Podcast
Questions and Answers
Which of the following symptoms are indicative of Kawasaki Disease?
What is the primary complication associated with endocarditis?
Which aspect distinguishes dilated cardiomyopathy from other forms?
What is a common mnemonic used to remember the symptoms of Kawasaki Disease?
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Which of the following is NOT considered a long-term complication of Kawasaki Disease?
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What is the primary consequence of valve stenosis?
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Which structure connects the left ventricle to the aorta?
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Which medication is not typically used for heart failure treatment?
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What is a distinguishing feature of ventricular insufficiency/regurgitation?
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Which medication class is typically used for dilated cardiomyopathy?
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What condition involves the valve falling back into the atrium?
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Which of the following is a symptom of valve insufficiency?
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Which of the following medications should be avoided in patients with hypertrophic cardiomyopathy?
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What is the typical presentation of complications from heart failure?
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Which medication is primarily used for managing acute pericarditis symptoms?
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What is a common diagnostic marker for endocarditis?
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What is the characteristic of hypertrophic ventricles in the context of valvular heart disease?
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Which of the following symptoms is NOT typically associated with mesenteric conditions?
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In the management of symptoms, which treatment is primarily recommended for flank pain associated with renal issues?
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What condition is indicated by the term 'pulsus paradoxus'?
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Which procedural intervention is commonly associated with treating obstructive valve disease?
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Which medication is used to manage inflammation and reduce the risk of recurrence in patients with certain conditions?
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What is the recommended duration for avoiding heavy physical activity after certain cardiac procedures?
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What imaging technique is preferred for visualization of cardiac structures that may not be clear on transthoracic echocardiography (TTE)?
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Which of the following is NOT advised for patients with mechanical valves for a duration of six months?
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What role do corticosteroids play in managing certain cardiac conditions?
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In patients who experience emboli, which organ is NOT typically affected based on the provided locations?
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Which of the following describes the phenomenon of cardiac tamponade?
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What is a key education point for patients regarding the use of antithrombotic medications?
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Which condition can manifest as plueritic chest pain and rapid heart rate?
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Which of the following symptoms is NOT commonly associated with a Transient Ischemic Attack (TIA)?
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In terms of systemic signs, which of the following is a symptom of Endocarditis?
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What is the significance of Janeway lesions in a clinical diagnosis?
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Which of the following would NOT typically be a symptom of chronic pericardial effusion?
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What is most likely to cause confusion and reduced concentration after eating?
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What is a common emotional symptom associated with respiratory distress?
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Which of the following options describes a treatment for chronic pericardial effusion?
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Study Notes
What is the difference between stenosis, prolapse and insufficiency/regurgitation
- Stenosis: This is when the valve stiffens, thickens or narrows making it difficult to open fully. This reduces blood flow through the valve.
- Prolapse: This is when the valve leaflets (flaps) fall back into the atrium (upper heart chamber) or the previous cavity.
- Insufficiency/Regurgitation: This is when the valve leaflets don't close completely causing a backflow of blood.
Medications used for Dilated Cardiomyopathy
- Ace Inhibitors: Lisinopril helps to relax blood vessels, reducing the workload on the heart.
- Beta Blockers: Atenolol, Metoprolol, Carvedilol help slow the heart rate and reduce the force of contractions.
- Calcium Channel Blockers: Nifedipine, Verapamil, Diltiazem help relax blood vessels, lowering blood pressure.
- Diuretics: Furosemide helps reduce fluid buildup in the body.
- Digoxin: Helps strengthen the heart's contractions.
- Statins: Simvastatin helps lower cholesterol.
- Aldosterone Antagonists: *Spironolactone * helps reduce fluid build-up.
Pneumonic to remember the symptoms of Endocarditis
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FRICTION:
- F: Friction rub - a scratching sound heard when listening to the heart.
- R: Radiating substernal pain - pain under the breastbone that spreads to the left shoulder, neck, and back.
- I: Increase in pain when in a supine position - pain intensifies when lying flat.
- C: Chest pain, stabbing.
- T: Trouble breathing when lying down.
- I: Inspiration or coughing causes pain.
- O: Overall feeling sick.
