What is infective endocarditis(IE)?

What are the causes?

an infection of the endocardial surface of the heart

Caused by: bacteria, viruses , fungi

What some predisposing conditions for the development of endocarditis?

• Prior endocarditis
• Prosethetic valves
• Acquired valve disease(MVP)
• Cardiac lesions(ventricular septal defect)
• Rheumatic heart disease
• Congenital heart disease
• Pacemakers
• Cardiomyopathy

What are the manifestations of IE?

• Arthralgias
• myalgias
• back pain
• abd discomfort
• weight loss
• headache
• finger clubbing
• Splinter hemorrhages
• Petechiae
• Oslers nodes
• Janeways lesions
• Roth spots
• Aortic murmur

What diagnostic studies are used in the treatment of IE?

• Blood cultures x 2
• CBC
• ESR
• CRP

What is the treatment for IE?

IV Drug therapy-

*broad spectrum antibiotic

                 initially until Blood C & S results come in

What is percarditis?

What are the manifestations?

Inflammation of the pericardial sac caused usually by a virus

Symptoms include:

Sharp, pleuritic like Chest pain that radiates to neck,arm,left shoulder. Pain worsens w/ deep inspirations, dyspnea

What are the (2)  major complications of pericarditis?

1. Pericardial effusion

2. Cardiac Tamponade

What is the treatment(s) for acute pericarditis?

*Treatment of underlying cause

Bed rest

Aspirin

NSAIDS

Corticosteroids

Pericardiocentesis

What are common laboratory findings found w/ pericarditis?

Leukocytosis

Elevation of CRP and ESR

What is myocarditis?

What are the common causes?

Myocarditis is a diffuse inflammation of the myocardium.

Causes include: *Viruses(*most common),bacteria, fungi, radiation, pharmacologic/chemical factors

What are the manifestations of myocarditis?

• Fever
• fatigue
• malaise
• myalgias
• pharyngitis
• dyspnea
• lymphadopathy
• nausea/vomiting
• Pleuritic chest pain

Late signs:

• heart failure
• crackles
• JVD
• syncope
• peripheral edema
• angina

What is the treatment for myocarditis?

 Medications

Digoxin for ventricular failure

Diuretics-reduce fluids volume overload

Nitropress for hypotension

Inocor/Primacor-reduces afterload and improves cardiac outut

Immunosuppressive therapy to reduce myocardial inflammation

Supportive measures: oxygen therapy, bed rest, restrictive activity

What is mitral stenosis?

What are the causes?

Constriction of the mitral valve

Congenital mitral stenosis, rheumatoid arthritis, systemic lupus

What are the mainfestations of mitral stenosis?

• Exertional dyspnea(primary)
• fatigue
• palpitations
• Atrial fibrillation

Less common:

Hoarseness

hemoptysis

chest pain

seizures

stroke

What is mitral valve regurgitation?

It is the incomplete closure of the mitral valve which results in a backward flow of blood into the atrium.

What are the manifestations of mitral regurgitation?

Acute:

Rapid development of pulmonary edema and shock

Chronic:

Weakness, fatigue, exertional dyspnea, palpitations, S3 gallop, murmur

What is Mitral valve prolapse(MVP)?

An abnormality of the mitral valve leaflets and papillary muscles/chordae that allows the leaflets to prolapse bavk into the lt atrium.

** It is the most common form of valvular heart disease

What are the manifestations of MVP?

• Systolic murmur
• Dysrhythmias(esp. PVCs, PSVT, and V-tach)
• Palpitations
• Lightheadedness
• dizziness
• Chest pain

What is the treatment for MVP?

Beta blockers for chest pain/palpitations

What are some teaching instructions for pts w/ MVP?

• Importance of prophylaxic antibiotics before undergoing dental or suirgical procedures
• Instruct pt to take medications as prescribed(beta blockers)
• Adopt healthy eating  patterns and avoid caffeine b/c it can exacerbate symptoms
• Instruct pt on OTC  drugs/diet pills w/ stimulants
• Implement exercise program
• Call EMS if symptoms develop or worsen

What is Aortic stenosis?

What are the causes?

 It is a constriction/narrowing of the aortic valve causing obstruction of flow the left ventricle to the aorta during systole. This leads to Hypertension and heart failure

Results from: Rheumatic fever

Senile fibrocalcific degeneration

What are some  manifestations of aortic stenosis?

•  Triad angina
• syncope
• excertional dyspnea
• lt ventricular failure
• Prominent S4 heart sound

What is aortic regurgitation?

