management of patient with structural infection and inflamatory cardiac desorder

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 29
Management of Patients With
Structural, Infectious, and
Inflammatory Cardiac
Disorders

Question
Is the following statement True or False?
The mitral valve is a semilunar valve located between the
right ventricle and the pulmonary artery.

Answer
False
The mitral valve is an atrioventricular valve located
between the left atrium and left ventricle. The pulmonic
valve is a semilunar valve located between the right
ventricle and the pulmonary artery.

Valvular Disorders
• Regurgitation: the valve does not close properly and
blood backflows through the valve.
• Stenosis: the valve does not open completely and blood
flow through the valve is reduced.
• Valve prolapse: the stretching of an atrioventricular valve
leaflet into the atrium during diastole.

Question
Which statement is correct about regurgitation?
A.Valve does not close properly and blood backflows
through the valve.
B.Valve does not open completely and blood flow through
the valve is reduced.
C.Stretching of an atrioventricular valve leaflet into the
atrium during diastole.
D.Repair of a cardiac valve’s outer ring.

Answer
A
• Regurgitation: the valve does not close properly and
blood backflows through the valve.
• Stenosis: the valve does not open completely and blood
flow through the valve is reduced.
• Valve prolapse: the stretching of an atrioventricular valve
leaflet into the atrium during diastole.
• Annuloplasty: repair of a cardiac valve’s outer ring.

Specific Valvular Disorders
• Mitral valve prolapse
• Mitral regurgitation
• Mitral stenosis
• Aortic regurgitation
• Aortic stenosis

Pathophysiology: Left Heart Failure as a
Result of Aortic and Mitral Valvular Heart
Disease

Question
Is the following statement True or False?
Xenograft is a heart valve replacement made of tissue from
an animal heart valve.

Answer
True
Xenograft is a heart valve replacement made of tissue from
an animal heart valve.

Valve Repair and Replacement Procedures
• Valvuloplasty
– Commissurotomy: open or closed
– Balloon valvuloplasty: open or closed
– Annuloplasty
– Leaflet repair
– Chordoplasty
• Valve replacement

Balloon Valvuloplasty

Annuloplasty Ring Insertion

Valve Leaflet Resection and Repair with
Ring Annuloplasty

Valve Replacement

Types of Replacement Valves
• Mechanical valves
– Do not deteriorate or become infected as easily, but
are thrombogenic and require life-long
anticoagulation therapy.
• Tissue (biologic) valves
– Xenograft (heterograft): pig or cow valve
– Homograft (allograft): human valve
– Autograft: patient’s own valve

Mechanical Valves

Cardiomyopathy
• Cardiomyopathy is a series of progressive events that
culminates in impaired cardiac output and can lead to
heart failure, sudden death, or dysrhythmias.
• Types:
– Dilated cardiomyopathy
– Hypertrophic cardiomyopathy
– Restrictive cardiomyopathy
– Arrhythmogenic cardiomyopathy
– Unclassified cardiomyopathies

Types of Cardiomyopathy

Infectious Diseases of the Heart
• 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.

Rheumatic Endocarditis
• Occurs most often in school-age children, after group A
beta-hemolytic streptococcal pharyngitis.
• 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.

Infective Endocarditis
• 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
– Subacute

Pericarditis
• Inflammation of the pericardium
• Many causes
• Nursing diagnosis: pain
• Potential complications
– Pericardial effusion
– Cardiac tamponade

Question
Patients with myocarditis are sensitive to digitalis. What
might be an expected change in order for digitalis for
these patients?
A.Increase in dosage required
B.Decrease in dosage required
C.No change in dosage required

Answer
B
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.

management of patient with structural infection and inflamatory cardiac desorder

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