NUR 301 Spring 2018 Alterations of Cardiovascular Function -24 - MI, ACS, Pericarditis, Endocarditi

Progressive cardiac chamber dilation and contractile

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Progressive cardiac chamber dilation and contractile dysfunction Some with related hypertrophy Heart 2 to 3 times normal weight, flabby, dilation of all chambers Manifestations Heart failure signs and symptoms Dyspnea, orthopnea, decreased exercise tolerance, decreased ejection fraction Stagnant blood in chambers with thrombus, emboli formation Mitral valve regurgitation Arrhythmias Treatment Manage signs and symptoms and decrease work load of heart
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8 Diuretics to decrease preload, beta blockers to decrease heart rate and oxygen need, dilators to decrease afterload, ACE inhibitors to prevent vasoconstriction Anticoagulants, antidysrhythmics Pacing, implantable cardioverter-defibrillator Heart transplant Primary Restrictive Cardiomyopathy Restriction to ventricular filling Idiopathic, radiation damage, amyloidosis, sarcoidosis, tumors Dyspnea, paroxysmal nocturnal dyspnea (PND), orthopnea, edema, ascites, fatigue, weakness Heart failure without enlargement of heart Acquired Cardiomyopathies Myocarditis – inflammation/immune response Peripartum Cardiomyopathy Last weeks of pregnancy Secondary Cardiomyopathies Cardiomyopathy in presence of multisystem disorders Drugs, DM, MD, autoimmune disorders, cancer treatment (radiation, Adriamycin) Endocardial and Valvular Disorders 625 Valvular Heart Disease Hemodynamic Changes Valves function to provide direction to blood flow within the heart Valves altered by congenital defects, trauma, ischemia, degeneration, inflammation Mitral and aortic disorders most common Stenosis/Stenotic Valves – narrowing of valve opening – resistance to blood flow – causes turbulent flow Incompetent/Regurgitant Valves – do not close completely allowing back flow of blood Effects vary with valve involved Aortic Valve Disorders 626 Openings to coronary arteries located behind the aortic valve Aortic Valve Stenosis 626 Narrowing of valve opening with resistance to blood flow from left ventricle to aorta Valve malformations and calcifications (wear and tear) Valve calcification similar to coronary artery disease Develops gradually so left ventricle adapts by becoming thicker (hypertrophy) but with normal chamber volume Loud systolic ejection murmur or split second heart sound
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9 Develop to angina, syncope, heart failure following decrease activity tolerance May treat with valve replacement – area of aortic valve near conduction system of heart so increased risk for dysrhythmias post operative Aortic Valve Regurgitation 627 Backflow of blood to left ventricle during diastole Left ventricle increases stroke volume to keep up with blood flow from the lungs Seen with rheumatic fever, aortic dilation, infective endocarditis, Marfan Syndrome, HTN, trauma, prosthetic valve failure Starling mechanism increases stretch of left ventricle and heart rate but will fail eventually End diastolic pressure increases, is transferred to left atrium, and back to the lungs causing pulmonary edema Decrease in cardiac output increases HR and peripheral vascular resistance
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