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M6 13-005

Exam 4: Cardiovascular System; Inflammatory DO of the Heart

Rheumatic Heart Disease An inflammatory disease caused by Group A hemolytic streptococci pharyngitis or URI.
Rheumatic Heart Disease (Today) Results from ineffective treatment or isolated virulent stains.
Rheumatic Heart Disease (Affects) Pericardium, Myocardium, Epicardium
Rheumatic Heart Disease (Most affected site) The valves of the heart, they can become necrotic leaving scar tissue. Result in valvular stenosis.
Rheumatic Heart Disease (S/S) Specific to valve involved. Fever, increased pulse, epistaxis, anemia, joint movement, nodules found on joints & SQ tissues.
Rheumatic Heart Disease (Subjective Data) joint pain (polyarthritis), ABD pain, Chest pain, lethargy, fatigue
Rheumatic Heart Disease (Objective Data) Small erythematous circles (skin), Erythema marginatum, Involuntary purposeless movement, heart murmur resulting from stenosis
Erythema Marginatum wavy lines of the trunk that disappear rapidly
Healthy Valve Opens and closes properly
Diseased Valve w/ Incompetence Fails to close properly, Leaks
Rheumatic Heart Disease (Dx Tests) Echocardiogram, Electrocardiogram (ECG), Lab Values (Indicate inflammation)
Rheumatic Heart Disease (Lab Values) Leukocytes increased, Erythrocyte Sedimentation Rate (ESR) elevated, C-Reactive Protein (CRP) elevated.
Rheumatic Heart Disease (Medical Management) Prevention is more effective than treatment.
Pericarditis Inflammation of the pericardium, the membranous sac enveloping the heart
Pericadirits (Causes) Acute or chronic, bacterial, viral and fungal. Chest Trauma. MI. Common after thoracic surgery, Malignant disorders, Azotemia, SLE, Radiation, Drug Reations
Pericarditis (Clinical Manifestations) Mimics pain of MI, Dyspnea, Fever, Chills, Diaphoresis, Leukocytosis
Hallmark Symptom of Pericarditis Pericardial Friction Rub
Heart Failure (HF) If fluid in percardial space is sufficient to compress heart
Pericarditis (Subjective Data) Muscle aches, Fatigue, Dyspnea, Excruciating Precordial Pain
Pericarditis (Objective Data) Orthopnic Position, Elevated Temp, chill, diaphoresis, Non-productive cough, VS changes: rapid/forcible pulse, rapid/shallow breathing, pericardial friction rub, muffled or distant heart sound. dysrhytmias
Pericarditis (Dx Test) Chest Radiograph, Electrocardiogram (ECG), Echocardiography
Pericarditis (Lab Values) Leukocytosis, ESR elevated, Blood Cultures, CRP, Cardiac Enzymes
Cardiac Tamponade Pericardial Effusion restricts heart movement
Pericaricentesis (Pericardial Tap) This is done when cardiac output is severely reduced. A small drainage catheter may be left in place when fluid reforms.
Pericardial fenestration (pericardial window) done in cases when pericardiocentesis and pericardiostomy were inadequate in allowing fluid to drain.
Endocarditis Infection or inflammation of the inner layer of heart tissue, particularly the heart valves.
Endocarditis (Etiology/Pathophys) Can be caused by bacterial, viral, or fungal organisms Most common: Streptococcus viridans Streptococcus pyogenes Staphylococcus aureus Staphylococcus epidermidis Enterococci
Endocarditis (Manifestations Acute) Symptoms progress rapidly and in dangerous sequence
Endocarditis (Manifestations Subacute) Symptoms occur gradually with damage occurring over a long period of time
Endocarditis (Subjective Data) Complaints of flu-like symptoms Recurrent fever Undue fatigue Chest pain Headaches Joint pain Chills
Endocarditis (Objective Data) Petechiae in conjunctiva, oral mucosa, neck, anterior chest, abdomen and legs. Splinter hemorrhages in nail beds Nontender macula (spot or blotch) on palms and soles Tender erythematous Elevated nodules on pads of finders and toes
Endocarditis (Dx Findings) Electrocardiogram (ECG) changes Chest radiograph reveal evidence of heart failure or cardiomegaly Transesophageal Echocardiography (TEE) to assess vegetation, thrombi, or abscesses on valves
Endocarditis (Lab Tests) Leukocytosis Erythrocyte Sedimentation Rate (ESR) elevated Anemia Hyperglobulinemia Blood cultures Culture and Sensitivity (C&S)
Myocarditis Inflammation of the myocardium or the muscle layer of the heart
Myocarditis (Manifestations) Symptoms Vary. Upper Respiratory Infection (URI) symptoms (fever, chills, sore throat) Abdominal pain with nausea, vomiting, diarrhea, and myalgia Symptoms generally occur up to 6 weeks before patient becomes symptomatic
Myocarditis (Symptomatic Signs) Chest Pain, Dyspnea, Cardiac Enlargement, Murmur, Gallop, Tachyca
Myocarditis (Dx Tests) Chest Radiograph, ECG, Echocardiogram, Endomyocardial Biopsy
Myocarditis (Medical Management) Therapy is symptomatic. Similar to endocarditis treatment: Bed rest Oxygen Antibiotics Anti-inflammatory agents Assessment Correction of dysrhythmias
Myocarditis (Goals of Treatment) Preserve myocardial function Prevent heart failure and other serious complications Cardiomyopathy
Myocarditis (Indications for Cardiac Transplant) Cardiomyopathy (weakness in the structure/function of the heart muscle) Accounts for 50% of all transplants End Stage Coronary Artery Disease (CAD) This accounts for 40% of all transplants.
Myocarditis (Immunosupressive Therapy) Begins in the operating room Regimens can vary, but usually include: azathioprine (Imuran) cyclosporine (Neoral, Sandimmune, Gengref) Corticosteroids (Prednisone) Life Long Therapy
Myocarditis (Nursing Dx) Develop nursing diagnoses and list appropriate interventions for the patient with: Rheumatic Heart Disease Pericarditis Endocarditis Myocarditis
Created by: jtzuetrong