Cardiac Pathologies For Nursing

Cardiac Pathologies
Bacterial Endocarditis


•     Inflammation of the Endocardium and heart valves.

Causes:
•    Direct invasion by bacteria as streptococci, entrerococci, pneumococci, staphylococci, or fungi
Risk factors:
•    Rheumatic heart disease
•    Mitral valve prolapse
•     Note: infective Endocarditis is more common in older persons, because of decreased immunologic responses to infection.

Clinical manifestation:
•    Fever is intermittent and may be absent in patients who receiving antibiotics or corticosteroids, anorexia, wt loss, cough, back and joint pain, heart murmurs, enlargement of the heart, headache.

Management:
•    If the cause is bacteria , so antibiotic penicillin is usually the medication of choice.
•    If the cause is fungus, so antifungal agent , such as amphatercin B , is the usual Rx.
•    Surgery : surgical valve replacement.

Infective Endocarditis
Infective Endocarditis

Myocarditis

•    Is an inflammatory process involving the cardiac muscles, usually results from infectious process, bacterial , viral,  or others (chemical poisons such as alcholism.
Clinical manifestation:
•    Depend on the type of infection and the dgree of myocardial damage. Fatigue, dyspnea, palpitations, chest discomfort, cardiac enlargement.
•    Fever and tachycardia are frequently seen.
•    Symptoms of C.H.F may developed.
Management:
•    If the cause of myocarditis is hemolytic streptococci, penicillin is the drug of choice.
•    Bed rest to ↓ cardiac work.
•    If CHF developed [the Rx of CHF]
•    Digitalis  (digoxin) to increase myocardial contractility
•    Diuretics (lasix)
Cardiomyopathies
–    The myocardium (middle muscular layer) around the left ventricle becomes flabby, altering cardiac function and resulting in decreased cardiac output. Increased heart rate and increase muscle mass compensate in early stages, but in later stages heart failure develops

Types Cardiomyopathies

Dilated (Congestive):
most common, in which dilated heart chambers contract poorly, causing blood to pool and reducing cardiac output.

Hypertrophic
In which hypertrophic left ventricular is unable to relax and fill properly

Restrictive
    Decreased compliance due to idiopathic     fibrosis.

Cardiomyopathies

Cardiomyopathies
Pericarditis


•    Refer to an inflammation of the pericardium, the fibroserous sac that envelops supports and protects the heart.

Causes:
•    Bacterial [streptococcus, staphylococcus or viral.
•    Rheumatoid fever, arthritis.
•    Radiation therapy. Cardiac catheterization and pacemaker implantation.
•    Idiopathic factors.

Clinical manifestation:
•    1- The characteristic symptoms is pain. The pain is felt beneath the clavicle and in the neck aggravated by breathing, turning in bed. And the pain relieved by sitting posture.
•    2- Friction rub: occurs when the pericardial surface loss their lubricating fluid because of inflammation [characteristic sign].
•    Sharp and commonly sudden pain that usually starts over the sternum and radiates to the neck, shoulders, back and arm (increase with deep inspiration and decreasing when the patient sits up , pulling the heart away from the diaphragmatic pleurae of the lungs.

Management:
•    Salicylates such as aspirin have both analgesic and anti-inflammatory effect .
•    Determine the cause and administer medications according to specific cause.
•    The patient is placed on bed rest until the fever, chest pain and friction rub have disappeared
•    Antibiotics
•    Surgery: pericardiocentesis

Pericardial Disease
Pericardial Disease
Cor Pulmonale

Definition:  Right-sided heart failure secondary to pulmonary hypertension
Causes of pulmonary hypertension are diverse and extensive

Cardiac tamponade

•    Also called cardiac compression. Compression of the heart produced by the collection of blood or fluid in the sac around the heart. This can result when a blood vessel in the heart breaks or by a wound to the heart.
•    S & S: Muffled heart sounds on auscultation, neck vein distension, restlessness, low blood pressure, decreased heart sounds, fast breathing, and weak or absent pulses.
•    Chest x-ray shows slightly widened mediastinum and cardiomegaly, Echocardiography records pericardial effusion with signs of right ventricular and atrial compression
Pericardial Effusions
Refers to the accumulation of fluid in the pericardial sac, this occurrence may accompany with pericarditis.

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Posted in Cardiovascular, Critical Care Nursing

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