Download Valvular Heart Disease/Myopathy/Aneurysm

Valvular Heart
Disease/Myopathy/Aneurysm
Valvular Heart Disease
HeartPoint: HeartPoint Gallery
http://www.heartcenteronline.com/myheartdr/co
mmon/articles.cfm?ARTID=187
Risk Factors
Rheumatic Heart Disease MI
Congenital Heart Defects
Aging
CHF
Pathophysiology
Stenosis- narrowed valve, increases afterload
Regurgitation 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 failure
All valvular diseases have a characteristic
murmur murmurs
Mitral Valve Stenosis
Mitral Stenosis
Dec. flow into LV
LA hypertrophy
Pulmonary pressures increase
Pulmonary hypertension
Dec. CO
* early symptom is DOE
Later get symptoms of R heart failure
A fib is common- anticoagulants
Usually secondary to rheumatic fever
Mitral Regurgitation
Regurg of blood into LA during systole
LA dilation and hypertrophy
Pulmonary congestion
RV failure
LV dilation and hypertrophy-to
accommodate inc. preload and dec CO
Mitral Valve Prolapse
A type of mitral insufficiency
Usually asymptomatic
May get atypical chest pain related to
fatigue
Tachydysrhythmias may develop
Risk for endocarditis is increased and
need prophylactic antibiotics
A&P 1 Heart part 1
Aortic Stenosis
Increase in afterload
Reduced CO
LV hypertrophy
Incomplete emptying of LA
Pulmonary congestion
RV strain
Symptoms
Syncope
Angina
Dyspnea
Aortic Stenosis
May be asymptomatic for many years
due to compensation
DOE, angina, and exertional syncope
are classic symptoms
Later get signs of R heart failure
Untreated-poor prognosis- 1020%sudden cardiac death
Aortic Regurgitation
Get increased preoad- 60% of SV can
be regurgitated
Characteristic water hammer pulse
Regurgitation of blood into the LV
LV dilation and hypertrophy
Dec. 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 Tests
Echo- assess valve motion and chamber
size
CXR
EKG
Cardiac cath- get pressures
Medications
Like Heart Failure
ACE,
Dig
Diuretics
Vasodilators
Beta blockers
Anticoagulants
*Prophylactic antibiotics
Medical/ Surgical Treatment
Percutaneous balloon valvuloplasty
Surgery
Open commissurotomy- open stenotic
valves
Annuloplasty- can be used for both
Valve Replacement
Mechanical-need anticoagulant
Biologic-only last about 15 years
Ross Procedure
Ross Procedure
Nursing Diagnoses
Decreased Cardiac Output
Activity Intolerance
Risk for Infection
Ineffective Protection
Case study
http://edcenter.med.cornell.edu/Pathophysiology_Case
s/96-97_Pathophysiology_Cases/96-97Case_04.html
Cardiomyopathy
Primary-idiopathic
Secondary
Ischemia
infectious disease
exposure to toxins
Metabolic disorders
Nutritional deficiencies
Pathophysiology
Dilated
Most common
Cocaine and alcohol abuse
Chemotherapy pregnancy
Hypertension
Genetic
* Heart chamber dilate and contraction is
impaired and get dec. EF%
*Dysrhythmias are common- SVT Afib and VT
Prognosis poor-need transplant
Pathophysiology
Hypertrophic
Genetic
Also known as IHSS or HOCM
Get hypertrophy of the ventricular mass and
impairs ventricular filling and CO
Symptoms develop during or after physical
activity
Sudden cardiac death may be first symptom
Symptoms are dyspnea, angina and syncope
Pathophysiology
Restrictive
Least common
Rigid ventricular walls that impair filling
Contraction and EF normal
Prognosis-poor
Diagnostics
Echo-wall motion and EF
EKG
CXR
Hemodynamics
Perfusion scan
Cardiac cath
Myocardial biopsy
Medications
Same as for heart failure except for
hypertrophic
Treatment
Surgery
Vad-bridge to transplant
Heart Transplant
Myoloplasty
ICD- antiarrhythmics are negative
inotropes
Dual chamber pacemaker
Hypertrophic- excision of ventricular
septum
Heart transplant
virtual transplant
Nursing Diagnoses
Decreased Cardiac Output
Fatigue
Ineffective Breathing Pattern
Fear
Ineffective Role Performance
Anticipatory grieving
Aortic Aneurysms
Definition
Abnormal 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
Dissecting
Blood 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 Aneurysm
Frequently asymptomatic
May have substernal, neck or back pain
Other symptoms depend on location
and structures they compress
Abdominal Aortic
Pulsating mass in mid and upper
abdomen and bruit over the mass
Pain intensity correlates to size and
severity
May have thrombi
It can rupture causing shock and death
in 50% of rupture cases
Aortic dissection
Life threatening emergency
Happens when the intima tears and
causes hemorrhage into the media
Hypertension is main cause
*Primary symptom is excruciating pain
May get syncope,dyspnea and
weakness
Peripheral pulses are absent
Diagnostic Tests for Aneuysms
Most are diagnosed on routine work-up
CXR
Abd. Ultrasound
TEE
CT or MRI
Angiography
Medications
Anti-hypertensives
Beta blockers,
Vasodilators
Calcium channel blockers
Nipride
Sedatives
Niacin, mevocor, statins
Post-op anti-coagulants
Surgery
Usually repaired if >5cm
Open procedure- abd incision, cross clamp
aorta,aneuysm opened and plaque removed,
then graft sutured in place
Pre-op assess all peripheral pulses
Post-op-check urine output and peripheral pulses
hourly for 24 hours- (when to call Dr.)
Endovascular stents- placed through femoral
artery
Nursing Assessment
Pain- chest, abd or back pain
Hypertension(other vital signs)
Peripheral pulses
Pulsation in upper abdomen
SOB
Nursing Diagnoses
Risk for Ineffective Tissue Perfusion
Risk for Injury
Anxiety
Pain
Knowledge Deficit
Prevention
Prevent atherosclerosis
Treat and control hypertension
Diet- low cholesterol, low sodium and
no stimulants
Careful follow-up if less than 5cm. It
can grow .5cm /year
Complications
Rupture
Back pain
Hypotension
Pulsating mass
Thrombi
Renal Failure
Rupture Triad
Back
pain
Hypotension
Pulsating
hematoma
http://www.cotc.edu/vstone/wk3.htm
http://www.medi-smart.com/cardce5.htm