- N: Noticeable ST-segment elevation - a change in the electrical activity of the heart.
Complications of Endocarditis
- Valvular dysfunction
- Emboli - blood clots that travel through the bloodstream to the lungs, brain, or other organs.
- Systemic complications: These can include kidney failure, neurological defects, and other organ damage.
Long-term complication of Kawasaki Disease
- Development of coronary artery aneurysms - This is a serious complication that can lead to heart attack or stroke.
- Heart Failure -
ABCDD - Medications used to treat Kawasaki Disease
- A: Aspirin: Used to reduce fever, inflammation and prevent blood clots.
- B: Blood thinners: Used to prevent blood clots from forming.
- C: Corticosteroids: Used to reduce inflammation.
- D: Immunoglobulins (IVIG): Used to suppress the immune system and help reduce inflammation.
Post-operative education for valve replacement
- Prophylactic antibiotics: Patients need to take antibiotics before certain medical procedures, like dental work to prevent infections.
- Warfarin: Patients with mechanical valves will need to take Warfarin long term, which is a blood thinner.
- Return to normal activity: Patients will need to avoid heavy physical activity for three to six months after surgery. It can take up to six weeks to return to normal activity.
- No invasive dental procedures for six months: These can increase the risk of infection.
- No using MRI: The metal in mechanical heart valves can interfere with an MRI.
- Medical alert bracelet/card with valve information: This is important because it helps healthcare providers know that the patient has a mechanical valve.
NEVER give these medications to patients with hypertrophic cardiomyopathy
- Digoxin
- Diuretics
- Dilators (vasodilators)
Medications used to treat Pericarditis
- Aspirin or NSAIDs: Help reduce pain and inflammation.
- Colchicine: Helps reduce inflammation and prevent recurrences. It is important to note that colchicine can have side effects, and potential interactions with other medications.
What to remember about Colchicine
- Colchicine can cause side effects like diarrhea, nausea, stomach pain, and muscle weakness. It can also interact with other medications, so it's important to tell your doctor about all the medications you're taking, including over-the-counter drugs and herbal supplements.
How to diagnose Endocarditis
- **Positive blood cultures: ** The presence of bacteria in the blood confirms endocarditis.
- Low H&H (Hematocrit and Hemoglobin): This indicates anemia, which can occur with endocarditis.
- **Echocardiography: ** This soundwave imaging test can reveal damage to the heart valves and other signs of endocarditis.
- **Transesophageal echocardiography (TEE): ** This invasive procedure provides a more detailed look at the heart valves by passing a small probe down the esophagus.
- New murmur: An abnormal heart sound that can indicate a heart valve problem.
Treatments for Endocarditis
- IVIG with salicylate therapy
- Aspirin
- Antithrombotic medications: Used to prevent blood clots, particularly for children with aneurysms.
Treatment for Kawasaki Disease
- IVIG with salicylate therapy
- Aspirin
- Antithrombotic medications: Used to prevent blood clots, particularly for children with aneurysms.
Pneumonic to remember symptoms of Endocarditis
-
SHOTS:
- S: Sudden high fever
- H: Heart murmur
- O: Osler's nodes (painful red or purple nodules under the skin)
- T: Tiny red spots (petechiae) on the skin or mucous membranes
- S: Splinter hemorrhages (small streaks of blood under the fingernails).
Discharge education for Kawasaki Disease
- Irritability can last 2 weeks or longer: This is common after Kawasaki disease, and parents need to be aware of it.
- Be sure to take medication as prescribed: This is important to prevent complications.
- Limit strenuous activity until doctor clears patients: This is important to prevent further heart damage.
- Make follow-up appointments as instructed: This is crucial to ensure that the patient is recovering well.
The 3 main types of Cardiomyopathy
- Dilated: The heart muscle is stretched or distended, weakening the ability of the heart to pump blood.
- Hypertrophic: The left ventricle wall thickens, reducing the volume of blood the heart can hold and making it harder for the heart to pump.
- Restricted: This is a rare condition that causes the ventricular walls (chambers) to become stiff and unyielding which hinders the heart from filling with blood.
