心脏瓣膜病课件（25p）

Chapter 37 Inflammatory and Structural Heart Disorders Valvular Heart Disease Valvular Heart Disease lStenosis Valve orifice is restricted Impending forward blood flow Creates a pressure gradient across open valve Degree of stenosis reflected in pressure gradient differences lRegurgitation Incomplete closure of valve leaflets Results in backward flow of blood Mitral Stenosis lMost adult cases result from rhematic heart disease Other causes lMitral valve becomes scarred and narrowed Left atrial overload eventually leads to right ventricular failure Mitral Stenosis lManifestations include fatigue, palpitations, dysrhythmias, low pitched diastolic murmur Mitral Regurgitation lMitral valve fails to close properly Usually chronic Blood flows back into left ventricle, elading to LA and LV dilation lManifestations include symptoms of LV failure, holosystolic murmur Mitral Valve Prolapse lOne or more of the mitral valve leaflets prolapses back into the left atrium during systole lUsually congenital lUsually benign, but can be problematic if it progresses to mitral regurgitation lMost people asymptomatic, but manifestations may include CP, dyspnea and palpitations Aortic Stenosis lNarrowing of the aortic valve causes obstruction of blood flow form the LV to the aorta during systole lCommon causes include congenital, rheumatic heart disease and senile or degenerative stenosis lManifestations: classic triad; systolic ejection murmur Aortic Regurgitation lAortic valve fails to close properly Blood flow back from the aorta into the LV during diastolevolume overload of LV lCause may be acute or chronic (rheumatic disease, bicuspid AV, autommune conditions) lManifestations include signs and symptoms of LV failure (late), waterhammer pulse, high pitched diastolic murmur Tricuspid and Pulmonic disease lUncommon lWill manifest as RV failure Diagnosis of valvular heart disease lHistory and physical lCXR lECG lEchocardiogram lCardiac catheterization Collaborative Care lProphylactic antibiotic therapy Rheumatic fever, infective endocarditis lManagement of associated heart failure Vasodilators (except aortic stenosis) Inotropes (digoxin) Diuretics Beta blockers lAnticoagulant therapy as indicated Surgical Treatment lPercutaneous transluminal balloon valvuloplasty For stenotic disease lValve repair Eg, valvuloplasty, annuloplasty lValve replacement (prosthetic valves) Mechanical valves Biological valves Choice of valve depends on variety of factors Surgical Treatment lValve replacement Teaching lProphylaxis lAnticoagulation Nursing Diagnoses and Interventions lActivity intolerance lExcess fluid volume lDecreased cardiac output lDeficient knowledge lChapter 37 lCardiomyopathies Cardiomyopathy lConstitutes a group of diseases that directly affect the structural or functional ability of the myocardium lThree major types Dilated Cardiomyopathy lCharacterized by diffuse inflammation and rapid degeneration of the myocardium that results in ventricular and atrial dilation and impaired systolic function lMay develop acutely or insidiously Manifest as heart failure, often biventricular Causes (table 37-18) Dilated Cardiomyopathy lInterventions focused on improving heart failure Enhance contractility, decrease afterload Drugs lNitrates, diuretics, ACE inhibitors, beta blockers, aldosterone antagonists, anticoagulation Treat underlying disease process (as able) Cardiac resychronization therapy May require VAD or transplant Hypertrophic Cardiomyopathy lAsymmetical left ventricular hypertrophy without ventricular dilation Primary defect is diastolic dysfunction May be idiopathic, often genetic Usually seen in young adults High risk of SCD lManifestations include dyspnea, fatigue, angina, syncope Hypertrophic Cardiomyopathy lCollaborative management Reduce contractility and relieve outflow obstruction Drugs lBeta blockers, calcium channel blockers lNitrates, digoxin contraindicated lAvoid diuretics ICD placement Surgical treatment Teaching lAvoid strenous activity lAvoid dehydration lSymptoms - elevate feet Restrictive Cardiomyopathy lImpaired ventricular filling lManifestations include signs and symptoms of heart failure lTreat to maintain cardiac output and manage symptoms Patient and Family Teaching for Cardiomyopathy lMeds as prescribed lLow sodium diet lHydra