
| hypertrophic cardiomyopathy (obstructive) |
|
|
Term
| which type of cardiomyopathy might involve treatment with an ICD and pacemaker if <40 % CO? |
|
Definition
arrhythmogenic right ventricular cardiomyopathy if they don't respond to drugs
(of if at risk of dysrhythmias) |
|
|
Term
| to manage obstructive hypertrophic cardiomyopathy do what? |
|
Definition
negative inotropics (to decrease outflow obstruction and decerase HR) like
- beta blockers
- calcium channel blockers |
|
|
Term
| which drugs to we AVOID in hypertrophic (obstructive) cardiomyopathy? why? |
|
Definition
vasodilators, diuretics, nitrates, cardiac glycosides
- BC vasodilating and positive inotropic effects may worsen obstruction |
|
|
Term
| in which cardiomyopathy is strenuous exercise inhibited? |
|
Definition
| obstructive hypertrophic myopathy |
|
|
Term
| what happens in restrictive cardiomyopathy? |
|
Definition
this is rarest
- stiff ventricles RESIST filling during diastole
- but not thick like in hypertrophic |
|
|
Term
| which cardiomyopathy is due to stiff ventricles (that aren't thick) restricting filling during diastole? |
|
Definition
| restrictive cardiomyopathy |
|
|
Term
| causes of restrictive cardiomyopathy? |
|
Definition
sarcoidosis
amyloidosis
autoimmune disorders |
|
|
Term
| what are the symptoms with restrictive cardiomyopathy? |
|
Definition
| left or right HF symptoms |
|
|
Term
| what is arrythmogenic/right ventricular cardiomyopathy? |
|
Definition
when myocardial tissue is replaced with fibrous and fatty tissue
- can affect both ventricles in about 1/3
- usually familial and often affects young adults |
|
|
Term
ventriculomyomectomy
what is it?
who is it most commonly used for?
what are the results? |
|
Definition
- excising portion of hypertrophic ventricular septum
-hypertrophic (obstructive) cardiomyopathy (this is the most commonly used surgical treatment for them)
- results in long term improvement in activity tolerance |
|
|
Term
| besides ventriculomyomectomy, what is another treatment used for hypertrophic cardiomyopathy? |
|
Definition
| - percutanoues alcohol spetal ablation (absolute alcohol injected into target septal branch of LAD coronary artery to induce septal infarction) |
|
|
Term
| what are the surgical treatments used for patients with arrythmogenic right ventricular cardiomyopathy? |
|
Definition
- radiofrequency catheter ablation
- OR placement of ICD |
|
|
Term
| restrictive and hypertrophic cardiomyopathy result in more of ______ issues while dilated cardiomyopathy is a ____ issue |
|
Definition
restrictive/hypertrophic- diastolic filling
dilated- systolic |
|
|
Term
| in which cardiomyopathy do you see a globular shape of heart with the largest circumference of the left ventricle being midway between apex and base instead of at base? |
|
Definition
|
|
Term
| in which cardiomyopathy is the wall of the left ventricle thickened making the ventricle cavity small and leading to atrial dilation due to poor diastolic relaxation of left ventricle? |
|
Definition
| hypertrophic cardiomyopathy |
|
|
Term
| in which cardiomyopathy is the left ventricle cavity normal size, but the left atrium is dilated due to reduced diastolic compliance of ventricle? |
|
Definition
restrictive cardiomyopathy
(amyloid) |
|
|
Term
| heart transplant is treatment of choice for which cardiomyopathy? (when severe) |
|
Definition
dilated cardiomyopathy!
(may also be considered for restrictive) |
|
|
Term
| heart transplant is done when (in general) |
|
Definition
- severe dilated cardiomyopathy
- possibly considered for restrictive cm
- end stage heart disease due to CAD
- valvular disease
- congenital heart disease |
|
|
Term
| before heart transplant becomes available patients might use what? |
|
Definition
left ventricular assist device
(like impella) |
|
|
Term
| the heart from donor must be transplanted into recipient in how many hours? |
|
Definition
|
|
Term
| which medications don't work after heart transplant? |
|
Definition
-atropine
- digoxin
DUE TO DENERVATION! |
|
|
Term
| what can denervation result in after transplant surgery? what might they need to control this? |
|
Definition
-orthostatic hypotension (no nerves controlling)
- might need permanent pacemaker to increase activity tolerance and improve CO |
|
|
Term
| what drugs are people on for the rest of their lives after heart transplant? |
|
Definition
immunosuppressants
**infection is major cause of death post transplant!! |
|
|
Term
| signs of rejection in heart transplant |
|
Definition
- fever
- sob
- fatigue
- fluid gain
- abdominal bloating
- new bradycardia
- hypotension
- a fib or a flutter
- decreased activity tolerance
- decreased ejection fraction |
|
|
Term
| what is the form of CAD that may occur in heart transplant patients? |
|
Definition
Coronary artery Vasculopathy (CAV)
- diffuse plaque in arteries of the donor heart
- don't have angina d/t denervation
- regular scheduled exercise tolerance tests and angiography are required to identify CAV
- encourage life style changes to prevent!
