Cardiac Disorders

a systemic inflammatory disease that sometimes follows a group A streptococcal infection of the throat

Rheumatic fever

The heart is a double pump—the right side facilitates

pulmonary circulation

the left side of the heart is responsible for

systemic circulation

an emergency condition in which fluid accumulates in the pericardium

cardiac tamponade

the sac in which the heart is enclosed

pericardium

It is a major thoracic operation requiring a full thoracotomy.Nowadays this procedure can be performed using thoracoscopy. All fibrous tissue is removed from the visceral pleural peel and pus is subsequently drained from the pleural space.

decortication

the formation of a blood clot ("thrombus") in a deep vein

deep vein thrombosis(DVT)

inflammation of endocardium, myocardium, and pericardium
of the heart.

pancarditis

fast abnormal heart rhythms

Tachydysrrhythmias

Carditis ,polyarthritis ,rash, subcutaneous nodules, and chorea

s/s of rheumatic fever

characterized by involuntary grimacing and an inability to use skeletal muscles in a coordinated manner

chorea

A red, spotty rash appears on the trunk but disappears rapidly, leaving irregular circles on the skin which is characteristic for

rheumatic fever

antistreptolysin O titer, erythrocyte sedimentation rate (ESR), and C-reactive protein are elevated in this condition

rheumatic fever

Specific cardiac tests, such as ________, may show structural changes in the valves, size of the heart, and the heart's ability to contract.

electrocardiography (ECG) and echocardiography

____ is the drug of choice for group A streptococci

Penicillin

In rheumatic fever,_____is used to control the formation of blood clots around heart valves

Aspirin

______ are used to suppress the inflammatory response.

Steroids

The nurse plans diversional activities that require minimal activity, such as reading and putting puzzles together, to reduce the work of the myocardium in what condition

Rheumatic carditis

inflammation of the inner layer of heart tissue

Infective endocarditis

clients with rheumatic carditis do develop _____, it is initially considered an autoimmune response—not an infection

endocarditis

Streptococcus viridans and Staphylococcus aureus are the bacteria most frequently responsible for this disorder

Infective endocarditis

anyone can contract endocarditis, clients with a history of ______ are especially susceptible

rheumatic carditis

microorganisms migrate to the endocardial surface, they attach themselves to the vegetations composed of fibrin and platelets surrounding the heart valves, chordae tendineae, and papillary muscles

endocarditis

Account for 55% of cases of endocarditis

Streptococci

Cause 30% of cases of endocarditis

Staphylococci

Related to GI malignancy

S. bovis

Require culture for 2 weeks or longer when initial culture is negative

Haemophilus parainfluenzae and Haemophilus aphrophilus

The endocardium on the _____ of the heart is affected more often bacterial endocarditis

left side

_______can have an acute onset (less than 1 week) from a previously healthy state

Infective endocarditis

s/s are fever, chills, muscle aches in the lower back and thighs, and joint pain related to this condition

Infective endocarditis

purplish, painful nodules called _______ may appear on the pads of the fingers and toes related to infective endocarditis

Osler nodes

Black longitudinal lines, called _____, can be seen in the nails are related to infective endocarditis

splinter hemorrhages

In infective endocarditis there may be small, painless, red-blue macular lesions known as _____on the palms and soles of the feet

Janeway lesions

white areas in the retina surrounded by areas of hemorrhage, may be detected.

Roth's spots

A _______ may be present from malfunctioning valves.

heart murmur

tiny, reddish hemorrhagic spots on the skin and mucous membranes, are signs of embolization

Petechiae

Emboli to the brain cause

cerebrovascular accidents

pulmonary emboli result in sudden

chest pain and dyspnea

Clients with heart failure have s/s of

dyspnea, hypotension, and peripheral or pulmonary edema

_______is more likely than transthoracic echocardiography in infective endocarditis

Transesophageal echocardiography

If a heart valve has been severely damaged and drug therapy does not adequately support the heart in failure, _______may be necessary

valve replacement

In bacterial endocarditis, the nurse informs clients that periodic antibiotic therapy is a ____ necessity because they will be vulnerable to the disease for the rest of their lives

lifelong

The usual viral agents are coxsackie virus A and B, influenza A and B, measles, adeno-virus, mumps, rubella, rubeola, Epstein-Barr virus, and cytomegalovirus are evidenced by this condition

myocarditis

______can become inflamed from the toxins of microorganisms, chronic alcohol and cocaine abuse, radiation therapy, or autoimmune disorders.

The myocardium

Clients with bulimia who use syrup of ipecac to facilitate purging can develop

myocardial damage

an inflammatory response causes the cardiac muscle tissue to swell, which interferes with the myocardium's ability to

stretch and recoil

Cardiac output is reduced and blood circulation is impaired, predisposing the client to

CHF

The myocardium becomes ischemic from a reduced supply of oxygenated blood, predisposing the client to

tachycardia and dysrhythmias

In myocarditis,Clients may complain of sharp stabbing or squeezing chest discomfort that resembles a myocardial infarction; however, the pain is relieved by

sitting up

Myocarditis manifestations include a:

low-grade fever, tachycardia, dysrhythmias, dyspnea, malaise, fatigue, anorexia and may be cyanosis

Crackles may be heard in the lungs if the left side fails. An S3 galloping rhythm or a pericardial friction rub may be heard in this condition

myocarditis

An impaired motion of the ventricular wall and reduced ejection of blood from the heart in myocarditis can be diagnosed by a

Echocardiography

Radionuclide studies reveal areas where the myocardial wall is .

enlarged, thickened, or scarred

Bed rest, a sodium-restricted diet, and cardiotonic drugs (digitalis and related drugs) are prescribed to treat

myocarditis or heart failure

The nurse monitors the client's cardiopulmonary status to assess for possible complications such as CHF or dysrhythmias. Assessments include

vital signs, daily weights, intake and output, heart and lung sounds, pulse oximetry measurements, and dependent edema

The nurse also maintains the client on ______ to reduce cardiac workload and promote healing

bed rest

If the client has a fever,independent nursing measures such as

minimizing layers of bed linen, promoting air circulation and evaporation of perspiration, and offering oral fluids.