What are the causes?

 It is the incomplete closure of the aortic valve causing a backward flow of blood.

Causes:

Acute- infective endocarditis

trauma

aortic dissection

Chronic- rheumatic heart disease

congenital bicuspid aortic valve

syphyllis

chronic rheumatic diseases

What are the manifestations of aortic regurgitation?

• Cardiovascular collapse:

Acute: Profound dyspnea, chest pain, left ventricular failure and shock

Chronic: Fatigue, exertional dyspnea, orthopnea, water-hammer pulse, heaving precordial impulse, diminished/absent S1, S3, S4, high pitched diastolic murmur, systolic ejection click

What is the primary cause for

tricuspid stenosis and pulmonary stenosis?

Tricuspid: Rheumatic fever, IV drug use,  administration of  dopaine agonist

Pulmonary: Congenital abnormality

What is the collaborative care for valvular heart disease?

• Prophylactic antibiotic therapy-(Rheumatic fever/infective endocarditis)
• Sodium restriction
• Medication for control of Heart Failure

(vasodilators,digioxin, diuretics, beta blockers)

• Anticoagulation therapy
• Anti dysrghymic drugs
• Percutaneous transluminal therapy

Surgical:

Valvulotomy

valvuloplasty

annuloplasty

valve replacement

What are the types of prosthetic heart valves?

Mechanical: Starr-Edwards, St Jude, Carpenter-Edwards

Biologic:Bovine, porcine, human cardiac tissue

What is Cardiomyopathy?

What are the (3) types?

Cardiomyopathy are a group of diseases that directly affect the structural/functional ability of the myocardium

1. Dilated

2. Hypertrophic

3. Restrictive

What is dilated cardiomyopathy?

It is the most common type of cardiomyopathy. It is characterized by a diffuse inflammation and rapid degeneration of myocardial fibers that results in ventricular dilation, impairment of systolic function, atrial enlargement, and stasis of blood in the left ventricle 

What are the manifestations of dilated cardiomyopathy? 

S/S:

decreased exercise capacity

fatigue

dyspnea at rest

paroxysmal nocturnal dyspnea

orthopnea 

Other symptoms as disease worsens:

Cough, palpitations, abdominal bloating, N/V, and anorexia, irregular heart rate w/ an abnormal S3-S4, tachycardia/bradyvardia, pulmonary crackles, edema, weak peripheral pulses, pallor, hepatomegaly, JVD

thrombus formation and systemic emboli 

What is the treatment for dilated cardiomyopathy? 

**Treat underlying cause

Drug therapy:

Nitrates

Beta blockers

Antidysrhythmics

Ace inhibitors

Diurectics

Digitalis

Anticoagulants

Ventricular assisted device(LVAD)

Implantable cardioverter-defibrilator

Surgical correction

Cardiac transplant 

What is the goal for dilated cardiomyopathy? 

The goal of therapy is to keep the patient at an optimal level of function and out of the hospital 

What is Hypertrophic cardiomyopathy? 

It is an asymmetric left ventricular hypertrophy without ventricular dilation(the septum between the two ventricles becomes enlarged andobstructs the blood flow from the left ventricle). 

It is more common in men ages 30-40 and in young african american athletes 

What are the (4) main chacteristics of hypertrophic cardiomyopathy? 

1) Massive ventricular hypertrophy

2) rapid,forceful contaction of the left ventricle

3) Impaired relaxation

4) Obstruction to aortic outflow(not always present) 

What are the mainfestation of hypertrophic cardiomyopathy(HCM)?  

S/S:

Dyspnea(most common),fatigue, angina, syncope

Dysrhythmias:SVT, A-fib, V-tach, V-fib

What is the treatment for HCM? 

Beta blockers

Calcium channel blockers

Digitalis 

Amiodarone

cardioverter-defibrilator 

Ventriculomyotomy

Myectomy 

What is restrictive cardiomyopathy?

What are the causes? 

Restrictive cardiomyopathy is the least common cardiomyopathy. It impairs diastolic filling and stretch

Common causes: myocardial fibrosis, hypertrophy and infiltration (produces stiffness of the ventricular wall) 

What are the manifestations of restrictive cardiomyopathy(CMP)? 

S/S:

Fatigue

Exercise intolerance

Dyspnea

Angina

orthopnea

syncope

palpitations 

What is the most common dysrhythmia for restrictive CMP? 

Atrial fibrillation 

What is the treatment for dilated CMP? 

Conventional therapy for heart failure and dysrhythmias

Heart transplant