complications of heart disease 1.5

8/13/2019 Complications of Heart Disease 1.5

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inflammation of pericardium


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Refers to INFLAMMATION OF PERICARDIUM

May be primary or develop in the course of a variety of

medical conditions

Prolonged or frequent episodes may lead to thickening or

decreased elasticity

Can lead to fluid accumulation in the pericardial sac

(pericardial effusion) and increased pressure on heart,

leading to cardiac tamponade


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SOME ARE UNKNOWN

INFECTION (Rarely bacterial or fungal, usually viral)

CONNECTIVE TISSUE DISORDERS

HYPERSENSITIVITY STATES

DISEASES OF ADJACENT STRUCTURES

NEOPLASTIC DISEASE

RADIATION THERAPY

TRAUMA

RENAL DISORDERS

TUBERCULOSIS


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Characteristic Symptom is PAIN.

Felt over the precordium or beneath the clavicle

Aggravated by breathing, turning in bed, and twisting the body

Relieved by sitting up


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Most Characteristic Sign: Friction Rub

CREAKY OR SCRATCHY

Heard most clearly at the left lower sternal borders


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Fever

Increased WBC

Anemia

Elevated ESR or C-reactive protein level

Non-productve cough

Dyspnea and other signs of heart failure


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Falling BP Rising Venous pressure (distended neck veins)

Elevated CVP (central venous pressure)

Muffled Heart sounds with Pulsus Paradoxus Shortness of Breath

Chest Tightness

Dizziness

Anxious, confused, restless

Dyspnea, tachypnea, and precordial pain


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History & Physical Examination

Echocardiogram

may detect inflammation, pericardial effusionor tamponade, and heart failure

may help confirm the diagnosis

may be used to guide pericardiocentesis


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ECG CT scan

may be the best diagnostic tool for

determining the size, shape, and location ofpericardial effusions

may be used to guide pericardiocentesis

MRI

Video-assisted pericardioscope-guided

biopsy


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Identify cause, treat it

BED REST (until fever, chills, friction rub disappears)

Analgesics and NSAIDS (Aspirin and Ibuprofen)

Colchicine (used as alternative)

Corticosteroids (e.g. Prednisone) for severe or nonNSAID responsive


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Indomethacin (Indocin, an NSAID) is

contraindicated

because it may decrease coronary blood

flow


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Thoracotomy(for penetrating injuries)

Pericardiocentesisfor pericardial fluidremoval

Pericardectomyfor tough encasingpericardium


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Recognize the

triad of symptoms of cardiac tamponade:

1. Falling arterial pressure

2. Rising venous pressure

3. Distant heart sound


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Bed rest and Assist in ADLs

Give meds, monitor and record responses

Instruct patient to resume bed rest ifchest pain and friction rub recur


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Relief of pain is achieved by rest

Because sitting upright and leaning forward is theposture that tends to relieve pain

chair rest may be more comfortable

restrict activity until the pain subsides

Patients response to medicines like NSAIDs aremonitored and recorded

IF CHEST PAIN AND FRICTION RUB RECUR, BED REST

OR CHAIR REST IS RESUMED


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Fluid may accumulate between the pericardiallinings (in the pericardial sac)

Most have no effects or symptoms

However, enough fluid accumulation may lead

to: Myocardial constriction

Impaired ventricular filling

Myocardium pumping impaired (Cardiac Tamponade)


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Note for manifestations

Inform physician

Monitor patient

Standby and assist for diagnostics and

pericardiocentesis


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Monitor potential complications: Observe for pericardial effusion:

(arterial pressure falls, systolic BP falls

while Diastolic BP is stable, narrowed pulsepressure)

Neck vein engorgement, CVP

Notify physician immediately upon observing

for symptoms


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heart muscle disease associated with

cardiac dysfunction

One patient may have more than one type


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Dilated cardiomyopathy (DCM)

hypertrophic cardiomyopathy (HCM)

restrictive or constrictive cardiomyopathy (RCM)

arrhythmogenic right ventricular cardiomyopathy(ARVC)

unclassified cardiomyopathy


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X decreased stroke volume

Decreased cardiac output

stimulatesthe sympathetic nervous system

SNS and the RAAS

Fluid and Na retention

Increased cardiac workload

Heartfailure


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Most common form

significant dilation of the ventricles

without simultaneous hypertrophy (ie,

increased muscle wall thickness) andsystolic dysfunction


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More than 75 conditions and diseases may

cause DCM

Including: pregnancy, heavy alcohol intake, viral infection

(eg, influenza), chemotherapeutic medications

(eg, daunorubicin [Cerubidine], doxorubicin

[Adriamycin]), and Chagas disease. If cant be identified = IDIOPATHIC


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muscle tissue shows diminished contractileelements (actin and myosin filaments) of themuscle fibers

and diffuse necrosis of myocardial cells

result is poor systolic function

Blood may also be retained in the ventriclescausing blood clot formation


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rare autosomal dominant condition, occurring inmen, women, and children

may be idiopathic

heart muscle asymmetrically increases in size andmass, especially along the septum

reduces the size of the ventricular cavities

and causes the ventricles to take a longer time torelax after systole


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the coronary arteriole walls are thickened, which

decreases the internal diameter of the arterioles

The narrow arterioles restrict the blood supply tothe myocardium, causing numerous small areas of

ischemia and necrosis.

The necrotic areas of the myocardium ultimately

fibrose and scar, further impeding ventricular

contraction.


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characterized by diastolic dysfunctioncaused by rigid ventricular walls

impairs diastolic filling and ventricular

Stretch

Systolic function is usually normal.


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Most cases have unknown origins

may be associated with amyloidosis(amyloid, a protein substance, is deposited

within cells)

And other such infiltrative diseases


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the myocardium of the right ventricle isprogressively infiltrated and replaced by

fibrous scar and adipose tissue

Initially, only localized areas of the rightventricleare affected, but as the diseaseprogresses, the entire heart is affected.


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RV will dilate

Develops:

poor contractility

right ventricular wall abnormalities and DYSRHYTHMIAS


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different from or have characteristics ofmore than oneof the previously describedtypes

Examples include:

fibroelastosis

noncompacted myocardium systolic dysfunction with minimal dilation,

and mitochondrial involvement


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Patients with cardiomyopathy may remain

stable and without symptoms for many years.

As the disease progresses, so do the

symptoms.


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Frequently, dilated or restrictive cardiomyopathyis first diagnosed when the patient presentswith signs and symptoms of heart failure (eg,dyspnea on exertion, fatigue).

Patients may also report:

PND

cough (especially with exertion)

and orthopnea

which may lead to a misdiagnosis of bronchitis orpneumonia.


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Other symptoms include:

fluid retention

Peripheral Edema and nausea, which is caused by poor perfusion

of the gastrointestinal system.


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The patient also may experience:

chest pain

Palpitations dizziness, nausea,

and syncope with exertion.


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However, with HCM, cardiac arrest (ie,sudden cardiac death) may be the initial

manifestation in young people, includingathletes


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Hx and PE (p. 809)

MRI

2D echo Chest x ray

12 lead ECG

Cardiac catheterization Endomyocardial biopsy


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Treat Heart failure (see previous lectures)

Fluid restriction

Bed rest Anticoagulants

Alcohol septal ablation (for HCM)


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Myectomy (heart tissue is excised)

Left Ventricular Outflow Tract Surgery

Latissimus Dorsi Muscle Wrap

Heart Transplantation

LVAD

Total artificial heart


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complications of heart disease 1.5

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