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

May be debilitating recurring after treatment or may

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May be debilitating Recurring after treatment or may be seen with autoimmune disorders as SLE, RA, Scleroderma, or viral pericarditis Treatment – NSAIDS, Steroids, Colchicine Pericardial Effusion and Cardiac Tamponade 623 Pericardial Effusion – accumulation of fluid in the pericardial cavity – often with inflammation or infection S/S and effect vary with speed of fluid accumulation, elasticity of pericardium, amount of fluid Slow development of a large amount of fluid may have few S/S if pericardium expands and does not compress heart Cardiac Tamponade – compression of heart related to fluid or blood accumulation in pericardial sac Fluid from trauma, rupture, aortic dissection may be life threatening Fluid causes increase in intra cardiac pressure which decreases the ability of the ventricles to fill When ventricles do not fill or have decreased filling the stroke volume and cardiac output CO decrease Manifestations 1. Elevated central venous pressure CVP 2. Jugular venous distention JVD 3. Decreased systolic blood pressure BP 4. Narrow pulse pressure 5. Signs of shock 6. Pulses Paradoxus Decreased cardiac output initiates sympathetic nervous system response of tachycardia and increased myocardial contractility Pulses Paradoxus is greater than 10 mm Hg drop in systolic BP with inhalation Diagnostics Echocardiogram, MRI, ECG Treatment – varies with progression and size NSAIDS, colchicine, steroids Pericardiocentesis – removal of pericardial fluid via needle or open surgery Constrictive Pericarditis 623 Scar tissue develops between visceral and parietal layers of pericardium Scar tissue contracts and decreases filling during diastole Manifestations Elevated venous pressure – jugular venous distention JVD Decreased cardiac output Small/narrow pulse pressure Fluid retention Ascites, pedal edema, dyspnea on exertion DOE, fatigue Muscle wasting, activity intolerance, weight loss are late stage S/S
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7 Treatment – Constrictive Pericarditis Pericardiectomy surgery to remove pericardium Cardiomyopathies 624 Mechanical (heart failure) or Electrical (arrhythmias) Primary Cardiomyopathies Genetic Cardiomyopathies Hypertrophic Cardiomyopathy (HCM) Hypertrophied (thick) left ventricle, thickening of ventricular septum, abnormal diastolic filling, arrhythmias, left ventricular outflow obstruction Sudden cardiac death in athletes Autosomal dominant – mutation in genetic encoding of proteins of cardiac muscle fiber Manifestations – variable Dyspnea and chest pain Syncope (fainting) Diagnosis 2-D echocardiogram, ECG, cardiac monitoring Treatment Manage symptoms Beta blockers – slow heart rate Dual chamber and biventricular pacing Surgical excision of outflow tract restriction Ablation of electrically irritable nerve paths Implantable cardioverter-defibrillator (ICD) Heart Transplant Genetic and Nongenetic Cardiomyopathies Dilated Cardiomyopathy Some familial, varying inheritance patterns Some secondary to infections, toxins Some idiopathic (no identified cause)
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