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Chapter 37
Inflammatory and Structural Heart
Disorders
Valvular Heart Disease
Valvular Heart Disease
Stenosis
Valve orifice is restricted
Impending forward blood flow
Creates a pressure gradient across open valve
Degree of stenosis reflected in pressure
gradient differences
Regurgitation
Incomplete closure of valve leaflets
Results in backward flow of blood
Mitral Stenosis
Most adult cases result from rhematic
heart disease
Other causes
Mitral valve becomes scarred and
narrowed
Left atrial overload eventually leads to right
ventricular failure
Mitral Stenosis
Manifestations include fatigue,
palpitations, dysrhythmias, low pitched
diastolic murmur
Mitral Regurgitation
Mitral valve fails to close properly
Usually chronic
Blood flows back into left ventricle, elading to
LA and LV dilation
Manifestations include symptoms of LV
failure, holosystolic murmur
Mitral Valve Prolapse
One or more of the mitral valve leaflets
prolapses back into the left atrium during
systole
Usually congenital
Usually benign, but can be problematic if it
progresses to mitral regurgitation
Most people asymptomatic, but
manifestations may include CP, dyspnea
and palpitations
Aortic Stenosis
Narrowing of the aortic valve causes
obstruction of blood flow form the LV to the
aorta during systole
Common causes include congenital,
rheumatic heart disease and senile or
degenerative stenosis
Manifestations: classic triad; systolic
ejection murmur
Aortic Regurgitation
Aortic valve fails to close properly
Blood flow back from the aorta into the LV during
diastole-->volume overload of LV
Cause may be acute or chronic (rheumatic
disease, bicuspid AV, autommune
conditions)
Manifestations include signs and symptoms
of LV failure (late), waterhammer pulse,
high pitched diastolic murmur
Tricuspid and Pulmonic disease
Uncommon
Will manifest as RV failure
Diagnosis of valvular heart disease
History and physical
CXR
ECG
Echocardiogram
Cardiac catheterization
Collaborative Care
Prophylactic antibiotic therapy
Rheumatic fever, infective endocarditis
Management of associated heart failure
Vasodilators (except aortic stenosis)
Inotropes (digoxin)
Diuretics
Beta blockers
Anticoagulant therapy as indicated
Surgical Treatment
 Percutaneous transluminal balloon valvuloplasty
For stenotic disease
 Valve repair
Eg, valvuloplasty, annuloplasty
 Valve replacement (prosthetic valves)
Mechanical valves
Biological valves
Choice of valve depends on variety of factors
Surgical Treatment
 Valve replacement
Teaching
 Prophylaxis
 Anticoagulation
Nursing Diagnoses and Interventions
Activity intolerance
Excess fluid volume
Decreased cardiac output
Deficient knowledge
Chapter 37
Cardiomyopathies
Cardiomyopathy
Constitutes a group of diseases that
directly affect the structural or functional
ability of the myocardium
Three major types
Dilated Cardiomyopathy
Characterized by diffuse inflammation and
rapid degeneration of the myocardium that
results in ventricular and atrial dilation and
impaired systolic function
May develop acutely or insidiously
Manifest as heart failure, often biventricular
Causes (table 37-18)
Dilated Cardiomyopathy
Interventions focused on improving heart
failure
Enhance contractility, decrease afterload
Drugs
Nitrates, diuretics, ACE inhibitors, beta blockers,
aldosterone antagonists, anticoagulation
Treat underlying disease process (as able)
Cardiac resychronization therapy
May require VAD or transplant
Hypertrophic Cardiomyopathy
Asymmetical left ventricular hypertrophy
without ventricular dilation
Primary defect is diastolic dysfunction
May be idiopathic, often genetic
Usually seen in young adults
High risk of SCD
Manifestations include dyspnea, fatigue,
angina, syncope
Hypertrophic Cardiomyopathy
 Collaborative management
Reduce contractility and relieve outflow obstruction
Drugs
 Beta blockers, calcium channel blockers
 Nitrates, digoxin contraindicated
 Avoid diuretics
ICD placement
Surgical treatment
Teaching
 Avoid strenous activity
 Avoid dehydration
 Symptoms - elevate feet
Restrictive Cardiomyopathy
Impaired ventricular filling
Manifestations include signs and
symptoms of heart failure
Treat to maintain cardiac output and
manage symptoms
Patient and Family Teaching for
Cardiomyopathy
 Meds as prescribed
 Low sodium diet
 Hydration
 Avoid ETOH, tobacco and stimulants
 Balace activity and rest
 Avoid heavy lifting, discuss exercise with health
care provider
 Stress reduction
 Report signs/symptoms of heart failure promptly
 May require IE prophylaxis