Manning Lecture Notes on Heart Conditions PDF

Mitral Stenosis -- A lot of patients are asymptomatic at first which does not need to be treated S/S -Difficulty breathing when lying down -Proximal dyspnea (waking from sleep difficulty breathing -Palpitations -Dry cough or hypetonisis (coughing up blood) which is due to the alveoli only bein...

Mitral Stenosis -- A lot of patients are asymptomatic at first which does not need to be treated S/S -Difficulty breathing when lying down -Proximal dyspnea (waking from sleep difficulty breathing -Palpitations -Dry cough or hypetonisis (coughing up blood) which is due to the alveoli only being able to handle so much so the change in blood flow changes Right sided HF: Hepatomegaly ABD distention (asities) Peripheral edema (pitting edema if its bad enough) Patient might end up with AFib. If change in heart rhythm, call the doctor Apical diastolic murmur, a snapping sound after the S2 IV drug use Congenital deformities -- Diabetes Hypertension MITRAL REGURGIATATION - IV kinking analogy - Mitral valve does not close completely Causes Hypertrophy back up into ventricle Causes: Increase volume of pressure, prolapse, age related wear and tear, infective endocarditis, ischemic heart disease (due to heart muscle not getting enough blood flow, it can die off in certain areas), connective tissue disease, dilated cardiomyopathy Mitral Valve Prolapse: Normally these patients have normal blood pressure and normal heart rate This is regurgitation and patients are usually asymptomatic Midsystolic click and a late systolic murmur -- the intensity of the murmur will not determine how sever the disease is AORTIC STENOSIS -Most common heart problem, this is due to the wear and tear of the valve -Needs a high-pressure environment to get blood to the rest of the body -Not able to get blood through the aortic valve to the ventricle so hypertrophy happens from the build. This causes symptoms of low cardiac output -Eventually this will cause a backup in blood flow -Stenosis is typically 2 cm so when it becomes less than 1 cm they should go, and have it removed because it will begin to cause problems Causes: Calcium builds up, arthsclerosis congenital disorders, rhematic fever Symptoms: SAD = Syncope (loss of consciousness), Angina (chest pain, especially during physical activity, SOB, fatigued, maintained lightheadedness) Dyspnea Late symptoms -- could lead to right sided heart failure, diamond shaped murmur The worst complication is DEATH! Regurgitation Causes: congenital abnormalities, 2 leaflets instead of 3, dilation of aorta (aneurysm), endocarditis Symptoms: fatigued, chest discomfort, nocturnal angina with diaphoresis (chest pain in the middle of the night, palpitations, sweaty -- esp. in the middle of the night) -- diastolic murmur, bounding pulse, pulse pressures will be widened Complications: ASSESSMENT - History of having rheumatic fever or endocarditis (we want to know specifically when), history of family heart disease (genetics), do they use or have used IV drugs - Have you noticed an increase of fatigued, any angina, dyspnea, palpations - Physical assessment includes heart and lung sounds, and the most basic vital sign like pulses - Diagnosis, an echo in an noninvasive diagnostic procedure, evaluate the heart rhythm (esp. a fib for mitral stenosis), TEE is an external ultra sound to look at the heart or TTE is in interventional radiology when they use a scope to go through the throat, stress echo to see if when the heart is stressed does it have more issues usually after this specific study they determine if the patient needs a cardiac Cath, and finally a chest xray to show an enlarged aorta THE BEST SOURCE FOR THIS IS A TEE, THOUGH AN ECHO IS TYPICALLY WHAT THEY DO FIRST INTERVENTIONS - Medication is the first management like diuretics (Lasix, furosemide to manage symptoms and reduce pulmonary edema), Metoprolol and Labetalol which will in turn reduce the work load of the heart, ACE or ARB this will be one or the other never both (lisinopril or losartan, reduces blood pressure in turn reduces pressure on the heart, lower the cholesterol in the heart to reduce calcification in the heart (Lipitor decreases atherosclerosis, may give some antiarrhythmics to control that heartbeat, anticoagulants (risk for clots because of the blood pooling, or if the client has a fib), vasodilators (nitroglycerin, nisossobide which helps to reduce the after load in hopes to improve symptoms they are having), being cautious of nitrates with clients with aortic stenosis because of the reduced ventricular volume, calcium channel blockers - Lifestyle modifications -- STOP smoking, exercise (light to moderate, slowly building up in exercise), heart healthy diet that includes a low sodium diet, encourage rest which means finding a balance between exercise and rest periods, ensure they have regular cardiac workups, have scheduled echos just so they can keep an eye on things (annually), and as they progress this would be more frequent, monitoring heart rhythm esp. afib. - Goal of treating a fib is to prevent stroke and heart attack, ensure that patients heart rate is less than 100 (which means controlled) and control arrythmia - Different things that we can do that are non-surgery intervention -- valvuloplasty, most common in the balloon arthroplasty which gives valve wider opening (these balloons usually only last for about 6 months then they will more than likely need to consult surgery) -- after getting valvuloplasty monitor for bleeding at site -- also ensure vegetation that was not caught does not cause an emboli when they are broke off from opening the patient up, transcatheter valve replacement which is still technically called a procedure and not a surgery - Whether or not they have had any procedure or not prophylactic antibiotics is given especially for those clients with endocarditis, promote good oral health (oral diseases can lead directly to the heart) however antibiotics are not usually give for GI procedures The clip is the regurgitation How severe is the disease How old is the client