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Chapter 37

Chapter 37. Inflammatory and Structural Heart Disorders Valvular Heart Disease. Valvular Heart Disease. Stenosis Valve orifice is restricted Impending forward blood flow Creates a pressure gradient across open valve Degree of stenosis reflected in pressure gradient differences.

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Chapter 37

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  1. Chapter 37 Inflammatory and Structural Heart Disorders Valvular Heart Disease

  2. Valvular Heart Disease

  3. Stenosis • Valve orifice is restricted • Impending forward blood flow • Creates a pressure gradient across open valve • Degree of stenosis reflected in pressure gradient differences

  4. Regurgitation • Incomplete closure of valve leaflets • Results in backward flow of blood

  5. Mitral Stenosis • Most adult cases result from rhematic heart disease • Other causes • Mitral valve becomes scarred and narrowed • Left atrial overload eventually leads to right ventricular failure

  6. Mitral Stenosis • Manifestations include fatigue, palpitations, dysrhythmias, low pitched diastolic murmur

  7. Mitral Regurgitation • Mitral valve fails to close properly • Usually chronic • Blood flows back into left ventricle, elading to LA and LV dilation • Manifestations include symptoms of LV failure, holosystolic murmur

  8. Mitral Valve Prolapse • One or more of the mitral valve leaflets prolapses back into the left atrium during systole • Usually congenital • Usually benign, but can be problematic if it progresses to mitral regurgitation • Most people asymptomatic, but manifestations may include CP, dyspnea and palpitations

  9. Aortic Stenosis • Narrowing of the aortic valve causes obstruction of blood flow form the LV to the aorta during systole • Common causes include congenital, rheumatic heart disease and senile or degenerative stenosis • Manifestations: classic triad; systolic ejection murmur

  10. Aortic Regurgitation • Aortic valve fails to close properly • Blood flow back from the aorta into the LV during diastole-->volume overload of LV • Cause may be acute or chronic (rheumatic disease, bicuspid AV, autommune conditions) • Manifestations include signs and symptoms of LV failure (late), waterhammer pulse, high pitched diastolic murmur

  11. Tricuspid and Pulmonic disease • Uncommon • Will manifest as RV failure

  12. Diagnosis of valvular heart disease • History and physical • CXR • ECG • Echocardiogram • Cardiac catheterization

  13. Collaborative Care • Prophylactic antibiotic therapy • Rheumatic fever, infective endocarditis • Management of associated heart failure • Vasodilators (except aortic stenosis) • Inotropes (digoxin) • Diuretics • Beta blockers • Anticoagulant therapy as indicated

  14. Surgical Treatment • Percutaneous transluminal balloon valvuloplasty • For stenotic disease • Valve repair • Eg, valvuloplasty, annuloplasty • Valve replacement (prosthetic valves) • Mechanical valves • Biological valves • Choice of valve depends on variety of factors

  15. Surgical Treatment • Valve replacement • Teaching • Prophylaxis • Anticoagulation

  16. Nursing Diagnoses and Interventions • Activity intolerance • Excess fluid volume • Decreased cardiac output • Deficient knowledge

  17. Chapter 37 • Cardiomyopathies

  18. Cardiomyopathy • Constitutes a group of diseases that directly affect the structural or functional ability of the myocardium • Three major types

  19. Dilated Cardiomyopathy • Characterized by diffuse inflammation and rapid degeneration of the myocardium that results in ventricular and atrial dilation and impaired systolic function • May develop acutely or insidiously • Manifest as heart failure, often biventricular • Causes (table 37-18)

  20. Dilated Cardiomyopathy • Interventions focused on improving heart failure • Enhance contractility, decrease afterload • Drugs • Nitrates, diuretics, ACE inhibitors, beta blockers, aldosterone antagonists, anticoagulation • Treat underlying disease process (as able) • Cardiac resychronization therapy • May require VAD or transplant

  21. Hypertrophic Cardiomyopathy • Asymmetical left ventricular hypertrophy without ventricular dilation • Primary defect is diastolic dysfunction • May be idiopathic, often genetic • Usually seen in young adults • High risk of SCD • Manifestations include dyspnea, fatigue, angina, syncope

  22. Hypertrophic Cardiomyopathy • Collaborative management • Reduce contractility and relieve outflow obstruction • Drugs • Beta blockers, calcium channel blockers • Nitrates, digoxin contraindicated • Avoid diuretics • ICD placement • Surgical treatment • Teaching • Avoid strenous activity • Avoid dehydration • Symptoms - elevate feet

  23. Restrictive Cardiomyopathy • Impaired ventricular filling • Manifestations include signs and symptoms of heart failure • Treat to maintain cardiac output and manage symptoms

  24. Patient and Family Teaching for Cardiomyopathy • Meds as prescribed • Low sodium diet • Hydration • Avoid ETOH, tobacco and stimulants • Balace activity and rest • Avoid heavy lifting, discuss exercise with health care provider • Stress reduction • Report signs/symptoms of heart failure promptly • May require IE prophylaxis

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