- calcium channel blocker to prevent coronary spasm and closure
- regular exercise |
|
|
Term
| what do heart transplant patients need to identify CAV? |
|
Definition
| regular scheduled exercise tolerance tests and angiography required to identify CAV |
|
|
Term
| what is used in heart transplant patients to prevent coronary spasm and closure (as in CAV)? |
|
Definition
| calcium channel cblockers |
|
|
Term
| how is rejection detected?? |
|
Definition
| the surgeon performs endomyocardial biopsies at regularly scheduled intervals AND whenever symptoms occur |
|
|
Term
|
Definition
pericardium (fibrous pericardium on outside,then serous pericardium consisting of outer parietal layer and inner visceral layer/epicardium)
- myocardium
- endocardium (endothelial lining) |
|
|
Term
| teaching signs of worsening heart failure |
|
Definition
- rapid weight gain
- decrease in exercise tolerance
- cold symptoms
- excessive awakening at night to urinate
- development of dyspnea/angina at rest
- increased edema in feet, ankles |
|
|
Term
| people with valvular disease must carry |
|
Definition
|
|
Term
| when is prophylactic antibiotics not recommended? |
|
Definition
| prior to GI procedures such as GI endoscopy, colonoscopy, or Gentiourinary instrumentation |
|
|
Term
|
Definition
| early diastolic filling sound indicating an increase in left ventricular pressure |
|
|
Term
|
Definition
| s4 is not a sign of failure but a sign of decreased ventricular compliance |
|
|
Term
| drug therapy for valvular disease with symptoms of HF |
|
Definition
| - diuretics, beta blockers, digoxin, oxygen |
|
|
Term
| what might be done before synchronized cardioversion of atrial fib to ensure there are no thrombi present that could embolize? |
|
Definition
| TEE trans esophageal echocardiogram |
|
|
Term
| what drug IS NOT RECCOMMENDED to anticoagulate for A fib with valve disease? |
|
Definition
| Rivaroaxaban and dabigatran!!!! DONT USE |
|
|
Term
| balloon valvuloplasty used for what? |
|
Definition
- stenosis of mitral and aortic valves
- initial treatment for mitral (noncalcified mobile valve)
- FOR MITRAL valvuloplasty balloon cath placed from femoral VEIN through atrial septum and to the mitral valve and inflated to enlarge orifice
- for patients with AORTIC valvuloplasty (usually older and at risk of complications from surgery) (short lived benefits)
- for AORTIC valvuloplasty ballon cath goes through FEMORAL ARTERY and advanced to the aortic valve where it is inflated to enlarge orifice |
|
|
Term
| what precautions are needed after balloon valvuloplasty? |
|
Definition
bleeding
same angiogram precautions/ cath
- monitor heart sounds, CO, rhythm
- observe for systemic emboli due to dislodgement of vegetations from valve while balloon placed |
|
|
Term
| difference between mitral and aortic balloon valvuloplasty? |
|
Definition
aortic- we come through femoral ARTERY
mitral- we come through femoral VEIN |
|
|
Term
| transcatheter aortic valve replacement (TAVR) |
|
Definition
- valve within valve
- for aortic stenosis (usually in 70s to 80s cant withstand surgery)
- bioprosthetic valve placed percutaneously via transfemoral or transapical route under general anesthesia
- after initial valvuloplasty- new valve which is wrapped around balloon on large catheter is inserted via the femoral artery
- patient is transvenously paced at rate of 00 bpm to mimic ventricular standstill then the balloon is inflated and valve deployed
- transapical (small incision at apex of heart and cath threaded through incision and the left ventricle to access aortic valve)
- transfemoral- through femoral vein |
|
|
Term
| during a transcatheter aortic valve replacement what must they be prepared for? |
|
Definition
| to convert to open or traditional aortic valve replacement if necessary |
|
|
Term
|
Definition
- used to repair mitral valave in patients with mitral regurgitation
- general anesthesia
- gained percutenously via femoral vein
- cath and mitraclip advanced in the left atria and then left ventricle
