INFLAMMATORY & INFLAMMATORY & VALVULAR HEART VALVULAR HEART

DISEASE DISEASE

ObjectivesObjectives

• Compare and contrast Compare and contrast inflammatory and valvular inflammatory and valvular heart diseaseheart disease

• Evaluate a comprehensive Evaluate a comprehensive plan of care for the client plan of care for the client with inflammatory and with inflammatory and valvular heart disease. valvular heart disease.

Layers of the Layers of the HeartHeart

Fig. 37-1. Layers of the heart muscle and pericardium. The section of the heart wall shows the fibrous pericardium, the parietal and visceral layers of the serous pericardium (with the pericardial sac between them), the myocardium, and the endocardium.

Inflammatory Inflammatory Heart Disease Heart Disease

• Infective EndocarditisInfective Endocarditis

• PericarditisPericarditis

• Rheumatic FeverRheumatic Fever

• Myocarditis Myocarditis

Infective Infective EndocarditisEndocarditis

• Infection of the inner layer of Infection of the inner layer of the heart that usually affects the heart that usually affects the cardiac valvesthe cardiac valves

• Almost always a fatal Almost always a fatal condition until development condition until development of penicillin of penicillin

• 15,000 new cases diagnosed 15,000 new cases diagnosed in the in the United States each yearUnited States each year

Etiology & Etiology & PathophysiologyPathophysiology

Occurs when blood turbulence within heart allows causative agent to infect previously damaged valves or other endothelial surfaces

Cont’dCont’d

• Principal risk factorsPrincipal risk factors• AgeAge• Intravenous drug abuse Intravenous drug abuse

(IVDA)(IVDA)• Prosthetic valvesProsthetic valves• Use of intravascular Use of intravascular

devicesdevices• Renal dialysisRenal dialysis

Cont’dCont’d

• Vegetation Vegetation • Fibrin, leukocytes, Fibrin, leukocytes,

platelets, and microbesplatelets, and microbes• Adhere to the valve or Adhere to the valve or

endocardium endocardium • Embolization of portions of Embolization of portions of

vegetation into circulationvegetation into circulation

Fig. 37-2. Bacterial endocarditis of the mitral valve. The valve is covered with large, irregular vegetations (arrow).

CausesCauses

• Streptococcus viridansStreptococcus viridans• Staphylococcus aureusStaphylococcus aureus• VirusesViruses• Fungi Fungi

Clinical Clinical ManifestationManifestation

• Nonspecific Nonspecific

• Fever occurs in 90% of patients. Fever occurs in 90% of patients.

• ChillsChills

• WeaknessWeakness

• Malaise Malaise

• FatigueFatigue

• AnorexiaAnorexia

• MurmurMurmur• http://www.easyauscultation.com/

heart-sounds.aspx•

DiagnosisDiagnosis

• Thorough H&PThorough H&P• Dental ProceduresDental Procedures• Invasive ProceduresInvasive Procedures• IV devicesIV devices• Other recent infectionsOther recent infections

• Labwork & Dx StudiesLabwork & Dx Studies

Collaborative Collaborative CareCare

• What could be done for patients What could be done for patients having procedures involving:having procedures involving:• Certain dental proceduresCertain dental procedures• Respiratory tract incisionsRespiratory tract incisions• GI wound infectionGI wound infection• Urinary tract infectionUrinary tract infection

• _________________________________________________________________________??___??

Acute PericarditisAcute Pericarditis

• Inflammation of the Inflammation of the pericardium, the membranous pericardium, the membranous sac enveloping the heart. sac enveloping the heart.

• It may be a primary illness or It may be a primary illness or it may develop during various it may develop during various medical and surgical medical and surgical disorders.disorders.

• Asymptomatic or chest Asymptomatic or chest pain/friction rubpain/friction rub

• Motrin/bedrest/maybe Motrin/bedrest/maybe pericardiocentesis/watch for pericardiocentesis/watch for cardiac tamponade cardiac tamponade

MyocarditisMyocarditis

• Inflammatory process Inflammatory process involving the myocardiuminvolving the myocardium

• Results from infection, Results from infection, usually asymptomaticusually asymptomatic

• Frequently associated with Frequently associated with acute pericarditisacute pericarditis

• Treat underlying causeTreat underlying cause

Rheumatic FeverRheumatic Fever

• Inflammatory disease of the Inflammatory disease of the heart potentially involving all heart potentially involving all layers of the heartlayers of the heart

RHEUMATIC HEART DISEASE:RHEUMATIC HEART DISEASE:

• Chronic condition resulting Chronic condition resulting from rheumatic fever, from rheumatic fever, charachterized by scarring charachterized by scarring and deformity of the heart and deformity of the heart valvesvalves

Valve DisordersValve Disorders

• Regurgitation (re-GUR-jih-TA-Regurgitation (re-GUR-jih-TA-shun) shun)

• Stenosis (ste-NO-sis) Stenosis (ste-NO-sis)

Valve DysfunctionValve Dysfunction

• When any of the heart When any of the heart valves do not close or open valves do not close or open properly, blood flow is properly, blood flow is affected. affected.