He or she administers supplemental ______ to relieve tachycardia that may develop from hypoxemia

oxygen

In myocarditis, the nurse elevates the client's head to promote

maximal breathing potential.

a chronic condition characterized by structural changes in the heart muscle

Cardiomyopathy

The three major types of cardiomyopathies are

(1) dilated cardiomyopathy
(2 hypertrophic cardiomyopathy
(3) restrictive cardiomyopathy

______, which develops in women shortly before or after giving birth

peripartum cardiomyopathy

arrhythmogenic right ventricular cardiomyopathy, which is

inherited

a client's medical history includes disorders that are bacterial or viral in origin, a ______, or any of several other conditions that correlate with heart involvement, the possibility of cardiomyopathy is considered

family history of early cardiac deaths

others may be unaware of their condition until they experience a potentially fatal cardiac event such as a sudden dysrhythmia or heart failure in _____

others may be unaware of their condition until they experience a potentially fatal cardiac event such as a sudden dysrhythmia or heart failure

dyspnea on exertion and when lying down.
fatigued and his or her legs swell. He or she may experience palpitations and chest pain.

Dilated cardiomyopathy,

the affected person dies or becomes acutely ill after strenuous exercise with this condition

Hypertrophic cardiomyopathy

_______ is associated with syncope (sudden loss of consciousness) or near-syncopal episodes, which the client may describe as “graying out

Hypertrophic cardiomyopathy

A _______, which is an atypical heart sound, may be the first abnormal sign detected

heart murmur

The muscle of the left ventricle and septum thickens, causing heart enlargement

Hypertrophic

The cavity of the heart is stretched

dilated

Heart muscle stiffens, which interferes with its ability to stretch and fill with blood

restrictive

an endomyocardial biopsy is performed to obtain a specimen of heart tissue for microscopic examination. The biopsy may reveal

myocardial disarray

an alteration in the usual alignment of myofibrils, the contractile component of muscle tissue

myocardial disarray

In ______, radionuclide studies show the heart muscle's inability to contract efficiently when stressed during exercise.

Cardiomyopathy

which is the least common type in the United States but more common in tropical locales of Africa, India, South and Central America, and Asia, has symptoms of exertional dyspnea, dependent edema in the legs, ascites (fluid in the abdomen), and hepatomegaly (enlarged liver).

Restrictive cardiomyopathy

Antiinflammatory agents such as ______ are used in selected clients to control cardiomyopathy caused by autoimmune connective tissue disorders. Dietary _____ is restricted to reduce fluid retention.

corticosteroids

sodium

Clients with hypertrophic cardiomyopathy may experience relief of symptoms when a _____, removal of thickened myocardial muscle from the septum, is performed

ventriculomyomectomy

This surgical procedure enlarges the left ventricular chamber and allows a greater ejection of blood with each heart contraction

ventriculomyomectomy

When there are no other alternatives for supporting the heart's pumping function, the client may become a candidate for

heart transplantation

In cardiomyopathy, outpatients may be attached to an ambulatory cardiac monitor; nurses teach such clients to keep a ______ of their symptoms

journal

In cardiomyopathy, The nurse performs a physical examination that includes taking

vital signs, auscultating heart and lung sounds, and checking for peripheral edema and abdominal enlargement

In cardiomyopathy, The nurse performs a physical examination especially alert for an

irregular pulse, tachycardia, or reduced levels of oxygen saturation (SpO2) on pulse oximetry, which may occur during postural changes or exercise.

Achieve a healthy weight by following dietary instructions, limiting _____to reduce fluid retention, and avoiding beverages containing _____, which contributes to tachycardia

sodium
caffeine

Stop using tobacco products because nicotine is a ______ and cardiac stimulant

vasoconstrictor

Stay within your level of exercise tolerance or stop activity immediately if

dyspnea or chest pain develops.

Restrict driving or operating equipment if ______is a common symptom of cardiomyopathy

syncope

this can occur can occur with or without effusion

Pericarditis

the accumulation of fluid between two layers of tissue

effusion

_____usually is secondary to endocarditis, myocarditis, chest trauma, or myocardial infarction (MI; heart attack) or develops after cardiac surgery

pericarditis

Other contributing causes of pericarditis include

tuberculosis, malignant tumors, uremia, and connective tissue disorders.

acute compression of the heart

cardiac tamponade

Pericardial fluid accumulation results in

cardiac tamponade

______ is a difference of 10 mm Hg or more between the first Korotkoff sound heralding systolic blood pressure heard during expiration and the first that is heard during inspiration is evidenced by this condition:

Pulsus paradoxus

pericarditis

a difference of 10 mm Hg or more between the first Korotkoff sound heralding systolic blood pressure (BP) heard during expiration and the first that is heard during inspiration.The difference between the two is

4 to 5 mm Hg

Advise client to breathe normally throughout the assessment.
Inflate BP cuff 20 mm Hg above systolic pressure.
Deflate the cuff slowly, noting that sounds are audible during expiration but not inspiration.
Note when the first BP sound (Korotkoff's) is heard.
Continue to deflate the cuff until BP sounds are heard during both inspiration and expiration.
Measure the difference in mm Hg between the first BP sound heard during expiration and the first BP sound heard during both inspiration and expiration

Pulsus paradoxus