Pericarditis

Inflammation of the pericardial sac

progressive, sharp, pleuritic, chest pain

pain may radiate to trapezius muscle

*Hallmark finding: Pericardial friction rub*

Treatment: high-fowlers position, NSAIDS for pain, steriods for inflammation, diuretics for fluid retention, digoxin to increase cardiac output

Complications of Pericarditis

Pericardial Effusion

Cardiac Tamponade

Myocarditis

Cardiac Tamponade

*Medical Emergency*

Increased fluid causing increased pressure on heart

EKG will show ST segment elevation, T wave inversion, and PR interval depression

S/S: JVD, pulsus paradoxus, muffled heart sounds

Treatment: CVL/Arterial Lines, O2, Pericardiocentesis

S/S of Infective Endocarditis

fever, chills, fatigue,

Oslers Nodes (reddish tender lesions on hands & toes) 

Janeway's lesions (nontender lesions on fingers, nose) 

Roth's spots (hemorrhagic retinal lesions)

Splinter hemorrhages in the nail beds

Splenomegaly

Clubbing of the fingers

Arthralgias

Treatment for Infective Endocarditis

-Adm antibiotics after blood cultures are resulted

-Adm NSAIDS for fever and inflammation

-Promote rest to decrease cardiac output

-Monitor for emboli due to release of vegetation

-Educate about antibiotic prophylaxis in future

S/S of Myocarditis

Fever, fatigue, dyspnea

Pericardial friction rub

Pharyngitis

Tachycardia

Pleuritic chest pain

S3 heart sound

(Pericarditis often accompanies)

Treatment of Myocarditis

Position in semi-fowlers position

Digoxin to increase cardiac output & contractility

Diuretics to remove fluid and decrease preload

Steriods to reduce inflammation

Anticoagulants to decrease thrombus risk

O2 to increase oxygen demand

Rest to decrease cardiac workload

Antibiotics for causitive infectious agent

Inocor, Primacor, Nitropress if not hypotensive

S/S of Mitral Stenosis

Asymptomatic initially

Dyspnea, orthopnea

Pulmonary HTN

Dry cough

Dysphagia

JVP

Edema

"fish mouth" shape at mitral valve

Left ventricular failure

*Loud S1 and low pitched rumbling S2 heart sounds*

After auscultation, you note a rumbling diastolic S2 murmur. What structural disorder is this common?

Mitral Stenosis

Caused by obstruction to the left ventricle from the left atrium.

Treatment for Mitral Stenosis

Adm O2

Low-sodium diet

Diuretics for pulmonary HTN

Digoxin to increase cardiac output

Antidysrhythmics if atrial fib develops (common)

Prepare patient for surgical interventions

(valve replacement/ commissurotomy)

S/S of Mitral Valve Prolapse

Most are asymptomatic

*Midsystolic click, late S2 heart murmur*

Dysrhythmias (PVC, PSVT, VT)

Chest Pain

Palpatations

Anxiety

After auscultation, you note a midsystolic click and a murmur that gets more intense through systole. What structural disorder is this common?

Mitral Valve Prolapse

(Caused by the buckling of valve leaflets into the left atrium during systole)

S/S of Aortic Stenosis

Fatigue, syncope, dyspnea

Chest Pain

Diminished or absent S2 heart sound

systolic, crescendo-decreascendo murmur

Prominent 4th heart sound

CK-MB

Normal Ranges

Time Frame

Normal:  <5%

Time Frame:

-becomes elevated 3-12 hrs after MI

- lasts up to 24 hrs

Troponin T/ I

Normal Ranges

Time Frames

Normal:

Troponin T <0.1%

Troponin I <0.4%

Time Frames:

-lasts 5-12 days

Where do you auscultate for suspected Pericarditis?

At the lower left sternal border of chest

Stable Angina

Arterial blockage less than 70%

lasts approx 3-5 min; relieved when resting

Myocardial oxygen demand increases greater than supply- symptoms decrease as demand for oxygen decreases.

Treatment for Angina

Antiplatelet therapy (Aspirin, Plavix)

Nitroglycerin (up to 3x; notify dr)

Beta blockers

Ca channel blockers

ACE inhibitors

Lipid-lowering agents