How the Heart Works:

http://youtu.be/WXwYYsi6z7Q

Normal Heart Normal Heart

Valvular Stenosis and Valvular Stenosis and RegurgitationRegurgitation

Mitral Valve Mitral Valve StenosisStenosis

Mitral Valve Mitral Valve RegurgitationRegurgitation

• Valve patency depends onValve patency depends on• Left atriumLeft atrium• Left ventricle Left ventricle

• Abnormality of any of these Abnormality of any of these structures can result in structures can result in regurgitation. regurgitation.

Mitral Valve Mitral Valve ProlapseProlapse

• Mitral valve prolapse is Mitral valve prolapse is usually an inherited usually an inherited connective tissue disorder connective tissue disorder resulting in enlargement of resulting in enlargement of one or both of the mitral one or both of the mitral valve leaflets. valve leaflets.

• Infective endocarditis may Infective endocarditis may cause perforation of a cause perforation of a leaflet, or the scarring leaflet, or the scarring following the infection may following the infection may cause retraction of the cause retraction of the leaflets or chordae leaflets or chordae tendineae. tendineae.

Aortic Valve Aortic Valve StenosisStenosis

• Results from a previous Results from a previous rheumatic fever or rheumatic fever or fibrocalcific degeneration in fibrocalcific degeneration in older adultsolder adults

• Valve leaflets stiffen and Valve leaflets stiffen and retract, stenosis occursretract, stenosis occurs

• Obstruction of blood flow Obstruction of blood flow from left ventricle to aorta from left ventricle to aorta during systoleduring systole

Aortic Valve Aortic Valve RegurgitationRegurgitation

• Caused by infective endocarditis, Caused by infective endocarditis, trauma, or aortic dissectiontrauma, or aortic dissection

• Retrograde blood flow from Retrograde blood flow from ascending aorta into LV during ascending aorta into LV during diastole=volume diastole=volume overload=hypertrophy, decreased overload=hypertrophy, decreased contractility=pulmonary HTN & contractility=pulmonary HTN & RVFRVF

• Acute AVR =Life threatening Acute AVR =Life threatening emergencyemergency

• Chronic AVR= result of rheumatic Chronic AVR= result of rheumatic heart disease, congenital heart disease, congenital disorders; disorders;

Tricuspid & Pulmonic Tricuspid & Pulmonic Valve diseaseValve disease

• UncommonUncommon

• Stenosis occurs more frequently Stenosis occurs more frequently than regurgitation than regurgitation

• Increase in blood volume to RA Increase in blood volume to RA and RVand RV

• RA enlargement & elevated RA enlargement & elevated systemic venous pressuressystemic venous pressures

Collaborative Care of Collaborative Care of Valvular Heart Valvular Heart

Disease Disease

• Prevention Prevention

• Anticoagulant therapyAnticoagulant therapy

• Percutaneous Transluminal Percutaneous Transluminal Balloon ValvuloplastyBalloon Valvuloplasty

• SurgerySurgery• Valvulotomy (valve repair)Valvulotomy (valve repair)• Prosthetic mechanical Prosthetic mechanical

valves (valve replacement)valves (valve replacement)• Prosthetic biologic valves Prosthetic biologic valves

(valve replacement)(valve replacement)

Questions?Questions?

• For more information and to For more information and to post follow up comments or post follow up comments or questions:questions:

• http://teachingandlearninginnursing.wikispaces.com/

ReferencesReferences

• Lewis, S., Heitkemper, M, & Dirksen, S. Lewis, S., Heitkemper, M, & Dirksen, S. (2007). (2007). Medical Surgical Nursing, 7Medical Surgical Nursing, 7thth Ed. Ed.. St. . St. Louis: Mosby, Chapter 37.Louis: Mosby, Chapter 37.

• Lewis, S., Heitkemper, M, & Dirksen, S. Lewis, S., Heitkemper, M, & Dirksen, S. (2011). (2011). Medical Surgical Nursing, 8Medical Surgical Nursing, 8thth Ed. Ed.. St. . St. Louis: Mosby, Chapter 37.Louis: Mosby, Chapter 37.

• National Heart Lung and Blood Institute. National Heart Lung and Blood Institute. (2012). What is heart valve disease? (2012). What is heart valve disease? Retrieved from Retrieved from http://www.nhlbi.nih.gov/health/health-http://www.nhlbi.nih.gov/health/health-topics/topics/hvd/topics/topics/hvd/

• National Heart Lung and Blood Institute. National Heart Lung and Blood Institute. (2012). What is endocarditis? Retrieved (2012). What is endocarditis? Retrieved fromhttp://www.nhlbi.nih.gov/health/health-fromhttp://www.nhlbi.nih.gov/health/health-topics/topics/endo/ topics/topics/endo/

• Youtube.com. (2012). How the heart works Youtube.com. (2012). How the heart works animation video. Retrieved April 6, 2012 animation video. Retrieved April 6, 2012 from http://www.youtube.com/watch?from http://www.youtube.com/watch?v=WXwYYsi6z7Q&feature v=WXwYYsi6z7Q&feature