Ch 27
On a routine physical exam visit, the physician mentions that he hears a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds,
"One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problem."
systolic heart failure
- Decreased ventricular contractility leads to its impaired ability to eject blood - Myocardial contractility is impaired, leading to a decrease in ejection fraction and cardiac output
When an acute myocardial infarction (MI) occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI?
Conversion from aerobic to anaerobic metabolism
Complications of Kawasaki disease
Coronary artery aneurysm, myocarditis
Treatment of cardiomyopathy
Symptom management and prevention of lethal arrhythmias; contraindicated in sports
right sided heart failure
Usually occurs as a result of left sided heart failure; congestion of peripheral tissues, liver congestion, G.I. tract congestion; dependent edema and ascites, anorexia, G.I. distress, weight loss, signs related to impaired liver function
Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?
"The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel."; Stable plaque is associated with obstruction of blood flow, while unstable plaque may dislodge and result in thrombus formation.
Foramen ovale
- Communicating channel between the two upper chambers of the heart - This opening, which typically closes shortly after birth, allows blood from the umbilical vein to pass directly into the left heart, bypassing the lungs
A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client?
"Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."
Kawasaki disease
(inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms.; conjunctivitis, erythematous macular papular rash, erythema palms and soles with swelling, cervical adenopathy, dry red mucous membranes
symptoms of left sided heart failure
**L for lungs Pulmonary congestion • cough • crackles • wheezes • hemoptysis • tachypnea S3 heart sound Restlessness Confusion Tachycardia Exertional dyspnea Fatigue Cyanosis Paroxysmal nocturnal dyspnea Elevated pulmonary capillary wedge pressure
cardiomyopathy
- A heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilation and are due to a variety of causes that frequently are genetic
complications of shock to kidneys
- Acute Renal failure - Renal tubules are particularly vulnerable to ischemia and acute renal failure is an important factor in mortality because of severe shock - Most cases are due to impaired renal perfusion or direct injury to the kidneys - Most frequently seen renal dysfunction after severe shock is acute tubular necrosis which is reversible - Monitoring of urinary output provides a means of assessing renal blood blow - Monitor serum creat and BUN
diastolic heart failure
- An abnormality in ventricular relaxation and filling - Characterized by a normal ejection fraction but impaired diastolic ventricular relaxation, leading to a decrease in ventricular filling that ultimately causes a decrease in preload, stroke volume, and cardiac output - Systolic function has been preserved and heart failure occurs exclusively on the basis of left ventricular diastolic dysfunction
Low Output Heart Failure
- Caused by disorders that impair the pumping ability of the heart such as ischemic heart disease and cardiomyopathy - Characterized by clinical evidence of systemic vasoconstriction with cold, pale, and sometimes cyanotic extremities - Advanced stage: marked reduction in stoke volume are evidenced by narrowing pulse pressure
Mitral Valve Regurgitation
- Characterized by incomplete closure of the mitral valve with the left ventricular stroke volume being divided between the forward stroke volume that moves into the aorta and the resurgent stroke volume that moves back into the left atrium during systole - In acute severe mitral regurgitation, acute volume overload increases left ventricular preload, allowing a modest increase in left ventricular stroke volume. However, the forward stroke volume (that moves through the aorta into the systemic circulation) is reduced and the regurgitant stroke volume leads to a rapid ride in left atrial pressure and pulmonary edema and decrease in cardiac output
dilated cardiomyopathies
- Common cause of heart failure and leading indication for heart transplant - Genetics may be the cause or infections (viral, bacterial, fungal, mycobacterial, parasitic) toxins, alcoholism, chemotherapeutic agents, metals, and multiple other disorders - Characterized by ventricular enlargement, a reduction in ventricular wall thickness, and impaired systolic function of one or both ventricles
long term effects of rheumatic fever