- mitraclip is retracted and deployed to hold leaflets of the valve together |
|
|
Term
| what is the only DEFNIITIVE treatment for aortic stenosis and when is it recommended? |
|
Definition
surgery! (heart valve repair/replacement)
recommended when they have angina, syncope, dyspnea on exertion |
|
|
Term
| direct/open commissurtomoy |
|
Definition
- cardiopulmonary bypass used during open heart surgery
- they visualize valve, remove thrombi from atria, incises the fused commissures (leaflets), and debrides calcium from leaflets, widening orifice
so commissurotomy= them going in and debriding gunk off leaflets to open orifice |
|
|
Term
| mitral valve annuloplasty |
|
Definition
- reconstruction/ repair for mitral insufficiency
- MAKES ANNULUS SMALLER- suture leaflets to an annuloplasty ring or take tucks in the patients annulus
- leaflet repair
- enlogated leaflets shortened
- shortneed leaflets repaired by lengthening chordae that bind them in place
- perforated leaflets patched with synthetic grafts
RESULTS IN PROPER CLOSURE OF LEAFLETS
REGURG ELIMINATED OR MARKEDLY REDUCED!! |
|
|
Term
| which surgery is done to repair closure of leaflets and eliminate regurg? |
|
Definition
| mitral valve annuloplasty |
|
|
Term
| which surgery is done to debride calcified leaflets and make opening bigger? |
|
Definition
| direct/open commissurotomy |
|
|
Term
| prosthetic valve replacement |
|
Definition
- (xenograft, homograft, synthetic)
- OPEN HEART SURGERY!
- similar to procedure for CABG |
|
|
Term
| what must be ensured before an open heart surgery with prosthetic valve replacement? |
|
Definition
- STOP ANTICOAGULANTS 72 hours prior
- must have preoperative dental exam- dental caries or periodontal disease must be fixed first |
|
|
Term
biologic valve replacements
3 types |
|
Definition
xenografts (biologic)
- from other species
- cow, bovine
- pig, porcine
homograft
- from human cadaver
pulmonary autografts
- reloacation of patients own pulmonary valve to aortic position
- little risk for clot
- don't need anticoagulation
- not as durable as prosthetic though
- must be replaced 7-10 years
- durability of graft related to age of patient (older patient will have a better graft!- LESS CALCIUM IN BLOOD WHEN OLDER) |
|
|
Term
| venografts/ biologic valves last longer in who? |
|
Definition
OLDER PATIENTS!!!
- due to less calcium in blood
- younger patients have more calcium in blood which breaks down the valves |
|
|
Term
|
Definition
| donated from human cadavers |
|
|
Term
| what is a pulmonary autography |
|
Definition
| relocation of patients own pulmonary valve to aortic position |
|
|
Term
|
Definition
- require lifelong anticoagulation
- hear click
- tilting disk common? |
|
|
Term
| an aortic valve replacement requires what type of graft? |
|
Definition
| mechanical!!!!!!! because you can not use biologic in aorta due to high pressure of blood flow there |
|
|
Term
| risks post valve surgery? |
|
Definition
- if they had stiff lungs due to pulmonary hypertension (mitral stenosis valve replacement) MONITOR RESPIRATORY CLOSELY- due to weaning from ventilator
- be alert for bleeding esp with aortic valve replacements- HIGHER RISK OF HEMORRHAGE WITH AORTIC VALVE REPLACEMENT
- risk for atrial fibrillation!
- cardiac rehab program for these people! |
|
|
Term
| Patients with defective AND REPAIRED valves are at risk for what? |
|
Definition
|
|
Term
| why do those with repaired valves need to tell hcp before al linvasive procedures? |
|
Definition
| because they are at risk for infective endocarditis |
|
|
Term
| what procedures must prosthetic valve patients avoid? |
|
Definition
any procedures with magnetic resonance
AND dental procedures 6 months after repair for endocarditis risk |
|
|
Term
| those who have a failed valve or don't follow treatment plan after valve replacement are at risk for what? what should they report? |
|
Definition
HEART FAILURE!
report dyspnea, syncope, dizziness, edema, palpitations |
|
|
Term
| altered self image after valve replacement due to |
|
Definition
| visible medial sternotomy incision |
|
|
