Kristine Conde

Inflammatory and Valvular Heart Disease and Cardiomyopathy Worksheet

DIRECTIONS: There are 3 parts to this assignment and this module is worth a total of 5 points. Please email a copy Dr. Bawel-
Brinkley by April 12, 2013.

Inflammatory Heart Disease: Learning activity: Review Ch 37 in the Lewis textbook

DIRECTIONS: Identify the most appropriate definition, clinical manifestation, or description from column 2 (alphabetical letters: A-J) for
each of the numbered words (1 16) in column 1.

Column 1 Column 2
_F__1. Endocarditis A. Medication that increase myocardial contractility and
decrease ventricular filling pressures used for dilated
cardiomyopathy
_J__2. Acute Pericarditis B. Audible clicking sound and requires long-term
anticoagulation
_K _3. Myocarditis C. Benign that papillary muscle or chordate allows
leaflets to buckle
_L__4. Rheumatic Heart Disease D. Majority of cases result from rheumatic heart disease

_E__5. Mitral valve regurgitation E. Defeat in the mitral valve function causing
regurgitation
_C__6. Mitral valve Prolapse F. Associated with causative organism Staphylococcus
aureus
_G__7. Acute aortic valve regurgitation G. Unexpected onset of profound dyspnea, chest pain, &
left ventricular failure

_D__8. Mitral valve stenosis H. Aerobic exercise is prescribed

_I __9. Carpenter-Edwards porcine I. Biological, durability is not an issue, & anticoagulant

_B__10. Starr-Edwards prostehetic heart
valve
_Q__11. Intropin (dopaimine)
_N__12. Dilated cardiomyopathy
not required
J. Inflammation of the pericardium. Pain is worse with
deep inspiration and when lying supine
K. Inflammation of the myocardium. Early symptoms
may appear 7 10 days after a viral infection
L. Potential complication of streptococcal pharyngitis

_P__13. Hypertrophic cardiomyopathy M. Interventions focus upon improving diastolic filling

and underlying cause
_M__14. Restrictive cardiomyopathy N. Ventricular dilation, impairment of systolic function, &
atrial enlargement
_A__15. Dobutrex (dobutamine) O. Clinical manifestations: peripheral edema, ascites,
hepatomegaly
_R__ 16. Pulsus Paradoxus P. Asymmetric left ventricular hypertrophy without
ventricular dilation
_S__17. Pericardiocentesis Q. Positive inotropic effects: increase HR, CO, MAP

R. Decrease in systolic B/P with inspiration

S. Performed for the pericardial effusion.

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Objective 1: Differentiate the cause, pathophysiology, clinical manifestations, complications, diagnostic tests, treatments and goals,
and nursing management of 1) endocarditis, 2) pericarditis (acute and chronic), and Rheumatic heart disease (RHD).

I. Compare and contrast the following inflammatory disorders: 1) Endocarditis, 2) Pericarditis and Rheumatic Heart Disease (RHD). Be
concise but demonstrate your critical thinking ability. You can use the below Table of construct your own concept map of the 3 different
disease processes. If you do a concept map, please attach the concept map to the contents of this module with your name on the
page.

