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Inflammatory Heart Disease Rheumatic Fever/ Rheumatic Heart Disease Endocarditis Myocarditis Pericarditis Pathophysiology Characterized by nonsuppurative inflammatory lesions of the joints, heart, subcutaneous tissue, and central nervous system. Rheumatic fever follows pharyngeal infection with rheumatogenic group A streptococci. Damaged valves and endocardium contribute to the development of infective endocarditis. Specifically, the damaged part of a heart valve forms a local blood clot, a condition known as non-bacterial thrombotic endocarditis (NBTE). Inflammation and muscle damage, a heart affected with myocarditis is unable to respond to the increase in volume. acutely inflamed and has an infiltration of polymorph nuclear (PMN) leukocytes and pericardial vascularization Sign and Symptoms Fever, painful joints, itchy rash Nursing Care While corticosteroids are often used, evidence to support this is poor. Salicylates are useful for pain. Fever, heart murmur, weight loss, and coughing Surgical debridement of infected material and replacement of the valve with a mechanical or bioprosthetic artificial heart valve is necessary in certain situations Fever, rash, diarrhea, joint pains, and easily becoming tired. Decreased cardiac output related to a reduced mechanical function of the heart muscle or valvular dysfunction Fever higher than 38°C, subacute onset, large pericardial effusion, cardiac tamponade, lack of response to NSAIDs Assess the patient’s cardiovascular status frequently, watching for signs of cardiac tamponade. Valvular Heart Disease Mitral Stenosis Mitral Regurgitation Mitral Valve Prolapse Aortic Stenosis Aortic Regurgitation Tricuspid Stenosis Pathophysiology The normal mitral valve orifice area is approximately 4-6 cm2. As the orifice size decreases, the pressure gradient across the mitral valve increases to maintain adequate flow. The regurgitant volume causes a volume overload and a pressure overload of the left atrium and the left ventricle. The increased pressures in the left side of the heart may inhibit drainage of blood from the lungs via the pulmonary veins and lead to pulmonary congestion. Heart problem in which the valve that separates the upper and lower chambers of the left side of the heart does not close properly. Narrowing of orifice between LV & aorta. Valve flaps fail to completely seal the aortic orifice during diastole & thus permit back flow of blood from aorta into LV. Narrowing of tricuspid valve orifice due to commissural fusion & fibrosis. Sign and symptoms Heart failure, Palpitations, Chest pain, Hemoptysis Nursing Care Watch closely for signs of pulmonary dysfunction caused by pulmonary hypertension, tissue ischemia caused by emboli, and adverse reactions to drug therapy. 1.Shortness of breath, 2.Weakness or dizziness, 3.Wheezing and heavy coughing, 4.Physical exertion, 5. chest pain, 6.Fever, 7.Rapid weight gain, 8. Swelling of the ankles, feet or abdomen. Assess lung sounds and determine any occurrence of Paroxysmal Nocturnal Dyspnea (PND) or orthopnea. Chest pain, Dizziness, Fatigue, Panic attacks, Shortness of breath. Altered tissue perfusion related to narrowing of the coronary artery associated with atherosclerosis or thrombosis Heart failure, loss of consciousness, or chest pain, swelling of the legs. Dyspnea on exertion, Orthopnea, Paroxysmal nocturnal dyspnea, Palpitations, Angina pectoris, Cyanosis A fluttering discomfort in the neck, fatigue, cold skin, and right upper quadrant abdominal discomfort. Activity intolerance related to imbalance between oxygen supply and demand Activity intolerance related to imbalance between oxygen supply and demand The resultant tricuspid regurgitation from percutaneous treatment is better tolerated than insufficiency occurring during mitral valvuloplasty Tricuspid Regurgitation Allows regurgitation of blood from RV into the RA during systole. Pulmonic Stenosis Resistance to blood flow causes right ventricular hypertrophy. A patent ductus arteriosus partially compensates for the obstruction by shunting blood from the left ventricle to the aorta then back to the pulmonary artery and back into the lungs. The reasons for changes in stiffness of the right ventricle's walls are not well understood, but such stiffness is thought to increase with hypertrophy of the ventricle. Pulmonic Regurgitation Cardiomyopathy Characterized by ventricular chamber enlargement and systolic dysfunction with greater left ventricular (LV) cavity size with little or no wall hypertrophy. Hypertrophy can be judged as the ratio of LV mass to cavity size; this ratio is decreased in persons with dilated cardiomyopathies. Fatigue, Declining exercise capacity, Swelling, Abnormal heart rhythms, Pulsing in your neck, An enlarged liver, Shortness of breath with activity. Heart murmur, Shortness of breath, especially during exertion, Chest pain, Loss of consciousness, Fatigue. Assess lung sounds and determine any occurrence of Paroxysmal Nocturnal Dyspnea (PND) or orthopnea. Fatigue, Shortness of breath, especially during exertion, Chest pain, Palpitations, Enlarged liver, Fainting with exercise,Exercise intolerance. Assess manually peripheral pulses (with weak rate, rhythm indicated low cardiac output). Breathlessness with exertion or even at rest, Swelling of the legs, ankles and feet, Bloating of the abdomen due to fluid buildup, Cough while lying down, Fatigue, Irregular heartbeats that feel rapid, pounding or fluttering, Chest pain, Dizziness, lightheadedness and fainting. Decreased cardiac output related to reduced myocardial contractility Percutaneous balloon valvuloplasty and is done when a resting peak gradient is seen to be >60mm Hg or a mean >40mm Hg is observed.