Chapter 24: Managing Structural, Infectious & Inflammatory Cardiac Disorders

Managing Structural, Infectious & Inflammatory Cardiac Disorders begins by detailing valvular heart diseases, distinguishing between stenosis, where the valve orifice narrows and obstructs flow, and regurgitation, where incomplete closure leads to backward blood flow. Specific attention is given to mitral valve prolapse, mitral regurgitation, and mitral stenosis, as well as aortic regurgitation and stenosis, describing characteristic symptoms like dyspnea, fatigue, and distinct heart murmurs detectable upon auscultation. The text explores surgical management options extensively, including valvuloplasty techniques such as commissurotomy to separate fused leaflets, annuloplasty to repair the valve ring, and leaflet repair. It also covers valve replacement procedures, comparing mechanical valves, which require long-term anticoagulation, with tissue valves like bioprostheses, homografts, and autografts. Minimally invasive advancements such as Transcatheter Aortic Valve Replacement (TAVR) are highlighted as alternatives for high-risk patients. The discussion transitions to cardiomyopathies, classifying them into dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular types, each presenting unique structural abnormalities and functional impairments. For end-stage heart disease, the chapter reviews advanced therapies including orthotopic heart transplantation and mechanical circulatory support via Ventricular Assist Devices (VADs) and total artificial hearts. Finally, the chapter addresses infectious and inflammatory conditions, explaining the link between group A beta-hemolytic streptococcal pharyngitis and rheumatic endocarditis, the formation of vegetations and embolic risks in infective endocarditis, the viral origins of myocarditis, and the potential for cardiac tamponade in pericarditis. Nursing management focuses on assessment, enforcing activity restrictions, preventing complications like emboli and heart failure, and educating patients on infective endocarditis prophylaxis.