Procedural and surgical treatments for Valvular Heart Disease
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Procedural Treatments:
- Valvuloplasty: This procedure widens the narrowed valve.
- Transcatheter aortic valve replacement (TAVR): a minimally invasive procedure to replace a damaged aortic valve with a new valve.
- Transcatheter Mitral Valve Repair: a minimally invasive procedure to repair a damaged mitral valve. A "Mitra clip" is used to repair the mitral valve.
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Surgical Treatments:
- Valve Replacement: The damaged valve is replaced with a new valve made from tissue or synthetic material.
- Valve Annuloplasty: Procedure to repair the ring around the valve to ensure proper closure.
- Commisurotomy: A procedure done to open the valve in the heart.
- Valve-sparing aortic root replacement: Only the aortic valve is replaced, so the original aortic valve can be kept.
- Ross Procedure: This procedure involves removing the damaged valve and replacing it with the patient's own pulmonary valve.
Signs of Cardiac Tamponade
- JVD (Jugular Vein Distention): This is swelling of the neck veins, which can be a sign of increased pressure in the chest cavity.
- Paradoxic Pulse (Pulsus Paradoxus): This is a decrease in blood pressure during inhalation.
- Tachycardia: This is a rapid heartbeat.
- Muffled Heart Sounds: This is a sign that the heart is surrounded by fluid.
- Hypotension: This is a low blood pressure.
What are the 4 types of valves that can be used for valve replacement?
- Mechanical Valves: These are made of durable materials like metal or carbon. They last the longest (approximately 15-20 years), but they require lifelong anticoagulation therapy.
- Tissue (Bioprosthetic) Valves: These are made of biological materials such as pig or cow tissue or from donated human tissue. Though they are more prone to wear and tear, they have the advantage of not requiring lifelong anticoagulation therapy.
- Homograft Valves: These valves are from donated human tissue. They are used in cases where a patient is too young to receive other types of valves.
- Xenograft Valves: These are made from animal tissue and are designed to last longer than biological tissue valves.
What are 4 relative contraindications for a heart transplant?
- Severe obesity: Patients with severe obesity have a higher risk for complications after a transplant.
- Active drug or alcohol abuse: These habits can increase the risk for organ rejection and other complications.
- Severe pulmonary hypertension: This is a condition in which the pressure in the lungs is too high. It can make the heart work harder and increase the risk of heart failure.
- Severe mental health problems: Patients with severe mental health problems may not be able to comply with the complex post-transplant medication regime.
Describe symptoms when emboli travels to 3/6 of these locations
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Spleen: Sudden abdominal pain radiating to the left shoulder, with abdominal rebound tenderness.
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Kidneys: Flank pain radiating to the groin, hematuria (blood in the urine), and pyuria (pus in the urine).
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Mesenteric artery: Diffuse abdominal pain, especially after eating; abdominal distention.
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Central Nervous System: This will depend on where the embolus travels in the brain, but could lead to TIA/Stroke symptoms, confusion, reduced concentration, aphasia, or dysphasia.
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Lungs: Pleuritic chest pain, shortness of breath, cough, anxiety, agitation, restlessness, rapid heart rate (tachycardia).
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Systemic (Extremities): Petechiae (tiny red spots), Janeway lesions (painless red or purple spots on the palms of the hands or soles of the feet), Osler's nodes (painful red or purple nodules under the skin), splinter hemorrhages (small streaks of blood under the fingernails), Roth spots (small, white spots in the retina).
Nursing interventions to assist with symptom relief of Kawasaki Disease
- Cool cloths and unscented lotions: These can be used to help reduce fever and soothe itchy skin.
- Soft, loose clothing: This is more comfortable for the patient and can help prevent irritation.
- Mouth care: The patient may have dry mouth as a result of the disease.
- Lubricating ointment for lips: This can help prevent chapped lips.
- Clear liquids and soft foods: This can help prevent dehydration and make eating more comfortable.
- Quiet environment: This can help the patient rest and relax.
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Description
Test your knowledge on the differences between heart valve disorders such as stenosis, prolapse, and insufficiency/regurgitation. Additionally, explore the various medications used in treating Dilated Cardiomyopathy. Are you ready to dive into cardiovascular health?
