Exam 4: Cardiovascular System; Inflammatory DO of the Heart
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| Rheumatic Heart Disease | An inflammatory disease caused by Group A hemolytic streptococci pharyngitis or URI.
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| Rheumatic Heart Disease (Today) | Results from ineffective treatment or isolated virulent stains.
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| Rheumatic Heart Disease (Affects) | Pericardium, Myocardium, Epicardium
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| Rheumatic Heart Disease (Most affected site) | The valves of the heart, they can become necrotic leaving scar tissue. Result in valvular stenosis.
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| Rheumatic Heart Disease (S/S) | Specific to valve involved. Fever, increased pulse, epistaxis, anemia, joint movement, nodules found on joints & SQ tissues.
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| Rheumatic Heart Disease (Subjective Data) | joint pain (polyarthritis), ABD pain, Chest pain, lethargy, fatigue
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| Rheumatic Heart Disease (Objective Data) | Small erythematous circles (skin), Erythema marginatum, Involuntary purposeless movement, heart murmur resulting from stenosis
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| Erythema Marginatum | wavy lines of the trunk that disappear rapidly
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| Healthy Valve | Opens and closes properly
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| Diseased Valve w/ Incompetence | Fails to close properly, Leaks
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| Rheumatic Heart Disease (Dx Tests) | Echocardiogram, Electrocardiogram (ECG), Lab Values (Indicate inflammation)
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| Rheumatic Heart Disease (Lab Values) | Leukocytes increased, Erythrocyte Sedimentation Rate (ESR) elevated, C-Reactive Protein (CRP) elevated.
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| Rheumatic Heart Disease (Medical Management) | Prevention is more effective than treatment.
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| Pericarditis | Inflammation of the pericardium, the membranous sac enveloping the heart
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| Pericadirits (Causes) | Acute or chronic, bacterial, viral and fungal. Chest Trauma. MI. Common after thoracic surgery, Malignant disorders, Azotemia, SLE, Radiation, Drug Reations
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| Pericarditis (Clinical Manifestations) | Mimics pain of MI, Dyspnea, Fever, Chills, Diaphoresis, Leukocytosis
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| Hallmark Symptom of Pericarditis | Pericardial Friction Rub
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| Heart Failure (HF) | If fluid in percardial space is sufficient to compress heart
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| Pericarditis (Subjective Data) | Muscle aches, Fatigue, Dyspnea, Excruciating Precordial Pain
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| 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
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| Pericarditis (Dx Test) | Chest Radiograph, Electrocardiogram (ECG), Echocardiography
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| Pericarditis (Lab Values) | Leukocytosis, ESR elevated, Blood Cultures, CRP, Cardiac Enzymes
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| Cardiac Tamponade | Pericardial Effusion restricts heart movement
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| Pericaricentesis (Pericardial Tap) | This is done when cardiac output is severely reduced.
A small drainage catheter may be left in place when fluid reforms.
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| Pericardial fenestration (pericardial window) | done in cases when pericardiocentesis and pericardiostomy were inadequate in allowing fluid to drain.
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| Endocarditis | Infection or inflammation of the inner layer of heart tissue, particularly the heart valves.
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| Endocarditis (Etiology/Pathophys) | Can be caused by bacterial, viral, or fungal organisms
Most common:
Streptococcus viridans
Streptococcus pyogenes
Staphylococcus aureus
Staphylococcus epidermidis
Enterococci
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| Endocarditis (Manifestations Acute) | Symptoms progress rapidly and in dangerous sequence
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| Endocarditis (Manifestations Subacute) | Symptoms occur gradually with damage occurring over a long period of time
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| Endocarditis (Subjective Data) | Complaints of flu-like symptoms
Recurrent fever
Undue fatigue
Chest pain
Headaches
Joint pain
Chills
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| 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
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| 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
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| Endocarditis (Lab Tests) | Leukocytosis
Erythrocyte Sedimentation Rate (ESR) elevated
Anemia
Hyperglobulinemia
Blood cultures
Culture and Sensitivity (C&S)
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| Myocarditis | Inflammation of the myocardium or the muscle layer of the heart
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| 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
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| Myocarditis (Symptomatic Signs) | Chest Pain, Dyspnea, Cardiac Enlargement, Murmur, Gallop, Tachyca
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| Myocarditis (Dx Tests) | Chest Radiograph, ECG, Echocardiogram, Endomyocardial Biopsy
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| Myocarditis (Medical Management) | Therapy is symptomatic.
Similar to endocarditis treatment:
Bed rest
Oxygen
Antibiotics
Anti-inflammatory agents
Assessment
Correction of dysrhythmias
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| Myocarditis (Goals of Treatment) | Preserve myocardial function
Prevent heart failure and other serious complications
Cardiomyopathy
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| 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.
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| 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
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| Myocarditis (Nursing Dx) | Develop nursing diagnoses and list appropriate interventions for the patient with:
Rheumatic Heart Disease
Pericarditis
Endocarditis
Myocarditis
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