Exam 2 - Structural and Infective Disorders of the Heart

• body

• aorta

• aortic valve

• left ventricle

• mitral (bicuspid) valve

• left atrium

• pulmonary veins

• LUNGS

• pulmonary arteries

• pulmonary valve

• right ventricle

• tricuspid valve

• right atrium

• body

EKG!!!

1. endocarditis (infection/inflammation of the inside of the heart (valve))

2. myocarditis (infection/inflammation of the heart muscle (ventricles))

3. pericarditis (infection/inflammation AROUND the heart)

• bacteria is adhering the heart valve, leading to damaged valves / infection in the blood

the bacteria on the valve can break off and go to either the lungs (PE) or the brain (stroke)

• STREP!!

  • lack of antibiotic compliance (infection cannot go away, leading to rheumatic heart disease (damaged valves)

• rheumatic endocarditis - caused by STREP

• infective endocarditis - caused by every other form of bacteria

• populations: pts with prosthetic heart valves (bacteria adheres to foreign objects), cardiac devices, structural cardiac defects; elderly; IV drug abusers; immunosuppressed (with meds); fungal endocarditis

• Others situations: indwelling IV catheters; heart disease; bacteremia (tattoos, piercings); dental procedures in patients with prosthetic heart valves or other cardiac devices)

1. CBC (WBC)

2. echocardiogram

3. blood culture

1. SCRUB THE HUB on IVs

2. infection measures

3. medication adherence (antibiotics)

4. dental knowledge (know if pt has prosthetic heart valve or other cardiac devices when doing dental procedures)

LONG TERM ANTIBIOTICS (IV six weeks via a PICC line/home health care)

• telemetry

• vitals

• antipyretics (for fever)

• understand and recognize symptoms PE/stroke

• FEVER

• murmur

• petechia (micro hemorrhages; red spots on the skin)

• cardiomegaly

• splenomegaly

• comes from a viral infection (such as COVID); can be a complication from endocarditis

• can result in cardiomyopathy

• viral illness with chest pain

1. MRI of the heart

2. EKG changes (ventricular dysrhythmias)

SYMPTOM MANAGEMENT (antipyretics, keeping HR decreased, bed rest)

T-dap vaccine with booster

1. after CABG or MI

2. viral infection

1. chest pain

2. SOB

3. fever

1. pericardiocentesis (fluid removal from pericardium)

2. drain placement (maybe)

3. symptom management

SQUEEZE

they easily open when stimulated, letting the blood through, and easily closed with the leaflets coming back together, preventing ANY backflow to the previous chamber

• the valve is weakened, causing the leaflets to prolapse (BALLOON BACK) into the atrium as blood is pumped into the ventricles

• the result of PROLONGED PROLAPSE!!; the prolapsed valve starts to allow blood to leak back into the previous chamber (causing strain on that chamber)

• more common in females

• monitor using ECHO!!

• valve has trouble OPENING, leading to reduced blood flow to the next chamber (STIFF!!!)

RHEUMATIC HEART DISEASE, and you get it by getting a strep infection, leading to rheumatic fever

ANTIBIOTICS!! (SPECIFICALLY COMPLIANCE TO THEM)

• aortic and mitral

• the others can fail, and right sided heart failure can occur ☹

• inherited connective tissue disorders (usually produce no symptoms; more common in women; HEREDITARY!!)

• congenital heart defects!

HEART FAILURE!!

• LEFT: aortic valve (causes left ventricle to hypertrophy, as it it working harder to get blood out to the body)

• RIGHT: mitral valve (causes right ventricle hypertrophy, as it is working harder to get blood going forward)

1. transesophageal echocardiogram

2. regular echocardiogram

• dizziness

• syncope

• exercise intolerance

• fluid back up in lungs

• ventricular arrhythmias

• chest pain

• SOB

• avoidance of stimulants (tobacco, alcohol, caffeine)

• MONITOR if asymptomatic (echo)

• valve replacement surgery

• balloon valvuloplasty (for stenotic valves, to allow for more blood flow through the damaged valve)

• surgery ABRUPTLY corrects the flow of blood and complications may occur (backwards heart failure that resolves in a few hours or days)

• nearly ALL patients will have some STENOSIS post valve replacement

  • once the valve is replaced, it will take months for the chambers that were RECEIVING the extra blood to gradually improve

• bleeding

• thromboembolism

• infection (endocarditis)

• heart failure

• dysrhythmias

• WILL BE PUT ON LIFELONG ANTICOAGULANTS!!!

• common dental procedures (even non-srugircal), often causes bacteremia of oral commensals (the etiological agents of infective endocarditis)

  • periodontally disease pts are at risk from bacteremia even AFTER brushing the teeth, and can result in mortal infective endocarditis in those who have a predisposed risk for this disease

• NEED to be educated on how to prevent infective endocarditis

  • PROPHYLACTIC antibiotics for dental procedures and respiratory procedures (tonsillectomy, adenoidectomy)

  • repeat echo at the 3-4 week mark and then every 1-2 years

• LIFELONG ANTICOAGULATION

• B. “I will have my prothrombin time checked on a regular basis”

1. dilated (DCM)

2. hypertrophic (HCM)

3. restrictive (RCM)

4. arrhythmogenic right ventricular (ARVC)

DILATED (90% most common)

heart chamber dilates / thin mucus in the ventricles; heart muscle gets THINNER/WEAKER; NO SQUEEZE, meaning no blood to the body

• exaggerated hypertrophy of heart muscle (gets VERY ABNORMALLY LARGE)

YOUNG ATHLETES!!

heart muscle stiffens and does not allow contractions or squeeze (NO BLOOD TO THE BODY!!)

right ventricle muscle stiffens

systolic AND diastolic volumes are elevated, but a decreased EJECTION FRACTION:((

• idiopathic (MOST CASES)

• ETOH

• myocarditis

• chemo

• pregnancy

• the stretching of the heart muscle causes the heart to enlarge (CARDIOMEGALY); NO SQUEEZE!! LOW EJECTION FRACTION ☹

• development of both systolic and diastolic murmurs will occur, and S3/S4 will be audible on auscultation

• present if the diameter of the heart is more than 50% of the inner diameter of the ribcage (cardiothoracic ratio)

LEFT SIDED HEART FAILURE signs and symptoms (LUNG s/s, fatigue, confusion, etc)

• beta blockers (slow the heart rate)

• amiodarone (ventricular antidysrhythmic)

• diuretics (reduce excess fluid in body/decrease preload)

• diltiazem (cardizem) or Nifedipine (Procardia) (CALCIUM CHANNEL BLOCKERS)

• inotropes (DIGOXIN!!)

• blocks potassium currents that are responsible for the repolarization of the heart during phase 3 of cardiac action potential

relaxes the blood vessels so the heart does not have to pump as hard; also increases the supply of blood and oxygen to the heart; improves angina and exercise intolerance

• increases force and velocity of contractility of heart and improves cardiac output; produces antidysrhythmic effect as well

take the patients apical pulse for ONE WHOLE MINUTE!!! hold if below 60 or greater than 100 or heart rate is irregular

• fatigue

• muscle weakness

• confusion

• HALOS!!!!

hypokalemia increases toxicity, as you need potassium to bind for digoxin to work (no potassium = no work)

1. pacemaker/defibrillator

2. LVAD (left ventricular assistive device) - a hose to bypass the aortic valve; continuous pump

3. heart transplant

• need to get a manual bp cuff and get an MAP (mean arterial pressure)

• RIGHT SIDE!!

blood can’t even get to the left ventricle, causing right ventricle to fail due to excess strain