PART 8

MI AND SEX:
= SEX AT SIX WEEKS!
= WALK ONE BLOCK
= 2 FLIGHTS OF STAIRS

YES OR NO!
NITRO B4 SEX
SEX AFTER MEAL
NO ALCOHOL B4 SEX
REMEMBER:
TACHYCARDIA WITHOUT CHEST PAIN?
COMMON CHART ORDERS:
ADMIT: ICU
DX: AMI, ST ELEVATION, ANTERIOR WALL,
KILLIPS 1, DAY 1
DIET: Low salt, low fat
VS: QH RECORD PLS
NSG: I&O Qshift, CBR s BRP, HBR, ↓visitors,
anti-embolic stockings
IVF: D5W 500mL x 10mL/hr
DXTCS: CK-MB, CPK TOTAL, TROP T OR I,
ECG stat repeat p12-24hrs, CBC, Na, K,
Mg, RBS, BUN Crea, UA, Lipid profile
REVIEW: YES OR NO!

= COMMON IN TYPE A PERSONALITY

= RELIEVED BY O2 AND NARCOTICS
= MAY LEAD TO SHOCK
= WBC STAYS NORMAL.
= SEMI-FOWLER’S
= STOOL SOFTENERS NEEDED
= VALSALVA IS ENCOURAGED.
= SEX AT SIX WEEKS
= SEX WITH ALCOHOL.
INABILITY OF THE HEART
TO PUMP ADEQUATE
AMOUNT OF BLOOD INTO
SYSTEMIIC
CIRCULATION…

VENOUS STASIS
INABILITY OF THE HEART TO PUMP ADEQUATE AMOUNT OF
BLOOD INTO SYSTEMIIC CIRCULATION

VENOUS STASIS

FORWARD FAILURE
VITAL ORGAN HYPOPERFUSION

PULMONARY VESSELS ENGORGE

LOWER EDEMA WITH LIVER

CONGESTION
 L

R
LEFT OR RIGHT:
ANKLE SWELL.
DELAYED CAPILLARY REFILL
SLEEP APNEA
STOMACH SWELL.
LOSS OF APPETITE.
2 LB. WEIGHT GAIN.
JUGULAR VEIN DISTENDED.
LOSS OF MUSCLE MASS.
COUGH, WHEEZING
CAUSES of HEART FAILURE:

Pump
Conduction System
Valve
Malformations
Blood Loss
SIGNS: (YES OR NO)
 PULMO EDEMA
 CARDIOMEGALY
 PRODUCTIVE COUGH.
 DISPLACED APICAL IMPULSE
 DECREASED CVP.
 HEPATOMEGALY
 EDEMA
 OLIGURIA
 PULSUS ALTERNANS
 RALES
 S3
 BRADYCARDIA.
 WEIGHT LOSS.
1. CXR
2. ECHOCARDIOGRAM
3. CVP
4. PCWP

A. LEFT ♥ FXN
B. RIGHT ♥ FXN
C. VENTRICULAR FXN
D. CARDIOMEGALY
COMPLETE THE FOLLOWING…

CARDIAC OUTPUT…
ACTIVITY…
…TISSUE PERFUSION
FLUID VOLUME…
…GAS EXCHANGE
…SLEEP PATTERN
4D APPROACH:

DIET
DIURETICS
DILATORS
DIGITALIS
GOALS:
1. IMPROVE CO
2. DECREASE AFTERLOAD
3. DECREASE PRELOAD

A. DIGITALIS, O2
B. VASODILATOR, ↓ACTIVITY
C. DIURETICS, ↓NA-H2O, S-FOWLER
ANSWERS:
TOMBS CARE:

T = TX OF CAUSE
O = O2
M = MEDICATIONS (♥&H20)
B = BEDREST
S = Na, H20 RESTRICTION
INFANT: PULMO OR CARDIO PROBLEM?

CRYING  ↓ CYANOSIS =
PULMO

CRYING  ↑CYANOSIS =
CARDIO
REVIEW YES OR NO:
= WATER RETENTION
= LEFT – LUNGS
= PULSUS ALTERNANS
= CHEYNE STOKES
= LOW FLOW OXYGEN
= DIURETICS BEST GIVEN IN PM.
= WEIGH DAILY BEFORE BEDTIME.
= DISCUSS FOOD PREFERENCES
= LOW SODIUM DIET
Q&A:
BACTERIAL CAUSE?
= GABHS

COMMON HISTORY?
= SORE THROAT
MAJOR JONES'S SYMPTOMS:

P = POLYARTHRITIS (MIGRATE): 75%

E = ERYTHEMA MARGINATUM
C = CARDITIS: 35%
C = CHOREA:
S = SUBCUTANEOUS NODULES
 TITER

ASO
7-6!
7 DAYS - 6 WEEKS!
Normal Results
Low titers are in the range of 1:40 to 1:60
 CAUSE AND EFFECT NSG
DIAGNOSES:

A. POLYARTHRITIS…
B. CARDITIS…
C. CHOREA…

1. RISK FOR INJURY

2. PAIN
3. ↓CO
TREAMENT:

PROPHYLACTIC PENICILLIN
ASA FOR INFLAMMATION
ANALGESICS
INVASIVE PROCEDURE PROPHY
BACTERIAL ENDOCARDITIS
= IV ANTIBIOTICS 4-6 WEEKS
= BEDREST
= 3-5YRS PROPHYLACTIC MEDS
= VALVE SURGERY
ASSESSMENT: PERICARDITIS
SHARP PAIN OVER STERNUM, RUB

ANALYSIS:
PAIN, CARDIAC OUPUT

ACTION:
LEAN FORWARD, VS,
TAMPONADE
RX: ASA, CORTI, ANTIBIOTICS
= UPRIGHT POSITION, LEANING
FORWARD
= FOR PAIN AND ANTIMICROBIAL
MEDS…
1. ALLOGRAFT
2. HETEROGRAFT
3. HOMOGRAFT
4. XENOGRAFT

A. ANIMAL (HETEROGRAFT)
B. HUMAN HEART (ALLOGRAFT)
PARTNERS
STENOSIS
= NARROW

REGURGITATION
= BACKFLOW

PROLAPSE
= BACKWARD STRETCH
  Valvuloplasty

 Commissurotomy:
 Balloon valvuloplasty:
 Annuloplasty
 Leaflet repair
VALVEChordoplasty

REPAIR AND
 Valve replacement
REPLACEMENT PROCEDURES
BALLOON VALVULOPLASTY
ANNULOPLASTY RING INSERTION
VALVE LEAFLET RESECTION AND REPAIR WITH RING
ANNULOPLASTY
VALVE REPLACEMENT
  Mechanical valves

 Do not deteriorate - infected as easily

 Thrombogenic
 Life-long anticoagulation therapy.
TYPES OF REPLACEMENT VALVES
 Tissue (biologic) valves
 Xenograft (heterograft):
pig or cow valve
 Homograft (allograft):
human valve
 Autograft:
patient’s own valve

TYPES OF REPLACEMENT VALVES