- Common to all is a lesion called the Aschoff body which is a localized area of tissue necrosis surrounded by immune cells - Chronic phase is characterized by permanent deformity of the heart valves and is a common cause of mitral valve stenosis - Polyarthritis- may range from arthralgia to disabling arthritis most frequently affecting larger joints particularly the knees and ankles - Carditis- acute rheumatic carditis can affect endocardium, myocardium, or pericardium; manifests as mitral regurgitation - Subcutaneous nodules- hard, painless, and freely movable and usually occur on wrist, elbow, ankle and knee - erythema marginatum: macular areas seen on the trunk or inner aspects of the upper arm and thigh but never on the face - Sydenham chorea: most often young years under 20 years old; typically, insidious onset of irritability and other behavioral problems
complications of infective endocarditis
- Endothelial injury, bacteremia, and alerted hemodynamics can all induce the formation of a fibrin-platelet thrombus along the endothelial lining - The thrombus is susceptive to bacterial seeding from transient bacteremia causing continued monocyte activation and cytokine and tissue factor production—this results in progressive enlargement of infected valvular vegetations - Friable, bulky, and potentially destructive vegetative lesions form on the heart valves - The aortic and mitral valves are most common sites - Vegetative lesions consist of a collection of infectious organisms and cellular debris enmeshed in the fibrin strands of clotted blood - As the lesion grows, they cause valve destruction, leading to valvular regurgitation, ring abscess with heart block, pericarditis, aneurysm, and valve perforation - The intracardiac vegetative lesions also have local and distant systemic effects
complications of shock to GI
- GI complications - Risk factors for GI complications are shock and the drugs used to treat shock - Splanchnic perfusion and intolerance to enteral nutrition may lead to hypoperfusion of the gut - GI tract is particularly vulnerable to ischemia because of the changes in distribution of blood flow to its mucosal surface - People may experience; loss of appetite, nausea, vomiting - Bowel obstruction or bleeding may occur
Arrhythmogenic right ventricular cardiomyopathy (ARVC)
- Heart muscle disease where fibrofatty infiltration of the right ventricular myocardium causes right sided heart failure and various rhythm disturbances especially v-tach - Autosomal dominant - Characterized by progressive loss of myocytes with partial or complete replacement of the right ventricular muscle with fatty or fibrofatty tissue - Associated with reentrant ventricular tachyarrhythmia's or right ventricular origin that are often precipitated by exercise-induced discharge of catecholamines
treatment of cardiogenic shock
- Improving CO, reducing workload and oxygen needs of the myocardium, and increasing coronary perfusion - Fluid volume must be tightly regulated - Pulmonary edema and arrhythmias should be monitored and corrected - Vasodilators may be used such as NTG and nitroprusside - Positive inotropic agents are used to improve cardiac contractility (dobutamine and milrinone) - Intra-aortic balloon pulse enhances coronary and systemic perfusion yet decreases afterload and myocardial oxygen demands - Fibrinolytic, PCI, or CABG may be used to prevent or treat shock
Transposition of the great vessels
- In complete transposition of the great arteries, the aorta arises from the right ventricle and the pulmonary artery arises from the LV - Cyanosis is the most common symptom
Coarction of the aorta
- Localized narrowing of the aorta, proximal to, distal to, or opposite the entry of the ductus arteriosus - 98% of coarctions are juxtaductal - classic sign: disparity in pulsations and blood pressures in the arms and legs
pathophysiology of cardiogenic shock
- Most common cause is myocardial infarction - Decrease in stroke volume and cardiac output which results in insufficient perfusion to meet cellular demands for oxygen - Poor cardiac output is d/t decreased myocardial contractility, increased afterload, and excessive preload
acute pericarditis
- Mostly viral; s/sx last <2 weeks - Causes may include bacterial or mycobacterial infections, connective tissue diseases (SLE, RA), uremia, post cardiac surgery, neoplastic invasion of the pericardium, radiation, trauma, drug toxicity, and contiguous inflammatory process of the myocardium or lung - When inflamed, the capillaries in pericardium become more permeable allowing the proteins and fibrinogen to enter inside the pericardial cavity and form fibrous exudate
types of mechanical distortions with valvular heart disease
- Narrowing of the valve opening so it does not open properly • Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally • Significant narrowing of the valve orifice increases the resistance to blood flow through the valve, converting the normally smooth laminar flow to a less efficient turbulent flow • This increases the volume and work of the chamber emptying through the narrowed valve - Distortion of the valve so it does not close properly • An incompetent or resurgent valve permits backward flow to occur when the valve should be closed- flowing back into the LV during diastole when the aortic valve is affected and back into the left atrium during systole when the mitral valve is diseased
