1. Chapter 37 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2. 2

3. 3 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.

4. 4  Classification  Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

5. 5 Fig. 37-2. Bacterial endocarditis of the mitral valve. The valve is covered with large, irregular vegetations (arrow).

6. 6 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-3. Pathogenesis of infective endocarditis.

7. 7  Clinical Manifestations  Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

8. 8  Collaborative Care ◦ Prophylactic treatment ◦ Drug therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

9. 9  Nursing Assessment  Nursing Diagnoses  Planning Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

10. 10  Nursing Implementation ◦ Health promotion ◦ Ambulatory and home care  Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

11. 11  Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

12. 12 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-4. Acute pericarditis. Note shaggy coat of fibers covering surface of heart.

13. 13  Clinical Manifestations  Complications  Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

14. 14 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-5. A, X-ray of a normal chest. B, Pericardial effusion is present, and the cardiac silhouette is enlarged with a globular shape (arrows).

15. 15  Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

16. 16 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-6. Pericardiocentesis performed under sterile conditions in conjunction with electrocardiogram (ECG) and hemodynamic measurements.

17. 17 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

18. 18  Etiology and Pathophysiology  Clinical Manifestations  Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

19. 19 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

20. 20  Etiology and Pathophysiology  Clinical Manifestations  Diagnostic Studies  Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

21. 21 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

22. 22  Etiology and Pathophysiology ◦ Cardiac lesions and valve deformities Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

23. 23 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-7. Mitral stenosis and clumps of vegetation (V) containing platelets and fibrin. Mitral leaflets are thickened and fused and have clumps of vegetation containing platelets and fibrin.

24. 24  Etiology and Pathophysiology, continued ◦ Extracardiac lesions  Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

25. 25 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table 37-10. Modified Jones Criteria for Diagnosing Rheumatic Fever.

26. 26  Clinical Manifestations, continued ◦ Major criteria ◦ Minor criteria ◦ Evidence of infection  Complications  Diagnostic Studies  Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

27. 27  Nursing Assessment  Nursing Diagnoses  Planning  Nursing Implementation ◦ Health promotion ◦ Acute intervention ◦ Ambulatory and home care  Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

28. 28 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-8. Valvular stenosis and regurgitation. A, Normal position of the valve leaflets, or cusps, when the valve is open and closed. B, Open position of a stenosed valve (left) and position of closed regurgitant valve (right). C, Hemodynamic effect of mitral stenosis. The stenosed valve is unable to open sufficiently during left atrial systole, inhibiting left ventricular filling. D, Hemodynamic effect of mitral regurgitation. The mitral valve does not close completely during left ventricular systole, permitting blood to reenter the left atrium.

29. 29  Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

30. 30 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-9. Mitral stenosis with classic “fish mouth” orifice. S, Stenosis.

31. 31  Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

32. 32  Etiology and Pathophysiology  Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

33. 33  Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

34. 34 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-10. Mitral valve prolapse. In this valvular abnormality, the mitral leaflets have prolapsed back into the left atrium. They also demonstrate hooding (arrow). The left ventricle is on the right.

35. 35  Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

36. 36  Etiology and Pathophysiology  Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

37. 37  Etiology and Pathophysiology  Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

38. 38  Etiology and Pathophysiology  Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

39. 39 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

40. 40  Conservative Therapy ◦ Percutaneous transluminal balloon valvuloplasty Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

41. 41 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-11. Mitral valvuloplasty performed by the Inoue technique. The catheter is placed in the mitral valve and the distal part of the Inoue balloon inflated (top). The balloon is then pulled back in the mitral valve and inflated for 10 to 15 seconds under fluoroscopic control (middle) until the waist of the balloon is no longer visible (bottom) and the balloon falls back into the left atrium.

42. 42  Conservative Therapy, continued ◦ Surgical therapy  Valve repair  Valve replacement Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

43. 43 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-12. Types of prosthetic heart valves. A, Starr-Edwards caged ball valve. B, St. Jude bi-leaflet valve. C, Carpentier-Edwards porcine.

44. 44  Nursing Assessment  Nursing Diagnoses  Planning  Nursing Implementation ◦ Health promotion ◦ Acute intervention and ambulatory and home care  Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

45. 45 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

46. 46  Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

47. 47 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-13. Dilated cardiomyopathy. The dilated left ventricular wall has thinned, and the chamber size and volume are increased.

48. 48 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-14. Types of cardiomyopathy and the differences in ventricular diameter during systole and diastole, compared with a normal heart.

49. 49  Clinical Manifestations ◦ Diagnostic studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

50. 50 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

51. 51  Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

52. 52 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 37-15. Hypertrophic cardiomyopathy. There is marked left ventricular hypertrophy, and the chamber size and volume are decreased.

53. 53  Clinical Manifestations ◦ Diagnostic studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

54. 54 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

55. 55  Etiology and Pathophysiology  Clinical Manifestations ◦ Diagnostic studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

56. 56 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.