management of patient with structural infection and inflamatory cardiac desorder

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 29

Management of Patients With Structural, Infectious, and

Inflammatory Cardiac Disorders

Chapter 29

Management of Patients With Structural, Infectious, and

Inflammatory Cardiac Disorders


QuestionQuestion

Is the following statement True or False?

The mitral valve is a semilunar valve located between the right ventricle and the pulmonary artery.


AnswerAnswer

False

The mitral valve is an atrioventricular valve located between the left atrium and left ventricle. The pulmonic valve is a semilunar valve located between the right ventricle and the pulmonary artery.


Valvular DisordersValvular Disorders

• Regurgitation: the valve does not close properly and blood backflows through the valve.

• Stenosis: the valve does not open completely and blood flow through the valve is reduced.

• Valve prolapse: the stretching of an atrioventricular valve leaflet into the atrium during diastole.


QuestionQuestion

Which statement is correct about regurgitation?

A.Valve does not close properly and blood backflows through the valve.

B.Valve does not open completely and blood flow through the valve is reduced.

C.Stretching of an atrioventricular valve leaflet into the atrium during diastole.

D.Repair of a cardiac valve’s outer ring.


AnswerAnswer

A

• Regurgitation: the valve does not close properly and blood backflows through the valve.

• Stenosis: the valve does not open completely and blood flow through the valve is reduced.

• Valve prolapse: the stretching of an atrioventricular valve leaflet into the atrium during diastole.

• Annuloplasty: repair of a cardiac valve’s outer ring.


Specific Valvular DisordersSpecific Valvular Disorders

• Mitral valve prolapse

• Mitral regurgitation

• Mitral stenosis

• Aortic regurgitation

• Aortic stenosis


Pathophysiology: Left Heart Failure as a Result of Aortic and Mitral Valvular Heart Disease

Pathophysiology: Left Heart Failure as a Result of Aortic and Mitral Valvular Heart Disease


QuestionQuestion

Is the following statement True or False?

Xenograft is a heart valve replacement made of tissue from an animal heart valve.


AnswerAnswer

True

Xenograft is a heart valve replacement made of tissue from an animal heart valve.


Valve Repair and Replacement ProceduresValve Repair and Replacement Procedures

• Valvuloplasty

– Commissurotomy: open or closed

– Balloon valvuloplasty: open or closed

– Annuloplasty

– Leaflet repair

– Chordoplasty

• Valve replacement


Balloon ValvuloplastyBalloon Valvuloplasty


Annuloplasty Ring InsertionAnnuloplasty Ring Insertion


Valve Leaflet Resection and Repair with Ring AnnuloplastyValve Leaflet Resection and Repair with Ring Annuloplasty


Valve ReplacementValve Replacement


Types of Replacement ValvesTypes of Replacement Valves

• Mechanical valves

– Do not deteriorate or become infected as easily, but are thrombogenic and require life-long anticoagulation therapy.

• Tissue (biologic) valves

– Xenograft (heterograft): pig or cow valve

– Homograft (allograft): human valve

– Autograft: patient’s own valve


Mechanical ValvesMechanical Valves


CardiomyopathyCardiomyopathy

• Cardiomyopathy is a series of progressive events that culminates in impaired cardiac output and can lead to heart failure, sudden death, or dysrhythmias.

• Types:

– Dilated cardiomyopathy

– Hypertrophic cardiomyopathy

– Restrictive cardiomyopathy

– Arrhythmogenic cardiomyopathy

– Unclassified cardiomyopathies


Types of CardiomyopathyTypes of Cardiomyopathy


Infectious Diseases of the HeartInfectious Diseases of the Heart

• Any of the layers of the heart may be affected by an infectious process.

• Diseases are named by the layer of the heart that is affected.

• Diagnosis is made by patient symptoms and echocardiogram.

• Blood cultures may be used to identify the infectious agent and to monitor therapy.

• Treatment is with appropriate antimicrobial therapy. Patients require teaching to complete the course of appropriate antimicrobial therapy, and require teaching for infection prevention and health promotion.


Rheumatic EndocarditisRheumatic Endocarditis

• Occurs most often in school-age children, after group A beta-hemolytic streptococcal pharyngitis.

• Injury to heart tissue is caused by inflammatory or sensitivity reaction to the streptococci.

• Myocardial and pericardial tissue is also affected, but endocarditis results in permanent changes in the valves.

• Need to promptly recognize and treat “strep” throat to prevent rheumatic fever.


Infective EndocarditisInfective Endocarditis

• A microbial infection of the endothelial surface of the heart. Vegetative growths occur and may embolize to tissues throughout the body.

• Usually develops in people with prosthetic heart valves or structural cardiac defects. Also occurs in patients who are IV drug abusers and in those with debilitating diseases, indwelling catheters, or prolonged IV therapy.

• Types:

– Acute

– Subacute


PericarditisPericarditis

• Inflammation of the pericardium

• Many causes

• Nursing diagnosis: pain

• Potential complications

– Pericardial effusion

– Cardiac tamponade


QuestionQuestion

Patients with myocarditis are sensitive to digitalis. What might be an expected change in order for digitalis for these patients?

A.Increase in dosage required

B.Decrease in dosage required

C.No change in dosage required


AnswerAnswer

B

Patients with myocarditis are sensitive to digitalis. Nurses must closely monitor these patients for digitalis toxicity, which is evidenced by dysrhythmia, anorexia, nausea, vomiting, headache, and malaise.

management of patient with structural infection and inflamatory cardiac desorder

Education

semilunar valve

heart valve replacement

atrioventricular valve

health promotion

human valve autograft

blood flow throughthe

cow valve homograft

heart tissue