Endocarditis Acute Pericarditis Chronic Pericarditis RHD

Cause Staphylococcus aureus Idiopathic Results from Chronic condition
Streptococcus veridans Virus scarring with resulting from
Bacteria consequent loss of rheumatic fever that
Uremia elasticity of the is characterized by
MI pericardial sack scarring and
Cardiac surgery deformity of the
Tuberculosis heart valves
Neoplasm
Inflammation caused Streptococcal
by radiation pharyngitis
Trauma
Pathophyisology Blood flow turbulence An inflammatory Usually begins with RHD is a sequela of
within the heart allows response is the acute pericarditis RF (inflammatory
the causative organism characteristic and is characterized disease of the heart
to infect previously pathologic finding. by fibrin deposition potentially involving
damaged valves or There is an influx of with a clinically all layers).
other endothelial neutrophils, undetected Vegetation forms
surfaces increased pericardial pericardial effusion from deposits of
vascularity, and fibrin and blood cells
eventually fibrin in areas of erosion.
deposition on the The lesions create
epicardium fibrous thickening of
the valves and can
result in stenosis.
Aschoffs bodies
(nodules formed by
a reaction to
inflammation w/
accompanying
swelling and
destruction of
collagen fibers)
form.
-Lesions of
rheumatic fever are
systemic.
Clinical Manifestations -Low-grade fever -Progressive, -Dyspnea on -Heart murmurs
(Identify minimum of 3 -Chills frequently severe exertion -Cardiac
clinical manifestations) -Weakness chest pain -Peripheral edema enlargement and HF
-Malaise -Dyspnea -Ascites secondary to
-Fatigue -Pericardial friction -Fatigue myocarditis
-Anorexia rub -Anorexia -Pericarditis resulting
-Splinter hemorrhages -Weight loss in muffled heart
-Petechiae -Jugular vein sounds, chest pain,
-Oslers nodes distention pericardial friction
-Janewars lesions rub , or signs of
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Complications (Identify
minimum of 3 potential
complications/complications
) -Spreads to valves
Diagnostic tests (Identify a
minimum of 3 tests)
Treatment goal and
Treatments (Identify
minimum of 3 treatments)
and brief rationale
Nursing Management
(Identify 3 top priorities of
your nursing care) and
provide the rationale for
each
-Roths spots effusion
-Heart Failure -Pericardial effusion -Pericardial effusion -Chronic rheumatic
-Pulmonary emboli -Cardiac tamponade -Pulsus paradoxus carditis
-Sepsis -Tachypnea -JVD -Rheumatic
-Cardiac tamponade endocarditis. Mitral
valve is most
frequently involved
-Other valves may
be affected such as
the aortic and
tricuspid valves
-Blood cultures -ECG -ECG -Echocardiogram
-Chest- X-ray -Doppler imaging and -Chest X-ra -Chest X-ray
-ECG color M-mode -2D echocardiogram -ECG
-Cardiac -CT scan -CT Scan
catheterization -MRI -MRI
Goal: Maintain normal Goal: Identification Goal: Treat Goal: Treatment
body temp., Performs and treatment of pericarditis and consists of drug
ADLs with minimal underlying problem manage associated therapy and
fatigue or weakness, and symptoms cardiac symptoms supportive measures
Describes disease -Antibiotics treat -Pericardiectomy -Antibiotic therapy
process, appropriate bacterial pericarditis involves complete eliminates residual
treatments, and NSAIDs control the resection of the group A streptococci
measures to prevent pain and pericardium though remaining in the
recurrence of disease inflammation of acute a median tonsils and pharynx
-Administer antipyretic pericarditis sternotomy with the and prevent spread
medication as -Corticosteroids are use of of organisms to
appropriate or as generally reserved for cardiopulmonary close contacts
ordered to reduce fever patients with bypass -Salicylates,
-Administer antibiotics pericarditis secondary -Digoxin improves NSAIDs, and
to treat infection to systemic lupus myocardial corticosteroids are
-Encourage alternate erythematosus, contractility and the inflammatory
rest and activity patients already reduces ventricular agents most widely
periods to reduce taking steroids for rate used in the
cardiac workload rheumatologic or -Diuretics reduce management of RF
other autoimmune fluid volume, and are effective in
conditions, or patients decrease preload controlling fever and
who do not respond joint manifestations
to NSAIDs -Salicylates or
NSAIDs are used
when arthritis is the
main manifestation
-Corticosteroids are
used if severe
carditis is present
-Assess heart sounds -Management of pain -Management of -Inspect the patients
to detect a murmur or a and anxiety pain and anxiety to skin for
change in the -Assess amount, keep patient subcutaneous
character of a quality, and location comfortable nodules and
preexisting murmur, of pain to distinguish -Supplemental erythema
and the presence of the pain of MI from oxygen to help marginatum
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Identify the medications and
purpose of medication.
(Identify a minimum of 3)
extra heart sounds the pain of maintain O2 and help -Assess for the
-Assess the pt. for joint pericarditis with anxiety possible presense of
tenderness, decreased -Monitor for signs and -Spacing of activity these bright pink
ROM, and muscle symptoms of cardiac and implementation erythematous
tenderness tamponade and of rest to help with maculae in good
-Examine oral mucosa, prepare for possible breathing light because the
conjunctivae, upper pericardiocentesis rash is difficult to
chest and lower observe, especially
extremities for in dark-skinned
petechiae patients
-Complete a general -Promote rest to
systems assessment to reduce cardiac
determine any workload and to
hemodynamic and diminish metabolic
embolic complications needs of the body
-Administer
salicylates or
NSAIDs to treat
arthritis
-Penicillin G for -Antibiotics to treat -Diuretics reduce -Antibiotics to treat
Streptococcal bacterial pericarditis excess fluid group A streptococci.
endocarditis involving -NSAIDs to control -Analgesics for pain Best prevention is
native valve pain and -NSAIDs to control monthly injections of
-Ampicillin for inflammation pain and long-acting penicillin
Enterococcal -Colchicine, an inflammation -Salicylates or
endocarditis involving inflammatory drug, NSAIDs for
native or prosthetic can be used for inflammation and
valve patients who have fever
-Nafcillin for recurrent pericarditis -Corticosteroids to
Staphylococcal treat severe carditis
endocarditis in if present
absence of prosthetic
materials

