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1.

Discuss the pathophysiology of CONGESTIVE


HEART FAILURE, also include the
signs/symptoms in your discussion
2. What is the common outcome or
manifestation of Mitral Valve Prolapse, Mitral
Regurgitation, and Mitral Stenosis?
Substantiate your answer.

PRE-TEST
STRUCTURAL, INFECTIOUS,
AND INFLAMMATORY
CARDIAC DISORDERS
Acquired Valvular Disease
 Formerly known as mitral prolapse syndrome
 Deformity that usually produces no symptoms

MITRAL VALVE PROLAPSE


Mitral valve
deformity

Mitral valve leaflet


balloons back into
 Pathophysiology: atrium during
systole

Blood
regurgitates
back into atrium

MITRAL VALVE PROLAPSE


 Clinical Manifestations:
 Fatigue
 Shortness of breath
 Light-headedness
 Dizziness
 Syncope
 Chest pain
 Anxiety
 Palpitations

MITRAL VALVE PROLAPSE


 Assessment Findings:
 Mitral click
 Heart murmur

MITRAL VALVE PROLAPSE


 Medical/Surgical Management:
 Nitrates or Ca channel blockers
 Mitral vale repair or replacement

MITRAL VALVE PROLAPSE


 Nursing Management:
 Advise to eliminate caffeine, alcohol, smoking

MITRAL VALVE PROLAPSE


 Blood flowing back from the left ventricle into the left atrium
during systole

MITRAL REGURGITATION
Elongated, Enlarged or Ruptured,
Shorten/torn
torn/shortened calcified stretched/pulled-
mitral valve
chordae tendinae annulus out papillary muscle

 Pathophysiology

Blood regurgitates
back to atrium
during systole

MITRAL REGURGITATION
 Clinical Manifestations:
 Congestive heart failure symptoms
 Dyspnea
 Fatigue
 Weakness

MITRAL REGURGITATION
 Assessment:
 Murmur

MITRAL REGURGITATION
 Medical/Surgical Management:
 Mitral valve replacement or valvuloplasty

MITRAL REGURGITATION
 Obstruction of blood flowing from the left atrium into the left
ventricle
 Often caused by rheumatic endocarditis

MITRAL STENOSIS
Stenosed mitral
valve Right ventricular
failure
Increased
resistance of the
narrowed opening
 Pathophysiology Pulmonary
Difficulty of left congestion
atrium to pump
blood to ventricles
Blood regurgitates
to pulmonary vessels
Left atrium dilates
and hypertrophies

MITRAL STENOSIS
 Clinical Manifestations
 Dyspnea
 Fatigue
 Hemoptysis
 Cough

MITRAL STENOSIS
 Assessment
 Weak pulse
 Atrial fibrillation
 Heart murmur

MITRAL STENOSIS
 Medical/Surgical Management
 Anticoagulants
 Valvuloplasty
 Mitral valve replacement

MITRAL STENOSIS
1. Discuss the left-side heart failure
2. Discuss the right side-heart failure
3. What is the implication or connection of both heart failure to
the oxygenation of the human body?
4. What is the difference between rheumatic endocarditis and
infective endocarditis?

PRE-TEST
 Flow of blood back into the left ventricle from the aorta during
diastole.
 May be caused by inflammatory lesions that deform the leaflets
of the aortic valve.
 May result from
 Endocarditis,
 Congenital abnormalities
 Diseases such as syphilis
 Dissecting aneurysm
 Deterioration of an aortic valve replacement

AORTIC REGURGITATION
Blood Left
Aortic valve Left ventricle
 Pathophysiology regurgitates ventricle
hypertrophies
defect
on diastole dilates

AORTIC REGURGITATION
 Clinical Manifestations
 Forceful pulsations at head or neck
 Exertional dyspnea
 Fatigue
 Left ventricular failure

AORTIC REGURGITATION
 Assessment and Diagnostic Findings
 Echocardiogram
 Radionuclide imaging
 Electrocardiogram
 Magnetic resonance imaging
 Cardiac catheterization
 Diastolic murmur
 Widened pulse pressure
 Water-hammer pulse
 pulse strikes the palpating finger with a quick, sharp stroke and then
suddenly collapses

AORTIC REGURGITATION
 Medical Management
 Antibiotic prophylaxis prior to invasive/dental procedures
 Aortic valvuloplasty or replacement

AORTIC REGURGITATION
 Narrowing of the orifice between the left ventricle and the aorta.
 May result from rheumatic endocarditis or cusp calcification of
unknown cause.

