management of patient with structural infection and inflamatory cardiac desorder

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management of patient with structural infection and inflamatory cardiac desorder

  1. 1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsChapter 29Management of Patients WithStructural, Infectious, andInflammatory CardiacDisorders
  2. 2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?The mitral valve is a semilunar valve located between theright ventricle and the pulmonary artery.
  3. 3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerFalseThe mitral valve is an atrioventricular valve locatedbetween the left atrium and left ventricle. The pulmonicvalve is a semilunar valve located between the rightventricle and the pulmonary artery.
  4. 4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsValvular Disorders• Regurgitation: the valve does not close properly andblood backflows through the valve.• Stenosis: the valve does not open completely and bloodflow through the valve is reduced.• Valve prolapse: the stretching of an atrioventricular valveleaflet into the atrium during diastole.
  5. 5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionWhich statement is correct about regurgitation?A.Valve does not close properly and blood backflowsthrough the valve.B.Valve does not open completely and blood flow throughthe valve is reduced.C.Stretching of an atrioventricular valve leaflet into theatrium during diastole.D.Repair of a cardiac valve’s outer ring.
  6. 6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerA• Regurgitation: the valve does not close properly andblood backflows through the valve.• Stenosis: the valve does not open completely and bloodflow through the valve is reduced.• Valve prolapse: the stretching of an atrioventricular valveleaflet into the atrium during diastole.• Annuloplasty: repair of a cardiac valve’s outer ring.
  7. 7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsSpecific Valvular Disorders• Mitral valve prolapse• Mitral regurgitation• Mitral stenosis• Aortic regurgitation• Aortic stenosis
  8. 8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPathophysiology: Left Heart Failure as aResult of Aortic and Mitral Valvular HeartDisease
  9. 9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?Xenograft is a heart valve replacement made of tissue froman animal heart valve.
  10. 10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerTrueXenograft is a heart valve replacement made of tissue froman animal heart valve.
  11. 11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsValve Repair and Replacement Procedures• Valvuloplasty– Commissurotomy: open or closed– Balloon valvuloplasty: open or closed– Annuloplasty– Leaflet repair– Chordoplasty• Valve replacement
  12. 12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsBalloon Valvuloplasty
  13. 13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnnuloplasty Ring Insertion
  14. 14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsValve Leaflet Resection and Repair withRing Annuloplasty
  15. 15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsValve Replacement
  16. 16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsTypes of Replacement Valves• Mechanical valves– Do not deteriorate or become infected as easily, butare thrombogenic and require life-longanticoagulation therapy.• Tissue (biologic) valves– Xenograft (heterograft): pig or cow valve– Homograft (allograft): human valve– Autograft: patient’s own valve
  17. 17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMechanical Valves
  18. 18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCardiomyopathy• Cardiomyopathy is a series of progressive events thatculminates in impaired cardiac output and can lead toheart failure, sudden death, or dysrhythmias.• Types:– Dilated cardiomyopathy– Hypertrophic cardiomyopathy– Restrictive cardiomyopathy– Arrhythmogenic cardiomyopathy– Unclassified cardiomyopathies
  19. 19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsTypes of Cardiomyopathy
  20. 20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsInfectious Diseases of the Heart• Any of the layers of the heart may be affected by aninfectious process.• Diseases are named by the layer of the heart that isaffected.• Diagnosis is made by patient symptoms andechocardiogram.• Blood cultures may be used to identify the infectiousagent and to monitor therapy.• Treatment is with appropriate antimicrobial therapy.Patients require teaching to complete the course ofappropriate antimicrobial therapy, and require teachingfor infection prevention and health promotion.
  21. 21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsRheumatic Endocarditis• Occurs most often in school-age children, after group Abeta-hemolytic streptococcal pharyngitis.• Injury to heart tissue is caused by inflammatory orsensitivity reaction to the streptococci.• Myocardial and pericardial tissue is also affected, butendocarditis results in permanent changes in the valves.• Need to promptly recognize and treat “strep” throat toprevent rheumatic fever.
  22. 22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsInfective Endocarditis• A microbial infection of the endothelial surface of theheart. Vegetative growths occur and may embolize totissues throughout the body.• Usually develops in people with prosthetic heart valves orstructural cardiac defects. Also occurs in patients whoare IV drug abusers and in those with debilitatingdiseases, indwelling catheters, or prolonged IV therapy.• Types:– Acute– Subacute
  23. 23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPericarditis• Inflammation of the pericardium• Many causes• Nursing diagnosis: pain• Potential complications– Pericardial effusion– Cardiac tamponade
  24. 24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionPatients with myocarditis are sensitive to digitalis. Whatmight be an expected change in order for digitalis forthese patients?A.Increase in dosage requiredB.Decrease in dosage requiredC.No change in dosage required
  25. 25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerBPatients with myocarditis are sensitive to digitalis. Nursesmust closely monitor these patients for digitalis toxicity,which is evidenced by dysrhythmia, anorexia, nausea,vomiting, headache, and malaise.

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