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MED SURG II EXAM #1

Cardiomyopathy & Valvular Disorders

QuestionAnswer
Hypertrophic Cardiomyopathy is the huge overgrowth of heart muscles. The middle spetum can obstruct the aorta and block all oxygenated blood out of the body. They have very few symptoms, but can include chest pain, dyspnea, palpitations, syncope, JVD.
Hypertrophic Cardiomyopathy Symptoms Often asymptomatic but can include chest pain, dyspnea, palpitations, and syncope.
Hypertrophic Cardiomyopathy Assessment Findings Palpation of the apex beat of the heart may reveal an increased left ventricular apical impulse or rarely, a systolic thrill. Also a pan-systolic murmur resulting from mitral vaalve regurgitation
Hypertrophic Cardiomyopathy Diagnostics The ECG may display features such as high voltage complexes, left axis deviation, and P wave abnormalities. About 20-30 percent have atrial fibrillation, shown as a loss of P waves.
Restrictive Cardiomyopathy is the rock hard muscles. The heart cannot re-fill.
Restrictive Cardiomyopathy Symptoms Emboli's and clots are common. Low oxygen, HF, restless, agitation, altered LOC, syncope, dizziness, and fatigue
Restrictive Cardiomyopathy Diagnostics Enlargement of both atrial (bilateral enlargement) due to the stiffness of the heart. ECG may show large P waves, and changes suggestive of left ventricular hypertrophy (large R waves)
Dilated Cardiomyopathy Most common type, distended heart muscles. Fibrosis of the myocardium and endocardium, dilated chambers. Makes it hard for the heart to pump out oxygen rich blood
Dilated Cardiomyopathy Symptoms and Assessment Findings S3 murmur is present, cardiomegaly (dilated heart)
Dilated Cardiomyopathy Diagnostics ECG may display non-specific features of increased left ventricular mass, pathologival Q waves, and poor R wave progression with abnormalities affecting the T wave and ST segment. Sometimes electrical conduction down the ventricles may be disrupted and left or right bundle branch block may ensure, where the ECG would show a widened QRS complex.
Mitral Valve Prolapse Deformity that usually produces no symptoms. Most often no clear cause, but has been associated with inherited connective tissue disorders, causing enlargement of one or both of the mitral valve leaflets. A portion of one or both of the mitral valve leaflets balloons back into the atrium during systole.
Mitral Valve Symptoms Many never have symptoms. A small number have fatigue, SOB, lightheadedness, dizziness, syncope, palpitations, chest pain, or anxiety
Mitral Valve Assessment Findings Extra sound will be heard, referred to as the systolic click, or mitral click.
Mital Regurgitation A condition which blood flows from the left ventricle back into the left atrium during systole. The mitral valve leaflets do not close completely due to chordae tendineae thickening and becoming fibrotic, resulting in an abnormal contraction
Mitral Regurgitation Symptoms Often asymptomatic, but if resulting from an MI usually manifests as severe and sudden heart failure systoms, include dyspnea, fatigue, weakness, palpitations, SOB on exertion, and cough from pulmonary congestion
Mitral Regurgitation Assessment Findings Systolic murmur, with a blowing sound heard best at the apex and may radiate to the left axilla. Pulse may be regular or irregular due to extrasystole beats or atrial fibrillation
Mitral Stenosis Results in reduced blood flow from the left atrium into the left ventricle. Usually caused by rheumatic endocarditis, which progressively thickens the mitral valve leaflets and chordae tendineae causing them to fuse together. Eventually the mitral valve orifice narrows and progressively obstructs blood flow to the ventricle
Mitral Stenosis Symptoms First symptom is usually dyspnea on exertion, caused by pulmonary venous hypertension. Symptoms usually do not appear until after the valve opening is reduced by 1/3 to 1/2 its usual size. Progressive fatigue, enlarged left atrium may create pressure on left bronchial tree, resulting in a dry cough or wheezing. May have hemoptysis, the rupture of pulmonary blood vessels, experience palpitations, orthopnea, paroxtsmal nocturnal dyspnea, or repeated respiratory infections and development of arrythmias
Mitral Stenosis Assessment Findings Low-pitched, rumbling diastolic murmur, best heard at the apex. Patients may have a weak and irregular pulse if they develop atrial fibrillation and may have signs or symptoms of heart failure.
Aortic Regurgitation Is backward flow of blood into the left ventricle from the aorta during diastole. It may be caused by a congenital valve abnormality, inflammatory lesions that deform aortic valve leaflets or dilation of the aorta, preventing complete close of the aortic valve
Aortic Regurgitation Symptoms Develops without symptoms in most. Some are aware of a pounding or forceful heartbeat, especially in the head or neck. As it worsens dyspnea upon exertion develops
Aortic Regurgitation Assessment Findings May have visible or palpable arterial pulsations of the carotid or temporal arteries. A high-pitched, blowing diastolic murmur is heard at the third of fourth ICS at the left sternal border. Pulse pressure differences increases.
Aortic Stenosis The narrowing of the orifice between the left ventricle and aorta. Usually caused by degenerative calcification which is caused by proliferative and inflammatory changes that occur in response to years of normal mechanical stress, similar to those in atherosclerotic cardiovascular disease
Aortic Stenosis Symptoms First symptom is DOE, overtime ventricular failure develops, and symptoms include orthopnea, PND, and pulmonary edema. Reduced blood flow to the brain may cause dizziness, and improve syncope. Angina Pectoris may be felt.
Aortic Stenosis Assessment Findings Loud, Harsh, sytolic murmur is heard over the aortic area, and may radiate to the carotid arteries and apex of the left ventricle. An S4 sound may also be heard. Palpable vibration from the base of the heart, and up along carotid arteries.
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