Objective 1: Define pericardiocentesis, pericardio-window (may need to access the internet), and pericardiectomy.
Identify the teaching points for each procedure and pre-procedure care.
Identify the post-operative care of pericardiectomy. What are two nursing assessment priorities?

Valvular Heart Disease / Cardiomyopathy

Learning activity:
1. Review Ch 37 in the Lewis textbook
2. Review the following 2 articles posted on D2L:
a. Management of Aortic Valve Disease
b. Understanding Cardiomyopathies

Objectives 2, 3, & 4:
Objective 2: Define the mitral and aortic valve disorders
Objective 3: Describe the causes, pathophysiology, symptoms, diagnostic tests, treatment, and primary medications for
mitral and aortic valve disorders (*note: they are similar for both)
Objective 4: Describe the 3 types of cardiomyopathy and treatments.

Assignment part 3: Complete the questions on the attached sheet on Valvular Heart Disease & Cardiomypathy

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 Valvular Heart Disease / Cardiomyopathy Questions

Instructions: Please type your brief answers in the space provided. Name: Kristine Conde

1. The primary function of the heart valves is to control unidirectional blood flow.

2. How many valves are in the human heart? 4 Which valves are on the left side of the heart? Aortic and Mitral Valve

3. Which valves are on the right side? Tricuspid and Pulmonic Valve

4. Causes of valve disorders include both congenital and acquired factors.

5. State 3 causes of valve disorders cardiovascular disease , acquired immunodefiency syndrome , and the use of some
antiparkinsonian drugs

6. Signs and symptoms specific to aortic insufficiency include: profound dyspnea at rest , chest pain, cardiogenic shock, and left
ventricular failure.

7. Signs and symptoms specific to aortic stenosis include: dyspnea on exertion, angina, syncope on exertion, heart failure, systolic
murmur, orthopnea and paroxysmal nocturnal dyspnea.

8. What tests are used to diagnose valvular heart disease? ECG, Chest X-Ray, Echocardiogram, and Cardiac Catheterization

9. Primary objectives in the management of valvular disorders are to maximize cardiac function, reduce anxiety and prevent recurrent
rheumatic fever and IE (complications associated with valve disease).

10. Treatment of valvular heart disease involves both surgical and conservative (non-surgical) management.

11. Surgical management of valvular heart disease includes valve repair and/or valve replacement.

12. What are the two types of valves used for valve replacement surgery? Biological and Mechanical valves

13. Which type requires lifelong anticoagulation therapy? Mechanical valves

14. What are the 3 types of cardiomyopathy? Dilated, Hypertrophic, and Restrictive

15. Which type of cardiomyopathy is the most common? Dilated Cardiomyopathy

16. Cardiomyopathy is a change in the structure/shape of the cardiac muscle that causes decreased cardiac function generally leading
to heart failure.

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