Ch 40
Infective Endocarditis (Innermost layer of heart)
Related to IV drug use, rheumatic fever, prior IE, and Acquired valve disease
S/S = Involves multiple organ systems
- Fever, chills, weakness, fatigue
- Specific = splinter hemorrhages in nail beds, roth spots (retinal lesions),
- Most have a new or worsening systolic murmur
TX: prophylactic tx = Long term antibiotics and identifying the causative agent
Aortic valve stenosis
Adults: degen or caused by rheumatic fever (cause leaflets to stiffen and retract
- causes obstruction of BF from left ventricle to the aorta during systole, leads to left ventricular hypertrophy and increased myocardial O2 consumption
- s/s = triad of angina, syncope, and exertional dyspnea
Raynaud's phenomenon (Acute arterial ischemic disorder)
Episodic, vasospastic disorder of the small cutaneous arteries fingers and toes
Patho = abnormal vascular, intravascular and neuronal mechanisms that cause vasodilation
Venous Thrombosis
Predisposing conditions: Venous stasis, damage to endothelium, hypercoagulability of the blood
Prevention: SCDS, ambulation, physical lifestyle
Manifests: unilateral leg edema, pain and tenderness upon palpation
Tx: Thrombolytic therapy, dissolve clots and improve venous flow
Acute pericarditis
Inflammation of pericardial sac, often with fluid accumulation
Cause is unknown, 20% are due to post cardiac injury
s/s = severe sharp chest pain, worse with deep inspiration and when lying flat, leaning forward relieves the pain
Complication: Cardiac tamponade, fluid in pericardium and compresses heart decreasing CO and leading to shock
Valve disease Care
Replacement:
Mechanical
- Risk of thromboembolism, requires long term anticoagulation
Biologic
- Bovine, porcine and human, more natural BF, no anticoagulation required, less durable
Aortic Aneurysms (AAA)
Manifests: May mimic pain associated with abd or back disorders
- Causing blue toe syndrome, patchy mottling of the feet and toes
- Assessment: Diaphoresis, Pallor, Weakness, Tachycardia, hypotension, changes in LOC
Mitral valve stenosis/regurgitation
stenosis: thickening/shortening of mitral valve, "Fish mouth" shape, loud first heart sound and low pitched diastolic murmur
- BF impeded and pressure differences in left atrium and left ventricle during diastole, places pt at risk for a fib
Regurgitation: results from problems with leaflets (Primary), (Secondary) = myocardial disease (MI, rheumatic HD, mitral valve prolapse
- BF backwards from left ventricle to left atrium, acute regurg = pulmonary edema bc of the pressure and volume in left A and V
Peripheral artery disease
Involves thickening of the artery walls and narrowing of the extremities
- Manifests: depends on site and blockage, pain is due to the build up of lactic acid
- Paresthesia may result from nerve tissue ischemia, if PAD is severe
- Pain in the calf is usually relieved by gravity (Dangling leg)
Aortic Dissection
Result of false lumen between the inner lining and middle layer of the atrial wall
- Gradual onset of pain with increased intensity, older pts less likely to have abrupt onset
Chronic venous insufficiency
Abnormalities of venous system = edema, skin changes and venous leg ulcers
- Primary varicose veins
- Ambulatory venous hypertension
- Serous fluid, and RBC leak results in edema, Brown skin discoloration, skin is hard/thick/contracted
Mitral valve disease
Manifests: Exertional dyspnea, loud S1, fatigue, palpitations, hoarseness, hemoptysis
Regug manifests: Thready pulse, clammy hands
- Chronic = Asymptomatic for years, peripheral edema (Right heart), Audible S3
PAD S/S and care
- Lower limbs = thin/shiny skin, diminished or absent pedal pulses, elevated pallor, and dependent rubor
- In recovery area after surgery
- Assess cap refill, skin color and temp, pain and peripheral pulses
Aortic Dissection Complications
Cardiac Tamponade: fluid build up in pericardial sac compressing the heart and leading to a decrease in CO and shock
- Manifests: hypotension, Narrowed pulse pressure, distended neck veins muffled heart sounds, Pulsus paradoxus (BP increases with inhilation)
Could lead to occlusions for multiple organs, spinal cord ischemia
Extra heart sounds
S3 = Ventricular gallop, Normal in childs, AFTER S2, adults = HF
S4 = Atrial Gallop, end of diastole (Before S1), indicative of pathologic conditions
Murmurs = between S1 and S2, swooshing, pathologies that alter turbulence
Buerger's disease
Type of Acute arterial ischemic disorder = sudden interruption in art blood supply to organ
- recurrent inflammatory disorder of the small and medium arteries and veins of the arms/legs
- S/S = intermittent claudication, rest pain, ischemic ulcerations, changes in color and temperature
Phlebitis
Acute inflammation of the walls of small cannulated veins of the hand (Associated with IV caths)
If edema is present, raise extremity to promote fluid reabsorption