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Heart Disorders
Inflammatory and Structural Heart Disorders
| Term | Definition |
|---|---|
| Three layers of the heart | Endocardium, Myocardium, Pericardium |
| Endocardium | Innermost layer and heart valves |
| Myocardium | Muscle layer (middle layer) |
| Pericardium | Sac that encloses the heart (outer layer) |
| Inflammatory heart diseases | Acute or chronic inflammation that can occur in each layer, resulting in altered heart function |
| Endocarditis | Inflammation INSIDE the heart Pathogens enter the bloodstream and form vegetative lesions, which enlarge and disrupt blood flow Heart valves unable to close fully |
| Vegetative lesions | Irregular growths made of germs and cell pieces form a mass in the heart. These clumps are called vegetations. They can break loose and travel to the brain, lungs, kidneys and other organs. They can also travel to the arms and legs |
| Endocarditis Causes, | Caused by infection (bacteria, viruses or fungi) |
| Endocarditis Risk Factors | IV drug use, valve replacement/repair, valve disease, recent dental procedures, invasive procedures or URT infections |
| Endocarditis Complications | Embolization of vegetations can impact oxygen flow to other organs (spleen, lungs, kidney or brain) |
| Pericarditis | Inflammation OUTSIDE the heart (scaring and fibrosis) Heart gets compressed and cardiac function is restricted |
| Pericarditis Causes | • Infection (bacteria, viruses, tuberculosis) • Myocardial and pericardial injury • Connective tissue diseases • Autoimmune disorders |
| Pericarditis Risk Factors | End-stage renal disease, uremia, trauma, surgery or recent infection |
| Pericarditis Complications | • Pericardial effusion: fluid build up in the pericardial cavity • Cardiac tamponade: accumulation of fluid in pericardial sac that compresses the heart |
| Endocarditis Clinical Manifestations | Fever, malaise Heart murmur Splinter hemorrhage Petechiae Osler's nodes (painful) and Janeway Lesions (painless) Systemic emboli |
| Pericarditis Clinical Manifestations | Pain is prominent (in pericardial region on Lt. side of the neck, shoulder and back) Fever, chills and fatigue Precordial (in front of the heart), radiating pain on the Lt. side Gets worse with coughing, lying down and inspiration |
| Endocarditis interventions | Antibiotic therapy Repair or removal of affected valves Removal of vegetations at risk for embolization Moderate activity with rest periods Patient teaching |
| Pericarditis Interventions | NSAIDs for pain management (corticosteroids for more severe) Antibiotics for infection Pericardiectomy for chronic pericarditis Pericardial drainage (pericardiocentesis) Hemodialysis (uremic pericarditis) |
| Nonsteroidal anti-inflammatory drug (NSAIDs) | Therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. |
| S1 sounds produced by | Atrioventricular (AV) valves: mitral (left) and tricuspid (right) |
| S2 sounds produced by | Semilunar Valves: Aortic and pulmonic |
| Two types of valvular changes in Valvular Heart Disease | Stenosis and Regurgitation |
| Stenosis | Stiff, narrowed, hard valves FORWARD blood flow is affected |
| Regurgitation | Incomplete closure of valve leaflets RETURN of blood (backflow) |
| Aortic Stenosis | Blood flow FROM the LV TO the AORTA during systole (contract) is interrupted Congenital or caused by Rheumatic fever or Atherosclerosis Angina, fainting, systolic murmur |
| Aortic Regurgitation | Blood flows BACK INTO the LV FROM the AORTA during diastole (filling) Causes: Rheumatic Heart Disease, Congenital disorder, Infective, endocarditis, Syphilis, Trauma, Aortic aneurysm Tachycardia, palpitations, angina & diastolic murmur |
| Mitral Stenosis | Blood flow FROM the LT ATRIUM INTO the LV during diastole (filling) is interrupted Causes: Rheumatic Heart Disease Neck vein distention, atrial fibrillation & diastolic murmur |
| Mitral Regurgitation | Blood flows BACK INTO the LT ATRIUM from LV during systole (pumping) Causes: Aging, Myocardial infarction, Infective endocarditis, Mitral valve prolapse Atrial fibrillation, neck vein distention, anxiety & systolic murmur |
| Clinical Manifestations is all Valvular Disorders | Fatigue, dyspnea and orthopnea |
| Diagnostic Studies | Patient’s history/physical exam • Heart murmur: sign of valvular disorders Echocardiography and Doppler imaging • Thickened leaflets • Size of chamber Chest x-ray • Hypertrophy ECG • Cardiac catheterization • Contractility & pressure in the heart |
| Medication Therapy to treat/control HF | Digitalis (increase myocardial contraction/output, increase urine output/decrease blood volume) ACE Inhibitors (decrease workload) Vasodilators (lower BP) Diuretics (decrease blood volume & heart workload) B-Blockers (lower BP- block epinephrine) |
| Prevention | • Exacerbations of heart failure • Acute pulmonary edema • Thromboembolism • Recurrent endocarditis, infective endocarditis and rhematic fever |
| Other medication therapies | • Anticoagulants (prevent clot formation) • Antidysrhythmic |
| Interprofessional care | Percutaneous transluminal balloon valvuloplasty (PTBV) to split open fused commissures • Nonsurgical- for mitral stenosis Surgery • Valve repair • Valvular replacement (prosthetic valves) may be required for certain patients. |
| Nursing interventions | Patient and family education Monitor for infection No vigorous activity No invasive dental care for 6 mths (risk of endocarditis); antibiotics Anticoagulants for valve replacement Monitor drug effects Provide emotional support |
Created by:
selenay15
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