CARL E BALITA REVIEW CENTER

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Dr. Carl E. Balita
CARDIOMYOPATHY
with the Cardiac dysfunction As cardiomyopathy worsens and the heart
weakens, signs and symptoms of heart failure usually occur. These signs and
symptoms include:
Classification

1. DCM- the most common type of cardiomyopathy 5 is to 8 vcases per
100, 000, , it is primarily caused by dilatation of the ventricles without
simultaneous hyperthrphy and systolic dysfunction.
The disease often starts in the left ventricle, the heart's main pumping
chamber. The heart muscle begins to dilate (stretch and become thinner). This
causes the inside of the chamber to enlarge. The problem often spreads to the
right ventricle and then to the atria as the disease gets worse.
When the heart chambers dilate, the heart muscle doesn't contract normally.
Also, the heart can't pump blood very well. Over time, the heart becomes
weaker and heart failure can occur.
Clinical Manifestation:
shortness of breath,
The ventricles have elevated systolic and diastolic blood volumes b
a decrease ejection fraction
Inc. Blood in the ventricles left
fatigue (tiredness), and swelling of the ankles, feet, legs, abdomen, and veins in the neck

2. HCM- autosomal dominant condition

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Clinical Manifestation

No known cause
chest pain, dizziness, shortness of breath, or fainti
Hyperthrophy of the heart muscle
Reduced ventricular Cavities
Ventricle relax more
Normaly cardiac muscles lie end to end but in this case obliquely and perpendicular

3. RCM- Diastolic dysfunction caused by right ventricular walls that impair the diastolic filling and
ventricular stretch. the ventricles become stiff and rigid. This happens because abnormal
tissue, such as scar tissue, replaces the normal heart muscle.
cause by deposition of amyloid
Clinical Manifestation:
Systolic Function is normal Dyspnea and non productive caugh











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INFECTIVE ENDOCARDITIS
An infection of the endothelial surface of the heart a deformity or an injury leads to the accumulation on the endocardium of fibrin and
platelets. Thd infection is most likely result to platelet, fibrin blood cells and microorganism that accumulates in the endothelial surface of
the heart.

Cause: Staph and strep, GABS

Clinical Manifestation:

Osler nodes(smallpainful nodules may be present in the pads of the finger or toes)
Janeway lesions (Irregula or purple, painless flat macules may be present in the palms finger hands and soles )
Roth spot (Hemorrhage with pale centers)
Splinter hemorrhage (Reddish brown like streaked)
Diagnostic findings:
+ in a 2 separate blood cultures, elevate DSR, C reactive Protein, Microscopic hematuria(+) in urinalysis

Management: iv infusion + 2-6 weks of anti biotic therapy doc(Penicillin): amphoteracin for fungal cause
Indication for surgery: the vegetation is > 1 cm and develops septal perforation.

Nsg. Mangaement: Monito r for the patients temperatrure, sign and symptoms of Embolization.








Nursing Hazards!!! myocarditis
Patients with myocarditis is sensitive to digitalis, monitor for digitalis toxicity strictly as evidenced by dysrhtmia =,
anorexia, vomiting, headache and malaise...

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PERICARDITIS:
viral in nature(Coxsackieviruz, hiv) men aged 20 to 50 are prone

adhesive layer of the pericardium attach to the chest wall
Restricitive Ventricular feeling- Accumulation of fluid in the pericardial sac

Pathophysiology:

Acc. Of fluid in the pericardial sac... increase pressure in the heart...leading to cardiac taponade (a severe compression of the heart that impairs its
ability to function))

Clinical Manifestation:

Creaky or scratchy Friction rub BEST heard on left r sternal Edge 4
th
ICS at end of exhalation
Sharp and stabbing back of the shoulders, and difficulty breathing (caused by the rubbing of the heat`s pericardium)
May increase with coughing, swallowing, deep breathing when lying flat
Can be relieved by sitting up and leaning forward
Pain

Diagnostic tests may include:
Chest X-ray: Shows evidence of enlargement of the heart and congestion of the lungs.
CT : Best diagnostic tool(Because it determines the size ,shape and extent of the effusion)
Echocardiogram: Detects the hf, cardiac tamponade, effusion
12 lead ecg: Concave st elevation, depressed pr segments
Treatment
may include medication for pain (Priority)and inflammation, such as nonsteroidal anti-inflammatory drugs((+)allergy give Prednisone),
Indomethacin is contraindicated decrease coronary blood flow.




NURSING ALERT:Monitor strictly for chest tube cloting after a cardiac surgery could lead to cardiac
tamponede if lef clotted,, fluid that supposed ot be drain goes back to the myocardium
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CARDIAC TAMPONADE

Cardiac tamponade is pressure on the heart muscle which occurs when the pericardial space fills up with fluid faster than the pericardial
sac
Clinical Manifestation :
Pressure in the Chest (Stretching of Pericardium)
tachycardia,
distant or muffled heart sounds
jugular vein distention due to venpus pressure
falling BP systole
paradoxical pulse (a drop in inspiratory BP (Systole) by greater than 10 mmHg)

Diagnostic Procedures :
Echocardiogram: To confirm and quantify the amount of pericardial Fluid
Chest X ray may also show a large Effusion in the pericardium

Surdgical Management:
pericardial window to drain from the space surrounding the heart into the chest cavity - where the fluid is not as dangerous; an untreated
pericardial effusion can lead to cardiac tamponade and death.

