Valvular Heart Disease/Myopathy/Aneurysm

Valvular Heart Disease HeartPoint: HeartPoint Gallery mmon/articles.cfm?ARTID=187

Risk Factors Rheumatic Heart Disease MI Congenital Heart Defects Aging CHF

Pathophysiology Stenosis- narrowed valve, increases afterload Regurgitation or insufficiency- increases preload. The heart has to pump same blood **Blood volume and pressures are reduced in front of the affected valve and increased behind the affected valve. This results in heart failure All valvular diseases have a characteristic murmur murmurs

Mitral Valve Stenosis

Mitral Stenosis Dec. flow into LV LA hypertrophy Pulmonary pressures increase Pulmonary hypertension Dec. CO * early symptom is DOE Later get symptoms of R heart failure A fib is common- anticoagulants Usually secondary to rheumatic fever

Mitral Regurgitation Regurg of blood into LA during systole LA dilation and hypertrophy Pulmonary congestion RV failure LV dilation and hypertrophy-to accommodate inc. preload and dec CO

Mitral Valve Prolapse A type of mitral insufficiency Usually asymptomatic May get atypical chest pain related to fatigue Tachydysrhythmias may develop Risk for endocarditis is increased and need prophylactic antibiotics

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Aortic Stenosis Increase in afterload Reduced CO LV hypertrophy Incomplete emptying of LA Pulmonary congestion RV strain

Symptoms S yncope A ngina D yspnea

Aortic Stenosis May be asymptomatic for many years due to compensation DOE, angina, and exertional syncope are classic symptoms Later get signs of R heart failure Untreated-poor prognosis %sudden cardiac death

Aortic Regurgitation Get increased preoad- 60% of SV can be regurgitated Characteristic water hammer pulse Regurgitation of blood into the LV LV dilation and hypertrophy Dec. CO

Water Hammer pulse Pulse, water hammer: A jerky pulse that is full and then collapses because of aortic insufficiency (when blood ejected into the aorta regurgitates back through the aortic valve into the left ventricle ). Also called a Corrigan pulse or a cannonball, collapsing, pistol-shot, or trip-hammer pulse.

Tricuspid and Pulmonic Valve Disorders Result in R side heart failure

Diagnostic Tests Echo- assess valve motion and chamber size CXR EKG Cardiac cath- get pressures

Medications Like Heart Failure ACE, Dig Diuretics Vasodilators Beta blockers Anticoagulants *Prophylactic antibiotics

Medical/ Surgical Treatment Percutaneous balloon valvuloplasty Surgery Open commissurotomy- open stenotic valves Annuloplasty- can be used for both Valve Replacement Mechanical-need anticoagulant Biologic-only last about 15 years Ross Procedure

Nursing Diagnoses Decreased Cardiac Output Activity Intolerance Risk for Infection Ineffective Protection

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Cardiomyopathy Primary-idiopathic Secondary Ischemia infectious disease exposure to toxins Metabolic disorders Nutritional deficiencies

Pathophysiology Dilated Most common Cocaine and alcohol abuse Chemotherapy pregnancy Hypertension Genetic * Heart chamber dilate and contraction is impaired and get dec. EF% *Dysrhythmias are common- SVT Afib and VT Prognosis poor-need transplant

Pathophysiology Hypertrophic Genetic Also known as IHSS or HOCM Get hypertrophy of the ventricular mass and impairs ventricular filling and CO Symptoms develop during or after physical activity Sudden cardiac death may be first symptom Symptoms are dyspnea, angina and syncope

Pathophysiology Restrictive Least common Rigid ventricular walls that impair filling Contraction and EF normal Prognosis-poor

Diagnostics Echo-wall motion and EF EKG CXR Hemodynamics Perfusion scan Cardiac cath Myocardial biopsy

Medications Same as for heart failure except for hypertrophic

Treatment Surgery Vad-bridge to transplant Heart Transplant Myoloplasty ICD- antiarrhythmics are negative inotropes Dual chamber pacemaker Hypertrophic- excision of ventricular septum

Heart transplant virtual transplant

Nursing Diagnoses Decreased Cardiac Output Fatigue Ineffective Breathing Pattern Fear Ineffective Role Performance Anticipatory grieving

Aortic Aneurysms

Definition Abnormal dilation of a blood vessel at a site of weakness or a tear in the vessel wall. Usually secondary to atherosclerosis. Most commonly affect the aorta

Layers of an artery

AAA

Aneurysms location

Saccular

Fusiform Most are fusiform and 98% are below the renal artery

False or Pseudo A pseudoaneurysm is actually a disruption in the intima and media of the aorta, and only the adventitia/surrounding tissue retains blood within the aortic cavity. Ex. A hemotoma after a heart cath

Dissecting Blood invades or dissects the layers of the vessel wall

Aortic dissection occurs when blood enters the wall of aorta, separating its layers, and creating a blood filled cavity.

Thoracic Aortic Aneurysm Frequently asymptomatic May have substernal, neck or back pain Other symptoms depend on location and structures they compress

Abdominal Aortic Pulsating mass in mid and upper abdomen and bruit over the mass Pain intensity correlates to size and severity May have thrombi It can rupture causing shock and death in 50% of rupture cases

Aortic dissection Life threatening emergency Happens when the intima tears and causes hemorrhage into the media Hypertension is main cause *Primary symptom is excruciating pain May get syncope,dyspnea and weakness Peripheral pulses are absent

Diagnostic Tests for Aneuysms Most are diagnosed on routine work-up CXR Abd. Ultrasound TEE CT or MRI Angiography

Medications Anti-hypertensives Beta blockers, Vasodilators Calcium channel blockers Nipride Sedatives Niacin, mevocor, statins Post-op anti-coagulants

Surgery Usually repaired if >5cm Open procedure- abd incision, cross clamp aorta,aneuysm opened and plaque removed, then graft sutured in place Pre-op assess all peripheral pulses Post-op-check urine output and peripheral pulses hourly for 24 hours- (when to call Dr.) Endovascular stents- placed through femoral artery

Nursing Assessment Pain- chest, abd or back pain Hypertension(other vital signs) Peripheral pulses Pulsation in upper abdomen SOB

Nursing Diagnoses Risk for Ineffective Tissue Perfusion Risk for Injury Anxiety Pain Knowledge Deficit

Prevention Prevent atherosclerosis Treat and control hypertension Diet- low cholesterol, low sodium and no stimulants Careful follow-up if less than 5cm. It can grow.5cm /year

Complications Rupture Back pain Hypotension Pulsating mass Thrombi Renal Failure

Rupture Triad Back pain Hypotension Pulsating hematoma