Cardio-Valvular Disorders and Congestive Heart Failure PDF

Valvular disorders Loading… Mitral valve prolapse Loading…  Mitral valve prolapse Is a deformity that usually produces no symptoms Q portion of one or both the mitral valve leaflets balloons back into the atrium during systole It can be inherited but mostl...

Valvular disorders Loading… Mitral valve prolapse Loading…  Mitral valve prolapse Is a deformity that usually produces no symptoms Q portion of one or both the mitral valve leaflets balloons back into the atrium during systole It can be inherited but mostly, the cause is unknown  Clinical manifestation Most people have no symptoms Fatigue, shortness of breath, lightheadedness, dizziness, syncope, palpitations, chest pain, or anxiety Ventricular and atrial dysrythmias Mitral click (extra heart sound) Systolic click ECHOCARDIOGRAPHY  Medical management Avoid caffeine, alcohol and tobacco Calcium channel blocker or beta blocker for chest pain Surgical Management Mitral valve replacement/repair  Valvuloplasty Repair, rather than replace of cardiac valves Loading… Annuloplasty chordoplasty Balloon Valvuloplasty  Nursing management Assist the patient and family to prepare for the procedure, reinforce and supplements explanation provided by the physician Put the client on ICU Monitor for heart failure and emboli Monitor changes on heart sounds every four hours Assist in recovery from anesthesia Monitor hemodynamic stability Monitor for dysrythmias  Nursing management Monitor neurologic, respiratory and cardiovascular function Pain management and infection prevention Educate patient about diet, exercise, anticoagulant therapy, follow up care and blood studies  Special considerations Annuloplasty – require anticoagulation therapy Bioprostheses – aspirin with warfarin Mechanical valves – at risk of infective endocarditis. They reuire prophylactic antibiotics before any type of surgeries ECHOCARDIOGRAM 4 to 8 weeks after the procedure to evaluate the success of the procedure Mitral Stenosis  Mitral Stenosis Obstruction to blood flow flowing from the left atrium to the left ventricle Most commonly caused by rheumatic endocarditis, which progressively thickens mitral valve leaflets and chordae tendinae Leaflets often fuse together Mitral valve orifice narrows and progressively obstructs blood flow into the ventricles Left atrium will have difficulty moving blood to the left ventricles Back flow of blood to pulmonary circulation leads to congestion of the pulmonary system  Pulmonary congestion would result to right ventricular hypertrophy, congestion and failure  Clinical Manifestations First symtom is Dyspnea on Exertion as a result of pulmonary venous hypertension Progressive fatigue and decreased exercise tolerance It may create pressure on the bronchial tree resulting in dry cough and wheezing. Hemoptysis, palpitations, orthopnea Atrial dysrythmias Diagnostic Evaluaiton  Diagnostic Evaluation Echocardiogram Electrocardiogram Exercise testing Cardiac catheterization  Prevention Minimize the risk of bacterial infection Prevention of acute rheumatic fever Prophylaxis for rheumatic fever with rheumatic carditis  Medical Management Anticoagulants Beta blockers, digoxin, calcium channel blocker Loading… Avoid strenuous activities Valvuloplasty; commisurotomy Valve replacement Aortic regurgitation  Aortic regurgitation Is the flow of blood back to the left ventricle from the aorta during diastole. It may be caused by inflammatory lesions that deform aortic valve leaflets or dilation of aorta Complete closure of aorta is prevented  Because of back flow of blood, the left ventricle dilates to accomodate the blood  Clinical manifestations Forceful heartbeat Arterial pulsations Excertional dyspnea fatigue  Aortic regurgitation Left ventricle dilates Left ventricle hypertrophies Arteries dilates  Assessment and diagnostic findings High pitched, blowing diastolic murmur Widened pulse pressure (low diastole) Water hammer (Corrigan’s) pulse Transesophageal Echocardiography Cardiac MRI Radionuclide imaging  Prevention Same with prevention of mitral stenosis and regurgitation Prevent bacterial infection  CAUTION Calcium Channel blocker and Diltiazem and Verapamil is contraindicated because they decrease ventricular contractility and may cause bradycardia Aortic stenosis  Aortic stenosis Is narrowing of the orifice between the ledt ventricle and aorta It is often the result of degenerative calcifications Calcifications may be cuased by inflammatory changes that occur in response in years mechanical stress, similar to changes that occur in atherosclerotic atrial disease Diabetes, hypercholesterolemia, hypertension, low HDL level, are risk factors  Clinical manifestations Shows when the compensatory mechanisms of the heart to pump blood starts to fail Exertional dyspnea Orthopnea Pulmonary edema Reduced blood flow to brain leads to dizziness and syncope Angina because of increased oxygen demand of hypertrophied ventricles  Assessment and diagnostics Loud and rough systolic murmur may be heard over the aortic area and may radiate to the carotid arteries and apex of the left ventricles. Echocardiography 12 lead ECG  Prevention Prevention of proliferative inflammatory responses Treating diabetes Hypertension Avoid smoking and alcohol Reduce triglyceride and LDL CardioMyoPathy  Cardiomyopathy A disease of the heart muscle that is associated with cardiac dysfunction Dilated cardiomayopathy  Significant dilation of the ventricles without simultanous hypertrophyand systolic dysfunction The ventricles have elevated systolic and diastolic volumes but a decreased ejection fraction Microscopic examination reveals decreased contractile elements There is diffuse necrotic myocardial tissues  Poor systolic function Less cardiac output, more blood left in the ventricles after systole Regurgitation due to dilated ventricles Thrombi may be formed Hypertrophic cardiomyopathy  The heart muscle asymmetrically increase in size and mass, specially along the septum Increased size of ventricles reduces the sizes of the ventricular cavities Ventricles takes longer time to relax Cardiac muscles are disorganized and results in dysrythmias Coronary arteries have narrow lumens Restrictive Cardiomyopathy  ASSESSMENT AND DIAGNOSTICS Diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch Dyspnea, nonproductive cough, chest pain Fluid retension, peripheral edema, nausea Chest pain, palpitations, dizziness, syncope SEVERE HEART FAILURE, LETHAL DYSRYTHMIA, DEATH  MEDICAL MANAGEMENT identifying and managing the cause Correctingheart failure with medications Low sodium diet Exercise and rest regimen Antiarrythmic drugs or implantable cardioverter defibrillator or pacemaker Drug of choice is amiodarone Avoid obesity Surgical management  Heart transplant Replacement of the diseased heart with a new heart Since the new heart is foreign to the body, the patient is placed in immunosuppressive therapy corticosteroids Cyclosporine and tacrolimus Protect the patient against infection Infectious diseases of the heart Heart Failure