Valvular Heart
Name the 4 main heart valves and where they are located.
Tricuspid- between the right atria and right ventricle
Pulmonic-Between the right ventricle and the pulmonary artery
Mitral/bicuspid- between the left atrium and left ventricle
Aortic - between the left ventricle and the aorta
Type of cardiomyopathy with high incidence of sudden cardiac death. Explain why.
Hypertrophic cardiomyopathy. It can cause sudden cardiac death when the septal wall becomes so thick it obstructs the aorta/aortic valve so no output is going out to the body. May happen quickly with overexertion.
Acute pericarditis is most commonly associated with which 4 things? Name at least 3/4.
Infective organisms
Post-Myocardial infarction syndrome aka Dresssler Syndrome
Postpericardiotomy syndrome
Acute exacerbation of systemic connective tissue disorders
Antibiotics used for endocarditis- Name 4
Penicillin
Ampicillin
Vancomycin
Gentamycin
Ceftriaxone
Cefazolin
Rifampin
Criteria to diagnose Kawasaki
Fever for 5+ days,
Plus 4/5 of the following:
-cervical lymphadenopathy
-rash w/ diffuse erythroderma
-Changes in oral mucosa- erythema, cracking, oropharyngeal reddening, strawberry tongue
-Bilateral conjunctival injection w/o exudate
-Changes in the extremities- edema/erythema on palms and soles, periungual desquamation o the hands and feet
CRASH and Burn
Describe the difference between stenosis, prolapse, and insufficiency/regurgitation.
Stenosis is the stiffening/thickening/fusing of the valve to reduce its ability to open all the way which reduces flow through it.
Prolapse is when the valve falls back into the atrium or prior cavity.
Insufficiency/regurgitation is when the vales do not close all the way causing a back flow of blood.
Medications used for Dilated cardiomyopathy- name the class and give an example of them.
ABCDD- meds
Ace inhibitors- lisinopril
Beta-blockers - atenolol, metoprolol, carvedilol
Calcium channel blockers- nifedipine, verapimil, diltiazem
Diuretics- furosemidee
Digoxin-
Statins- simvastatin
Aldosterone antagonists- spironolactone
Pneumonic to remember symptoms with the symptoms
FRICTION
Friction rub, fever
Radiating substernal pain to left shoulder, neck, back
Increased pain in supine
Chest pain, stabbing
Trouble breathing when lying down
Inspiration or coughing causes pain
Overall feeling sick
Noticeable ST-segment elevation
Complications of endocarditis (name 3)
Valvular dysfunction
Embolism
Heart Failure
Systemic Complications ie renal failure, neurological defects, etc
Long-term complication of Kawasaki Disease
Development of coronary artery aneurysms.
Post-op education for valve replacement (name 5 separate things)
Prophylactic antibiotics
Warfarin for mechanical valves- many associated education points here
return to normal activity after 6 weeks, no heavy physical activity for 3-6 months.
No invasive dental procedures for 6 months
No using MRI
Medical alert bracelet/ card for valve info
When to call the provider
NEVER give these medications for hypertrophic cardiomyopathy.
The 3 D's- Digoxin, diuretics, dilators (vasodilators)
Medications used to treat Pericarditis and what they are used for.
Aspirin or NSAIDs- help with pain and inflammation
Colchicine- help reduce inflammation, and reduce risk of recurrence (what to remember about this?)
Corticosteroids like prednisone, reduce inflammation and immunosuppress
How to diagnose Endocarditis (name 3)
Positive blood cultures
low H&H
Echocardiography- shows evidence of endocardial involvement
Transesophageal echocardiography (TEE)- Allows visualization of cardiac structures that are difficult to see with the TTE
New Murmur
Treatment for Kawasaki Disease
IVIG w/ salicylate therapy
Aspirin
Antithrombotic meds- for children with aneurysms
Procedural and surgical treatments for Valvular Heart disease: Name 2 of each.
Procedural: Valvuloplasty, Transcatheter aortic valve replacement (TAVR), Transcatheter Mitral Valve Repair- Mitra clip.
Surgical: Valve replacement, Valve Annuloplasty, Commisurotomy, Valve-sparing aortic root replacement, Ross procedure
The 3 main types of cardiomyopathy and basic description of each.
Dilated- the heart is stretched out/distended.
Hypertrophic- left ventricular hypertrophy obstructing output
Restricted- ventricular walls are stiff, restricting output
Signs of cardiac tamponade (5)
JVD
Paradocical pulse aka pulsus paradoxus
Tachycardia
Muffled Heart Sounds
Hypotension
Treatment: Pericardiocentesis
Describe symptoms when emboli travels to 3/6 of these locations: Spleen, Kidneys, MEsenteric, Central Nervous System, Lungs, systemic/extremities
Spleen: sudden abdominal pain and radiation to left shoulder w/ abdominal rebound tendarness
Kidneys:flank pain radiating to groin, hematuria, pyuria
Mesenteric: diffuse abdominal pain, esp. after eating, abdominal distention
CNS: TIA/Stroke symptoms, confusion, reduced concentration, aphasia, dysphasia etc
Lungs: Pleuritic chest pain, dyspnea, cough, anxiety, agitation, restlessness, Rapid HR
Systemic/Extremities: petechiae, Janeway lesions, Osler's nodes, splinter hemorrhages, roth spots
Nursing scope of practice interventions to assist with symptom relief of Kawasaki Disease (Name 5)
Cool cloths
unscented lotions
soft, loose clothing
mouth care
lubricating ointment for lips
Clear liquids/soft foods
Quiet environment
What are the 4 types of valves that can be used for replacement- explain what they are, which lasts the longest and why?
Xenograft- another species (ie bovine etc)
Allograft- Cadaver
Autograph-Self
Mechanical- Man-made
What are 4 relative contraindications for a heart transplant?
Severe obesity
Psychological impairment
Hx of non-adherence to medications
Active substance abuse
Irreversible liver or kidney disease
Uncontrolled diabetes
Lack of social support
Unrealistic expectations
Treatments for chronic/recurring pericardial effusion
Pericardial window creation- small portion of pericardium is removed to permit excess fluid to drain into the pleural space
Pericardectomy - removal of the toughened encasing of the pericardium
Pneumonic to remember Endocarditis symptoms. Give the actual symptoms
Petechiae
Anorexia
Tired/weak
High fever, heart failure
Osler's nodes
FinGer nail changes (splinter hemorrages)
Embolic events + Janeway lesions
Night sweats , New Murmur
Splenomegaly, Roth Spots
Discharge Education for Kawasaki Disease (list 4)
Irritability may last 2 months
Periungual desquamation begins 2nd or 3rd week, painless peeling but new skin may be tender
Temporary arthritis
No live immunizations for 11 months
Daily temps for 1-2 weeks
Heart-healthy lifestyle
More specific education for children with aneurysms