Fetal circulation
- Occurs in parallel rather than in series with the right ventricle delivering most of its output to the placenta fort oxygen update and the LV pumping blood to the heart, bran, and primarily upper body of the fetus - Before birth, oxygenation of blood occurs through the placenta and after birth it occurs through the lungs - Fetal cardiac output is higher than at any other time in life and fetal hemoglobin has a higher affinity rate for oxygen - Blood flow through the lungs is less than at any other time in life
function of heart valve
- Promote unidirectional flow of blood through the chambers of the heart - Consist of thin leaflets of tough, flexible, endothelium-covered fibrous tissue firmly attached to the vase of the fibrous valve rings - Leaflets of the heart valves may be injured or become the site of an inflammatory process that can deform their line of closure - Healing of the valve leaflets is often associated with increased collagen content and scarring, causing the leaflets to shorten and become stiffer
Changes associated with aging that contribute to heart failure
- Reduced responsiveness to beta adrenergic stimulation limits the hearts capacity to maximally increase heart rate and contractility - Increased vascular stiffness which leads to progressive increase in SBP which leads to development of left ventricular hypertrophy and altered diastolic filling - The heart itself becomes stiffer and less compliant with age which alters diastolic filling and atrial function
Mitral valve stenosis
- Represents the incomplete opening of the mitral valve during diastole with left atrial distention and impaired filling of the left ventricle - Characterized by fibrous replacement of valvular tissue along with stiffness and fusion of the valve apparatus - As the resistance to flow through the valves increases, the left atrium becomes dilated and left atrial pressure rises - The increased left atrial pressure eventually is transmitted to the pulmonary venous system, causing pulmonary congestion - As condition progresses: sx of decreased cardiac output occur during extreme exertion or other situations that cause tachycardia, and thereby reduce diastolic filling time - Eventually leads to right-sided heart failure
Aortic Valve Regurgitation
- Resultant of an incompetent aortic valve that allows blood to flow back to the left ventricle during diastole - As a result, the left ventricle must increase its stroke volume to include blood entering from the lungs as well as that leaking back through the regurgitant valve
High Output Heart Failure
- Uncommon type of HF that is caused by an excessive need for cardiac output - Function of the heart may be suprabnormal but inadequate owing to excessive metabolic needs - Causes are: severe anemia, thyrotoxicosis, conditions that cause AV shunting, and Paget disease - Extremities are usually warm and flushed and the pulse pressure is widened or at least normal
Heart failure differs between younger and older adults
- With increasing age, which is often accompanied by a more sedentary lifestyle, exertional dyspnea becomes less prominent - Instead of dyspnea, the prominent sign may be restlessness
Treatment goal of ACS
- administration of oxygen, ASA, nitrates, pain meds, antiplatelet and anticoagulant therapy, beta blockers and PCI for people with EKG evidence of infarction - Importance of intensive insulin control to maintain blood glucose between 80-110 in people who are critically ill has been supported by multiple studies - NTG is given because of its vasodilating effect and ability to relieve pain
Determinants of myocardial oxygen demand
- heart rate, left ventricular contractility, systolic pressure or myocardial wall stress or tension ; Myocardial oxygen supply is determined by coronary arteries and capillary inflow and the ability of hemoglobin to transport and delivery oxygen to the heart muscle
complications of shock to the lungs
-Acute Lung injury/acute respiratory distress (ALI/ARDS) - Potentially lethal form of pulmonary injury that may be either the cause or result of shock - Marked by rapid onset of profound dyspnea that usually occurs 12-48 hours after the initiating event - Respiratory rate and effort of breathing increase
Pathophysiology of rheumatic fever
-Antibodies directed against the M protein of certain strains of streptococci cross-react with glycoprotein antigens in the heart, joints, and other tissues to produce an autoimmune response through a phenomenon called molecular mimicry
Pericardium
-Double-layered serious membrane that isolates the heart from other thoracic structures; outermost layer of the heart
Ductus Arteriosus
-In the process of forming a separate pulmonary trunk and aorta, a vessel called the ductus arteriosus develops. This vessel, which connects the pulmonary artery and the aorta, allows blood entering the pulmonary trunk to be shunted into the aorta as a means of bypassing the lungs