AORTIC STENOSIS
Progressive Left ventricle
Left ventricle
 Pathophysiology: narrowing of contracts
thickens
aortic valve more slowly

AORTIC STENOSIS
 Clinical Manifestations
 Left ventricular failure
 Dizziness and syncope
 Angina pectoris
 Low pulse pressure

AORTIC STENOSIS
 Assessment and Diagnostic Findings
 Systolic murmur
 Vibration over base of heart
 Electrocardiogram
 Echocardiogram
 Cardiac catheterization

AORTIC STENOSIS
 Medical Management
 Antibiotic prophylaxis
 Aortic valve replacement
 One or two-balloon percutaneous valvuloplasty

AORTIC STENOSIS
BALLOON VALVULOPLASTY
 Caused by rheumatic fever, specifically GABHS

RHEUMATIC ENDOCARDITIS
Leukocytes
GABHS lodges Leukocytes Nodules turn
 Pathophysiology accumulate on
on valve flaps form nodules to scars
infection site

RHEUMATIC ENDOCARDITIS
 Clinical Manifestations
 Mitral regurgitation/stenosis
 Dysrhythmias

RHEUMATIC ENDOCARDITIS
 Assessment and Diagnostic Findings
 Embolic phenomena of the kidney
 Hematuria, renal failure
 Embolic phenomena of the lung
 Recurrent pneumonia, pulmonary abscess
 Left-sided heart failure
 Shortness of breath with crackles and wheezes

RHEUMATIC ENDOCARDITIS
 Medical Management
 Long-term antibiotic therapy

RHEUMATIC ENDOCARDITIS
 Nursing management
 Health teaching on:
 Disease
 Treatment
 Prevention from complications

RHEUMATIC ENDOCARDITIS
 Infection of the valves and endothelial surface of the heart.
 Usually develops in people with cardiac structural defects.

INFECTIVE ENDOCARDITIS
Risk Factors
High Direct invasion of
• Prosthetic cardiac valves the endocardium
• History of bacterial endocarditis by a microbe
• Complex cyanotic congenital malformations
• Surgically constructed systemic or pulmonary
 Pathophysiology shunts or conduits
Moderate
• Mitral valve prolapse with valvular Deformity of the
regurgitation or thickened leaflets valve leaflets and
• Hypertrophic cardiomyopathy other structures
• Acquired valvular dysfunction
• Most congenital cardiac malformations

INFECTIVE ENDOCARDITIS
 Clinical Manifestations
 Mitral regurgitation/stenosis
 Dysrhythmias

INFECTIVE ENDOCARDITIS
 Assessment and Diagnostic Findings
 Fever
 Splinter hemorrhages (reddish-brown lines and streaks at nails)
 Osler’s nodes (small painful nodes in pads of fingers or toes)
 Roth’s spots (hemorrhages with pale centers) in the eyes
 Murmurs
 Enlargement of the heart
 Headache, transient ischemic attack, stroke
 (+) Blood cultures

INFECTIVE ENDOCARDITIS
 Medical Management
 Antibiotic therapy

INFECTIVE ENDOCARDITIS
 Nursing management
 Health teachings on:
 Prophylactic antibiotic
 Prevention
 Health promotion
 Monitors:
 Temperature
 Murmur
 Systemic embolization or pulmonary infarction

INFECTIVE ENDOCARDITIS
 Inflammatory process involving the myocardium.
 Can cause:
 Heart dilation
 Thrombi on the heart wall (mural thrombi)
 Infiltration of circulating blood cells around the coronary vessels and
between the muscle fibers
 Degeneration of the muscle fibers

MYOCARDITIS
Etiology:
• Virus
• Bacteria
• Fungi
• Parasite
• Protozoal
• Spirochete
 Pathophysiology Infection in an Spreads
area of the throughout the
Risk Factors: heart myocardium
• Rheumatic fever
• Immunosuppress
ive therapy
• Allergic reaction
to medications Dilated
cardiomyopathy

MYOCARDITIS
 Clinical Manifestations
 Congestive heart failure
 Fatigue
 Dyspnea
 Palpitations
 Chest and abdominal discomforts

MYOCARDITIS
 Assessment and DiagnosticFindings
 Chest pain
 Dysrhythmias
 Cardiac enlargement
 Gallop
 Murmur

MYOCARDITIS
 Medical Management
 Antibiotic therapy

MYOCARDITIS
 Nursing Management
 Promote bed rest
 Discourage NSAIDs

MYOCARDITIS
 Inflammation of the pericardium

PERICARDITIS
Accumulation
Cardiac
of fluid in
tamponade
pericardial sac

Inflammation of Prolonged
 Pathophysiology
the pericarditis episodes

Thickening and Pericardial


decreased elasticity calcification
of the heart

Ability to fill up blood Restricts ventricular


is restricted expansion

PERICARDITIS
Decreased cardiac
output
 Clinical Manifestations
 Chest pain
 Friction Rub
 Increased Erythrocyte sedimentation rate
 Heart failure signs and symptoms

PERICARDITIS
 Assessment and Diagnostic Findings
 Echocardiogram
 Electrocardiogram

PERICARDITIS
 Medical management
 Be alert for cardiac tamponade
 Analgesics and NSAIDs for pain
 Corticosteroids
 Pericardiocentesis

PERICARDITIS
 Nursing management
 Pain management
 Positioning
 Psychological support
 Educate that pain experienced is NOT heart attack

PERICARDITIS