Med-Surg - Cardiovascular System, part 9: Valvular Heart Disease, Infective Endocarditis, Rheumatic Carditis
by Cathy Parkes October 06, 2021 Updated: March 20, 2022 4 min read
Hi, I'm Cathy with Level Up RN. In this video, we are going to talk about valvular heart disease, infective endocarditis, and rheumatic carditis. At the end of the video, I'm going to be giving you guys a little quiz to test your understanding of some of the key concepts I'll be covering in this video. So definitely stay tuned for that. If you have our Level Up RN medical surgical nursing flashcards, definitely pull those out so you can follow along with me.
First up, let's talk about valvular heart disease, which is where we have a defect or damage to one of the heart valves. So this can be the tricuspid valve, the mitral valve, the aortic valve, or the pulmonic valve.
And this damage or defect can cause stenosis of the valve, which is narrowing of the valve.
It can cause prolapse, which is like improper closure of the valve, and that can result in regurgitation.
So normally we want blood going all in one direction, so from the atria to the ventricles. But if the valve between the atria and ventricle is not functioning properly, like what we would see with valvular heart disease, then that blood can regurgitate or flow backwards from the ventricle to the atria.
In terms of risk factors associated with acquired causes of valvular heart disease, risk factors include hypertension, older age, increased cholesterol, smoking, diabetes, and other key risk factors include rheumatic fever, as well as infective endocarditis. And we will talk about those conditions in depth in this video as well.
Signs and symptoms of valvular heart disease can include murmurs, extra heart sounds, such as S3 or S4 sounds, dysrhythmias, and then with mitral stenosis or insufficiency, dyspnea may be present in your patients, so difficulty with breathing.
In terms of diagnosis of this disorder, we can utilize a chest X-ray, an EKG, as well as an echocardiogram.
Medications that are useful in helping to treat this condition include diuretics, digoxin, antihypertensive agents, and anticoagulants.
In terms of procedures or surgeries, if the patient has stenosis, we can use something called a percutaneous balloon valvuloplasty. So this is where we insert a balloon up into the valve and we inflate it to help reduce that narrowing when we have stenosis. We can also try to do a valve repair surgically and ultimately the patient may require a prosthetic valve.
So if your patient gets a prosthetic valve, then they will require antibiotics prior to any dental work, surgery, or other invasive procedure. And as a nurse, you need to keep in mind that this is actually required for any prosthetic device. So my mom has a prosthetic knee as well as a prosthetic shoulder, so she has to take antibiotics before she goes to the dentist or before she has any other invasive procedure. So definitely keep that in mind for your patients with prosthetic devices.
Next, we have infective endocarditis, which, as I mentioned before, is a key risk factor for valvular heart disease. So with this disorder, we have bacteria or fungi that adhere to the heart and form these vegetative growths, which can lead to necrosis of a heart valve or the endocardium, which is the inner layer of the heart.
Key risk factors associated with this disorder include congenital heart disease, valvular heart disease, prosthetic bowels, as well as I.V. drug use.
Signs and symptoms of infective endocarditis include fever, flu-like symptoms, murmurs, petechiae, which are these red dots that form on the skin, as well as something called splinter hemorrhages. So if you haven't heard of this before, this is where we have red streaks that form under the nail bed, and this is definitely a unique feature with infective endocarditis.
In terms of diagnosis, we're definitely going to want to run blood cultures for a patient with suspected infective endocarditis, and those blood cultures will likely be positive for bacteria. We can also use an echocardiogram to help diagnose this disorder.
In terms of treatment, we're going to want to give the patient antibiotics to treat the infection and then the patient may end up needing a valve repair or a valve replacement.
Finally, we have rheumatic carditis, which is inflammation of the heart following a strep throat infection.
So an infection with group A beta hemolytic streptococci bacteria.
So this infection triggers an autoimmune response in the body, which is rheumatic fever. And this leads to the development of inflammatory lesions in the heart. And this can cause damage, long term damage, to the heart and to the heart valves. So it's going to be really important that any time a patient is diagnosed with strep throat, that they receive immediate treatment and we fully treat that infection to avoid the development of rheumatic carditis.
In terms of signs and symptoms, we have tachycardia, cardiomegaly, so enlargement of the heart, murmurs, possible friction rub, and chest pain.
In terms of diagnosis, we want to do a throat culture to check for streptococcal infection. We also want to run an ASO titer. So ASO stands for Antistreptolysin. If the ASO titer is positive, that means the patient developed antibodies in response to a strep throat infection.
In terms of treatment, we obviously need to give the patient antibiotics to treat the infection. Depending on the amount of damage that was done to the heart, the patient may also require a valve repair or a valve replacement.
All right, quiz time. I have three questions for you. First question. Splinter hemorrhages are indicative of what cardiac disorder? The answer is infective endocarditis. Question number two. Rheumatic fever is a risk factor for the development of valvular heart disease. True or false? The answer is true. Third question. What lab will be positive in a patient with rheumatic carditis? And there are two possible answers with this one. The answer is, they will have a positive throat culture for strep throat, and they may also have a positive ASO titer, so if you said either of those, then you are correct.
Okay, that's it for this video. I hope it's been helpful. If so, be sure to leave me a comment and thank you so much for watching.
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