obstructive shock
-Inability of heart to fill properly (cardiac Tamponade) -Obstruction to outflow from the heart (pulmonary embolus, cardiac myxoma, pneumothorax, or dissecting aneurysm)
cardiac tamponade
-Pleural effusions can lead to this life-threatening condition - Accumulated fluid compress the heart to an extent, where there is an increased intracardiac pressure, progressive limitation of ventricular filling, and reductions in stroke volume and cardiac output - A significant accumulation of fluid in the pericardium results in increased adrenergic stimulation, which leads to tachycardia and increased cardiac contractility. There is elevation of CVP. Jugular venous distension, fall in SBP, narrowed pulse pressure, muffled heart sounds, and signs of circulatory shock
Unstable angina
-Unstable plaque -Plaque disruption and platelet aggregation -Non-occlusive thrombus -Non-specific EKG -Normal cardiac enzymes
symptoms of acute pericarditis
-include triad findings of chest pain- pain is usually abrupt and sharp occurring in the precordial area, and may radiate to the neck, back, abdomen, or side; pericardial friction rub, and abnormal EKG - Pain typically is worse with position changes, deep breathing, coughing, swallowing - sitting up and leaning forward often relieve the pain
Function of pericardium
-maintains its position in the thorax -prevents the heart from overfilling -serves as a barrier to infection
physiologic abnormalities of hypertrophic cardiomyopathy
-reduced left ventricular chamber size, poor compliance with reduced stroke volume that results from impaired diastolic filling, mitral regurgitation
chronic pericarditis
-when someone gets recurrent bouts of pericarditis, its called chronic -May be associated with autoimmune disease process
Kussmaul sign
1. Increase in JVP on inhalation 2. Associated with pericarditis / restrictive cardiomyopathy
During an acute myocardial infarction (MI), there is ischemic damage to the heart muscle. The location and extent of the ischemic dam- age is the major predictor of complications, ranging from cardiac insufficiency to death, following an MI. What is the "window of opportunity" in restoring blood flow to the affected area so as to diminish the ischemic damage to the heart and maintain the viability of the cells?
20 to 40 minutes
A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)?
A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest; STEMI pain is not normally relieved by rest, nor would fever be a common symptom. Shortness of breath, vague chest discomfort, fatigue, GI symptoms, and radiating substernal pain are all associated with STEMI.
rheumatic heart disease
A complication of immune mediated response to group A strep throat. Most serious complication of RHD is the development of chronic valve disorders that produce a permanent cardiac dysfunction and some cause fetal heart failure years later.
Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect due to the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?
A hypercyanotic attack brought on by periods of stress
It is known that more than 100 distinct myocardial diseases can demonstrate clinical features associated with dilated cardiomyopathy (DCM). What is the most common identifiable cause of DCM in the United States?
Alcoholic cardiomyopathy
Endocardial cushion defects
AV canal defects
Signs and symptoms of anaphylactic shock
Abdominal cramps, apprehension, warm or burning sensation of the skin, itching, hives, coughing, choking, wheezing, chest tightness, difficulty in breathing
Pericardial effusion
Accumulation of fluid in the pericardial cavity
ST-elevated myocardial infarction (STEMI) is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?
Action decreases metabolic demands of the heart
Prinzmetal angina
Aka variant angina; causes unknown. Endothelial dysfunction, hyper active sympathetic nervous system, defects in the handling of calcium by vascular smooth muscle, or an alteration in nitric oxide production are among some explanations. It has been observed in people with migraine headaches or Reynards phenomenon. Unlike stable angina that occurs with exertion or stress, variant angina usually occurs during rest or with minimal exercise and frequently occurs nocturnally (between midnight and 8 AM). Arrhythmias often occur when the pain is severe, and most people are aware of their presence during an attack
Single-ventricle anatomy
All forms result in common mixing chamber of pulmonary and systemic venous return and cause varying degrees of cyanosis
Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction?
An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose.; The chest pain of myocardial infarction does not respond to rest or to nitrates. Ischemic injury to the myocardium alters the ECG patterns, often elevating the ST segment and inverting T waves. Abnormal Q waves indicate necrosis. Cardiac markers are released in response to myocardial injury; rising levels indicate damage to the heart.
