Med Surg Cardiac

Cardiomyopathy (disease of the muscle of the heart) is a series of progressive events that culminates in impaired cardiac output and can lead to heart failure, sudden death, or dysrhythmic
Types:
Dilated cardiomyopathy – dlaited muscle walls
Hypertrophic cardiomyopathy – heart walls are hypertrophic
Restrictive cardiomyopathy - refers to a group of disorders in which the heart chambers are unable to properly fill with blood because of stiffness in the heart
Arrhythmogenic cardiomyopathy – arrythmia associated with the RV. PVC, v tach and v fibb
Unclassified cardiomyopathies

Stenosis (hardening): the valve does not open completely and blood flow through the valve is reduced

Patients with myocarditis are sensitive to digitalis. Nurses must closely monitor these patients for digitalis toxicity, which is evidenced by dysrhythmia, anorexia, nausea, vomiting, headache, and malaise

Aortic stenosis – Narrowing of the orfice of the LV and the aorta. Result of regenerative calcification. Inflammatory changes. Risk factors. DB, HTN, Low HDL (High Cholesterol). Ventricular walls hypertrophies. Management is similar to pts with HF. Angina is a frequent symptom. Heard as a loud and ruff systolic mumur.
Use the bell of stethoscope when auscultating for extra heart sound.

Regurgitation (Back flow): the valve does not close properly and blood backflows through the valve.

Mitral valve prolapse – does not progress, asymptomatic, doesn’t normally leads to suddent death. May be caused by inherited tissue disorder. Affects women than men.
Extra heart sound is called a click. Increase of heart infection
Tell patient to avoid caffeine and alcohol and good oral hygiene practices when diagnosed with Mitral Valve Prolapse.

Occurs most often in school-age children, after group A beta-hemolytic streptococcal pharyngitis.
(Strep infect prior to 3 weeks. Pericardial and myocardial tissue affected. Permanent damage to valves. Strep must be treated)
Treatment - Aspirin, corcosteroids and ATB
Injury to heart tissue is caused by inflammatory or sensitivity reaction to the streptococci.
Myocardial and pericardial tissue is also affected, but endocarditis results in permanent changes in the valves.
Need to promptly recognize and treat “strep” throat to prevent rheumatic fever.

Mechanical valves
Do not deteriorate or become infected as easily, but are thrombogenic and require life-long anticoagulation therapy. ATB may be required for a period of time. May use cow valves or patients own valve
Tissue (biologic) valves
Xenograft (heterograft): pig or cow valve
Homograft (allograft): human valve
Autograft: patient’s own valve

Mitral valve prolapse – does not progress, asymptomatic, doesn’t normally leads to suddent death. May be caused by inherited tissue disorder. Affects women than men.
Extra heart sound is called a click. Increase of heart infection
Tell patient to avoid caffeine and alcohol and good oral hygiene practices when diagnosed with Mitral Valve Prolapse.

Mitral valve prolapse – does not progress, asymptomatic, doesn’t normally leads to suddent death. May be caused by inherited tissue disorder. Affects women than men.
Extra heart sound is called a click. Increase of heart infection
Tell patient to avoid caffeine and alcohol and good oral hygiene practices when diagnosed with Mitral Valve Prolapse.

Mitral stenosis – Obstructive of blood from left atrium to left ventricle. May be caused by Rheumatic encephalitis. Thickening of the leaflets. Left atrium is challenged to move blood into the Left ventricle and causes reduced cardiac output. Affects the right side of the heart. Eventually the R V system may fail. Narrow opening, increase resistance and heart issues. May have a weak pulse. May lead to a fibb

Inflammation of the pericardium
Many causes
Nursing diagnosis: pain
Characteristics of heart pain (Angina)
Treated with sitting up and resting hand on a table (Tripod)
Give oxygen
Potential complications
Pericardial effusion – CT scan may help diagnose large effusion
Cardiac tamponade – fluid that increases the pressure around the heart. (Emergency situation). Give oxygen, relieve pain.
Pain may increase on inspiration.
Pulse perdoxis – decrease by 10mm/hg in the systolic BP with inspiration

Infection of the inner heart
May be caused by IV drugs
A microbial infection of the endothelial surface of the heart. Vegetative growths occur and may embolize to tissues throughout the body.
Usually develops in people with prosthetic heart valves or structural cardiac defects. Also occurs in patients who are IV drug abusers and in those with debilitating diseases, indwelling catheters, or prolonged IV therapy.
Types:
Acute - Onsets (teaching is prevention education)
Subacute

Any of the layers of the heart may be affected by an infectious process.
Diseases are named by the layer of the heart that is affected.
Diagnosis is made by patient symptoms and echocardiogram.
Blood cultures may be used to identify the infectious agent and to monitor therapy.
Treatment is with appropriate antimicrobial therapy. Patients require teaching to complete the course of appropriate antimicrobial therapy, and require teaching for infection prevention and health promotion.
Pt must complete their ATB.
Teach pt infection prevention
Don’t drink after people
Promoting oral health

Aortic regurgitation – back up of blood from the left ventricle. Has no period of rest. Result of lesions affecting the integrity of the valves. Affects the closing of the valves. May be caused by trauma, encephalitis or the actual deterioration of a prior replacement of a valve. Left ventricle dilates to accommodate the increase of blood. “Muscles are thinking they need more strength” resulting in increased force. Will hear a high pitch blowing sound when you listening to heart. Tell pt to avoid physical exercision. Leads to dysrrthmia and treat HF in these pts.

Mitral regurgitation – backflow of blood from the left ventricle during systole. Leaflets of mitral valve is not closing. Chordinae tendinae thickens or fibrous. Caused by degenerative changes to the Mitral valves. May cause lung congestion by the cause of some blood backflowing into the left atrium. *** Left ventricle – Left Atrium – Lungs *** . Usually asymptomatic causing heart failure. Management is the same as patient with heart failure. Restricted activity levels.