Pericardiocentesis Punture of the pericardial sac to remove excess fluid (>20 ml)

Mangament: Connected to ECG,,, Upon Insertion of needle guided thru echocardiogram
Elevate head of the bed 45-60 degree
50 m syringed connected to 3 way stop cock
Priority : Oxygenation !!! .... sir!!!
can be associated with dullness to percussion over the left subscapular area due to compression of the left lung base Ewart's sign.
[


Causes: caused by a large or
uncontrolled pericardial effusion,
chest trauma
Efffects: Elevate pressure in all chambers
Decrease venous return
Inability of the Ventricles to distend
Decrease CO

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BASAIM AH GAMIN!!!!








PULMONARY EDEMA-
A.K.A pulmonary Flush... fluid accumulation in the air spaces and parenchyma of the lungs
Clinical Manifestation are results of LVF
Pulse is weak
coughing up blood (classically seen as pink, frothy sputum),
excessive sweating,
anxiety, confusion , anxious decrease cerebral oxygenation
Shortness of breath can manifest as orthopnea (inability to lie down flat due to breathlessness)
a paroxysmal (episodes of severe sudden breathlessness at night)

!!! Focus is on maintaining adequate oxygenation


Nursing Intervention:
Place the patient in upright position with the feet and legs dependent or dangling on the side of the bed decrease venous return and minimizing
stress.
Medical Management:
Reduced fluid overload
Oxygenation
Morphine (Reduced Peripheral resistance and venous return) antidote
Diuretics

BASIC LIFE SUPPORTV...HEART .......HEART,,,, HEART
Chest Compressions in CPR are performed by placing the heel of the one hand in the center of the chest between
the nipples and other handon top of the first hand . The elbow are kept straight and the body weight are used to
supply the force compression to the lower sternum. Head-tilt-chin-lift maneuver if there is neck injury used Jaw
thrust, Chest compression is 100x per min, 30:2, 1.5-``2 in depth toward the spine.

Diagnostic Test:
Chest X ray


Naloxone must
keep of the beside
in case of

morphine toxicity:
Urine output is low
BP
(+)Patellar reflex


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CARDIGENIC SHOCK- is a state in which the heart`s Cardiac output is LOW and has been damaged so much that it is unable to
supply enough blood to the organs of the body.(Possible due to the occlusion of LAD artery)
Clinical Manifestation: Changes in mental Status
Early: Hypotension, Tachycardia,Restlessness, Thirst, Decrease UO, Intermittent Thready Pulse,
Late: Hypotension, Braddycardia, Narrowed Pulase, Anuria , Cold clammy skin
Pain like angina,Dysrhtmia, fatigue, feeling of doom
Nursing Management:

Oxygenation 2-6 lpm
Fluid Replacement (the best type of fluid is the fluid available / crystalloids(PLR)) Vasoactive medication
Nutritional support >3000 kcal needed
Positioning: +Modifie Trendelenburg position( leg @20 degree knees are straight trunk are horizontal, head elevated )
!!! Priority: Improved Cardiac Function By CONTRACTILITY
VENTRICULAR AFTERLOAD
Medical Management:

Dobutamine (NTE 2.5-20 ug/kg/min),Dopamine (NTE: 2.5-10 ug/kg/min )(>10Increase Cardiac Afterload and
workload),Epinephrine,Norepinephrine,(Or the so called SNS STIMULANT drugs)These medicines may help in the short-term,...
cause dysrhtmia in long term used.
Morphine (Relieves pain and dilate the blood vessels decreases workload by decreasing both the preload anf afterload)
IABP


ADDITIONAL INPUTS MAR!!!
Vasoactive Medication(Decrease Preload and afterload )should be tapered to prevent Perpetuation of
shockrate .
to improved cardiac and tissue
oxygenation

CARL E BALITA REVIEW CENTER
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Do not study hard study smart with your heart
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JUNE NLE BOARD EXAM
Dr. Carl E. Balita
THROMBOEMBOLISM

DVTs are most common in adults over age 60. When a clot breaks off and moves through the bloodstream, this is called an embolism. An
embolism can get stuck in the brain, lungs, heart, or other area, leading to severe damage.

CAUSES:
Decrease mobility of the patient
Provoking Factor: Usually Present in atrial Fibrillation (Weakened pulse)

Diagnostic Test: ECG
Clinical Manifestation:
Chest Pain
Tachypnea
Tachycardia
Dyspnea
Hemoptysis
Deep Venious Thrombosis AHA! AHA! AHA!

Nursing Intervetion:
Anticoagulant Therapy The partial Thromboplastin (PTT) is maintained at 1.5 to 2.0 times the normal or a INR of 2.0-2.5
Heparin is administered at 5-7 days
Warfarin started at 24 hiurs and taken for 3-6 months.
Contraindicated to Green Leafy Vegetables or Vegetables such as kangkong and alukbati and Malungay.

PT-11-20
PTT-30-70
APTT-35-45

What is BNP??? (Brain natriuretic peptide)
Regulate bp and fluid volume secreted from ventricles in respoce to
increase preload resulting to eleveated ventricyular pressure... Increase in HF

A blood D Dimer Assay is helpful to determine whether Fibrinolysis of
clots is taking over the somewhere in the body.
Anti- Coagulant Therapy Heparin (Rapid Acting 2
days only) Warfarin Take it for 6 months
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COR PULMONALE
A conditioned ion which there is a hyperthrophy of the right side of the heart

Clinical Manifestation Such as COPD
Right Ventricular failure
Headache
Prioroty Nursing Managements is : Maintaing Oxygenation!!!









NI CE TO KNOW!!!










markers of renal function(creatinine, urea)......... Liver enzymes, inflammatory
markers (usually C-reactive protein)..... Low levels of BNP (<100 pg/ml) suggest a
cardiac cause is unlikely

CARL E BALITA REVIEW CENTER
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JUNE NLE BOARD EXAM
Dr. Carl E. Balita