Myocarditis
An inflammation of the heart
Treatment of Kawasaki Disease
Aspirin and IVIG
Prinzmetal angina
Chest pain due to a coronary artery spasm
Unstable angina
Chest pain occurring while at rest
Effusive-constrictive pericarditis
Combination of effusion-tamponade and constriction
Ion channelopathies
Conduction disorders in the heart resulting from abnormal membrane potentials (long QT/short QT syndromes)
A 66-year-old client's echocardiogram report reveals a hypertrophied left ventricle. The health care provider suspects the client has aortic stenosis. Which of the following clinical manifestations would be observed if this client has aortic stenosis? Select all that apply.
Decrease in exercise tolerance, Exertional dyspnea, Syncope; As the stenosis progresses, the patient will experience classic symptoms of angina, syncope, heart failure, and decrease in exercise tolerance or exertional dyspnea.
Why are beta blockers used with coronary artery disease?
Decrease myocardial oxygen demand by reducing heart rate, cardiac contractility and blood pressure. They also may decrease life-threatening ventricular arrhythmias. Should not be used in cocaine induced heart attacks
Ischemia
Decreased blood flow to tissue
Mixed cause cardiomyopathy
Dilated cardiomyopathy
hypertrophic cardiomyopathy
Disproportionate thickening of the ventricular septum and left ventricle
As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care?
Echocardiogram, PET scan, ECG; An echocardiogram would provide an image of the client's heart, while a PET scan reveals metabolic activity and an ECG the electrical activity.
A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics?
Echocardiogram, blood cultures, and temperature
Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome?
Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation; Myocardial necrosis releases creatine kinase and troponins that normally exist intracellularly.
Angina pectoris is a chronic ischemic coronary artery disease that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris?
Emotional stress
Pulsus paradoxus
Exaggeration of the normal variation in the pulse during the inspiratory phase of respiration
Left ventricular noncompaction
Failure of trabecular compaction in the developing myocardium
Symptoms of infective endocarditis
Fever and signs of systemic infection (such as spleen enlargement, anorexia, malaise, and lethargy), change in the character of an existing heart murmur, and evidence of embolic distribution of vegetative lesions, petechial hemorrhages, splinter hemorrhages under the nails of the fingers and toes are also common
Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset and sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis?
Have patient sit up and lean forward
secondary cardiomyopathy
Heart muscle disease in the presence of a multisystem disorder
Arrhythmogenic right ventricular cardiomyopathy
Heart muscle disease that affects primarily the right ventricle
A 31-year-old African American female who is in her 30th week of pregnancy has been diagnosed with peripartum cardiomyopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy?
Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes; Treatment is complicated, but not impossible, in antepartum women due to possible teratogenic drug effects. About half of women suffer long-term effects on cardiac function, while signs and symptoms are similar to those of early heart failure.
genetic cardiomyopathy
Hypertophic Cardiomyopathy Excessive hypertrophy most notable in septum Causes outflow obstruction → symptoms like aortic stenosis Seen in children & young adults - Familial pattern Can → sudden cardiac death Autosomal dominant disorder: Mutations of cardiac muscle genes Symptoms: Dyspnea, chest pain, fatigue & syncope with outflow obstruction Dx: Echo RX: β-blockers →↓ HR →↑ LV filling Surgical excision of septum may be needed
Troponin
Identifies necrosis and cardiac muscles earlier than CK-MB
How do unstable angina and NSTEMI differ?
If ischemia is enough to cause symptoms and or increased enzymes. Both have persistent pain at rest for at least 20 minutes. Nitroglycerin relieves the pain in both
Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)?
Increased aortic pressure; An increase in aortic pressure results in a rise in afterload, wall tension, and, ultimately, MVO2.
Infective endocarditis
Invasion of the heart valves and the mural endocardium by a microbial agent
The scar tissue that occurs between the layers of the pericardium becomes rigid and constrictive from scar tissue in constrictive pericarditis. What is a physiologic sign of constrictive pericarditis?
Kussmaul sign
Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications?
