Chapter 37

Inflammatory and Structural Heart Disorders

Valvular Heart Disease

Valvular Heart Disease

Stenosis Valve orifice is restricted Impending forward blood flow Creates a pressure gradient across open valve Degree of stenosis reflected in pressure

gradient differences

Regurgitation Incomplete closure of valve leaflets Results in backward flow of blood

Mitral Stenosis

Most adult cases result from rhematic heart disease Other causes

Mitral valve becomes scarred and narrowed Left atrial overload eventually leads to right

ventricular failure

Mitral Stenosis

Manifestations include fatigue, palpitations, dysrhythmias, low pitched diastolic murmur

Mitral Regurgitation

Mitral valve fails to close properly Usually chronic Blood flows back into left ventricle, elading to

LA and LV dilation

Manifestations include symptoms of LV failure, holosystolic murmur

Mitral Valve Prolapse

One or more of the mitral valve leaflets prolapses back into the left atrium during systole

Usually congenitalUsually benign, but can be problematic if it

progresses to mitral regurgitationMost people asymptomatic, but

manifestations may include CP, dyspnea and palpitations

Aortic Stenosis

Narrowing of the aortic valve causes obstruction of blood flow form the LV to the aorta during systole

Common causes include congenital, rheumatic heart disease and senile or degenerative stenosis

Manifestations: classic triad; systolic ejection murmur

Aortic Regurgitation

Aortic valve fails to close properly Blood flow back from the aorta into the LV during

diastole-->volume overload of LV

Cause may be acute or chronic (rheumatic disease, bicuspid AV, autommune conditions)

Manifestations include signs and symptoms of LV failure (late), waterhammer pulse, high pitched diastolic murmur

Tricuspid and Pulmonic disease

Uncommon

Will manifest as RV failure

Diagnosis of valvular heart disease

History and physicalCXRECGEchocardiogramCardiac catheterization

Collaborative Care

Prophylactic antibiotic therapy Rheumatic fever, infective endocarditis

Management of associated heart failure Vasodilators (except aortic stenosis) Inotropes (digoxin) Diuretics Beta blockers

Anticoagulant therapy as indicated

Surgical Treatment

Percutaneous transluminal balloon valvuloplasty For stenotic disease

Valve repair Eg, valvuloplasty, annuloplasty

Valve replacement (prosthetic valves) Mechanical valves

Biological valves

Choice of valve depends on variety of factors

Surgical Treatment

Valve replacement Teaching

Prophylaxis

Anticoagulation

Nursing Diagnoses and Interventions

Activity intolerance

Excess fluid volume

Decreased cardiac output

Deficient knowledge

Chapter 37

Cardiomyopathies

Cardiomyopathy

Constitutes a group of diseases that directly affect the structural or functional ability of the myocardium

Three major types

Dilated Cardiomyopathy

Characterized by diffuse inflammation and rapid degeneration of the myocardium that results in ventricular and atrial dilation and impaired systolic function

May develop acutely or insidiously Manifest as heart failure, often biventricular Causes (table 37-18)

Dilated CardiomyopathyInterventions focused on improving heart

failure Enhance contractility, decrease afterload Drugs

Nitrates, diuretics, ACE inhibitors, beta blockers, aldosterone antagonists, anticoagulation

Treat underlying disease process (as able) Cardiac resychronization therapy May require VAD or transplant

Hypertrophic Cardiomyopathy

Asymmetical left ventricular hypertrophy without ventricular dilation Primary defect is diastolic dysfunction May be idiopathic, often genetic Usually seen in young adults High risk of SCD

Manifestations include dyspnea, fatigue, angina, syncope

Hypertrophic Cardiomyopathy Collaborative management

Reduce contractility and relieve outflow obstruction Drugs

Beta blockers, calcium channel blockers Nitrates, digoxin contraindicated Avoid diuretics

ICD placement Surgical treatment Teaching

Avoid strenous activity Avoid dehydration Symptoms - elevate feet

Restrictive Cardiomyopathy

Impaired ventricular fillingManifestations include signs and

symptoms of heart failureTreat to maintain cardiac output and

manage symptoms

Patient and Family Teaching for Cardiomyopathy Meds as prescribed Low sodium diet Hydration Avoid ETOH, tobacco and stimulants Balace activity and rest Avoid heavy lifting, discuss exercise with health

care provider Stress reduction Report signs/symptoms of heart failure promptly May require IE prophylaxis