Large amount of pink, frothy sputum and new onset of murmur, Tachypnea with respiratory distress, Frequent ventricular arrhythmia unrelieved with amiodarone drip, Complaints of facial numbness and tingling
Stress cardiomyopathy
Left ventricular dysfunction in response to profound psychological or emotional stress
infective endocarditis
Life-threatening infection of the inner surface of the heart. Characterized by invasion of heart valves and endocardium by a microbial agent, leading to the formation of bulky, friable vegetations and destruction of underlying cardiac tissue
distributive shock
Loss of sympathetic vasomotor tone (neurogenic shock), presence of vasodilating substances in the blood ( anaphylactic shock), presence of inflammatory mediators (septic shock)
Cardiac tamponade
Mechanical compression of the heart
Compensatory mechanisms of hypovolemic shock
Mechanisms to maintain cardiovascular function, mechanisms to maintain blood volume
Antibodies directed against the M protein of certain strains of streptococcal bacteria seem to cross-react with glycoprotein antigens in the heart, joint, and other tissues to produce an autoimmune response resulting in rheumatic fever and rheumatic heart disease. This occurs through what phenomenon?
Molecular mimicry
Function of the heart
Move deoxygenated blood from Venous system through the right heart into the pulmonary circulation And oxygenated blood from the pulmonary circulation to the left heart and into the arterial circulation
Treatment of acute pericarditis
NSAIDs, colchicine, corticosteroids
Peripartum cardiomyopathy
Occurs during the last trimester of pregnancy or the first 6 months after delivery
Silent myocardial ischemia
Occurs in the absence of anginal pain
pleural effusion
accumulation of fluid in the pleural cavity usually due to infection or inflammation
myocarditis
acquired
Which of the following situations related to transition from fetal to perinatal circulation would be most likely to necessitate medical intervention?
Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week; One of the hallmarks of the transition from placental circulation is a rapid and then steady decrease in pulmonary vascular resistance.
Cardiac tamponade is a serious life- threatening condition that can arise from a number of other conditions. What is a key diagnostic finding in cardiac tamponade?
Pulsus paradoxus
anaphylactic shock
Results from an immunologically mediated reaction in which vasodilator substances such as histamine are released into the blood. The substances cause vasodilation of arterials and venules along with a market increase in capillary permeability. The vascular response and anaphylaxis often accompanied by life-threatening laryngeal edema and bronchospasm, circulatory collapse, contraction of gastrointestinal and uterine smooth muscle, and hives or angioedema
Heart attack
ST-segment elevation myocardial infarction
Symptoms of cardiomyopathies
Same as with heart failure
The diagnosis of chronic stable angina is based on a detailed pain history, the presence of risk factors, invasive and noninvasive studies, and laboratory studies. What test is not used in the diagnosis of angina?
Serum biochemical markers
Unstable angina/non-ST-segment elevation myocardial infarction is a clinical syndrome that ranges in severity between stable angina to myocardial infarction (MI). It is classified ac- cording to its risk of causing an acute MI and is diagnosed based on what?
Serum biomarkers, ECG pattern
Unstable plaque, a condition of atherosclerotic heart disease, occurs in unstable angina and myocardial infarction. Unstable plaque can rupture, causing platelet aggregation and thrombus formation. What are the major determinants of the vulnerability of plaque to rupture?
Size of lipid-rich core, presence of inflammation, thickness of fibrous cap
Etiology of infective endocarditis
Staph infection is the leading cause followed by strep and enterococci. Bacteria may enter via IV drug use, dental procedures, and other surgical procedure such as prosthetic heart valve placement. Other causes include mitral valve prolapse, congenital heart disease, pacemaker, defibrillator
An IV drug abuser walks into the ED telling the nurse that, "he is sick." He looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echocardiogram was ordered that shows a large vegetation growing on his mitral valve. The patient is admitted to the ICU. The nurse will be assessing this patient for which possible life-threatening complications?
Systemic emboli, especially to the brain; Systemic emboli develop and break off the mitral valve and travel into the vascular system. There is a high probability that the emboli could lodge in the brain, kidneys, lower extremities, etc.
Left sided heart failure
Systolic dysfunction: decreased ventricular contractility leads to its impaired ability to eject blood Diastolic dysfunction: in abnormality and ventricular relaxation and filling
Aortic valve stenosis
Systolic ejection murmur (crescendo-decrescendo)
Classic EKG changes with ACS
T-wave inversions, ST-segment elevation, and development of an abnormal Q wave.
In infective endocarditis, vegetative lesions grow on the valves of the heart. These vegetative lesions consist of a collection of infectious organisms and cellular debris enmeshed in the fibrin strands of clotted blood. What are the possible systemic effects of these vegetative lesions?
They can fragment and cause cerebral emboli.
dilated cardiomyopathy
Ventricular enlargement, a reduction in ventricular wall thickness, and impaired systolic function
Restrictive cardiomyopathy
Ventricular filling restricted because of excessive rigidity of the ventricular walls
Which of the following ECG patterns would the nurse observe in a patient admitted for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)?
Ventricular tachycardia with left bundle branch block pattern, T-wave inversion in the right precordial leads
Silent MI
When an MI occurs without signs of angina. Most common in elderly, diabetic, and those with impaired pain perception
Indicators of pericarditis
Widespread T-wave inversions that later normalize; chest pain radiating to the neck and scapula that is worse on inspiration; and high white cells, erythrocyte sedimentation rate, and C-reactive protein levels
Atypical presenters of ACS
Women, elderly, diabetic, older African-American women, lower socioeconomic status, history of angina, people who consult family first
Tetralogy of Fallot
a congenital malformation of the heart involving four distinct defects; cyanosis is caused by a right-to-left shunt across the ventricular septal defect; at risk for infective endocarditis
pulmonary stenosis
a narrowing of the pulmonary valve or pulmonary artery that results in obstruction of blood flow from the ventricles
complications of hypertrophic cardiomyopathy
a-fib, stroke, heart failure
why are beta blockers given to those with acute coronary syndrome?
alter resting myocardial membrane potentials and may decrease life-threatening ventricular arrhythmias
Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?
beta adrenergic blocking drugs
stenotic valvular defect
causes a decrease in blood flow through a valve, resulting in impaired emptying and increased work demands on the heart chamber that empties blood across the diseased valve
molecular mimicry
close resemblance between foreign and self-antigen
acute phase of kawasaki disease
fever, conjunctivitis, rash, involvement of the oral mucosa, redness and swelling of the hands and feet, and enlarged cervical lymph nodes
subacute phase of kawasaki disease
defervescence and desquamation
Heart failure in an infant usually manifests itself as tachypnea or dyspnea, both at rest and on exertion. When does this most commonly occur with an infant?
during feeding
Symptoms of pleural effusion
dyspnea, cyanosis, shock symptoms
Diagnosis of myocarditis
endomyocardial biopsy obtained through cardiac cath
symptoms of myocarditis
fever, myalgia, or exertional dyspnea to hemodynamic collapse and sudden death; Patients may present with viral syndrome such as fever, chills, N/V, joint pain occurring up to 6 weeks before dx of myocarditis; People may also present with AV block or complete heart block; frequent pathologic finding in persons withs AIDS
Left ventricular noncompaction
genetic
hypertrophic cardiomyopathy
genetic
Clinical manifestations of cardiac tampondae
increased intracardiac pressure, progressive limitation of ventricular diastolic filling, and decreased stroke volume and cardiac output. This accumulation of fluid results in tachycardia, elevated CVP, jugular vein distention, fall in systolic BP, narrowed pulse pressure, and signs of shock. Heart sounds may be muffled, weakened femoral pulses
myocarditis
inflammation of the heart muscle
common causes of heart failure in infants and children
inflammatory heart disorders (myocarditis, RF, bacterial endocarditis, Kawasaki disease), Cardiomyopathy, Congenital heart disorders
A 13-year-old boy has had a sore throat for at least a week and has been vomiting for 2 days. His glands are swollen, and he moves stiffly because his joints hurt. His parents, who believe in "natural remedies," have been treating him with various herbal preparations without success and are now seeking antibiotic treatment. Throat cultures show infection with group A streptococci. This child is at high risk for
mitral valve stenosis; Group A streptococcal infection can be adequately treated with antibiotics, but this infection may have been present long enough to trigger an immune response—rheumatic fever—that will damage his heart valves, ultimately causing mitral valve stenosis.
dilated cardiomyopathy
mixed
treatment of cardiac tamponade
pericardiocentesis
A regurgitant valvular defect
permits the blood flow to continue when the valve is closed. Valvular heart disorders produce blood flow turbulence
symptoms of dilated cardiomyopathy
systolic heart failure symptoms - fatigue, SOB, orthopnea, and reduced exercise capacity
The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications?
β-Adrenergic blockers are generally the initial choice for persons with symptomatic HCM. Calcium channel blockers can also be used.
