Cardiac/Vascular Nurse Exam Secrets Study Guide (7 page)

Pericarditis occurs in approximately 15% of individuals that experienced an acute myocardial infarction/heart attack. Approximately 25% to 85% of cases present with no clear reason and are idiopathic in nature.

Causes and risk factors

The cause of pericarditis remains unclear. However, pericarditis can develop post heart attack or surgery. Other causes of pericarditis include systemic inflammatory disorders such as lupus and rheumatoid arthritis, trauma due to car accident, slip and fall or other traumatic events, comorbid conditions such as renal disease, bacterial infections such as tuberculosis, viral infections such as coxsackie virus or echo virus, fungal infections, myocardial infarction, uremia, aortic dissection, HIV/AIDS, malignancy metastasis, Dressler syndrome, hypothyroidism, renal disease, radiation and pharmacologic agents such as tetracyclines, isoniazid, cyclosporine, and hydralazine. In adolescents, pericarditis is most commonly caused by adenovirus or Coxsackie virus.

Symptoms

The most common symptoms associated with pericarditis include sharp chest pain behind the breast bone or left side of chest wall cavity, dull/sharp chest pain radiating to the back and relieved by sitting up forward and worsened by lying down, pressure or ache in chest wall, shortness of breath, difficulty breathing when lying down, anxiety, low grade fever, weakness, fatigue, ill feeling, dry cough, and abdominal or extremity swelling.

The symptoms of pericarditis are very similar to other cardiovascular diseases such as heart attack and congestive heart failure and respiratory conditions such as asthma, emphysema, pulmonary embolism, and chronic obstructive pulmonary disease.

Screening and diagnosis

Physical examination, medical history, and diagnostic tools are used to diagnose pericarditis. Practicing clinicians will evaluate the patient by listening to the individual’s heart with a stethoscope and look for other comorbid conditions. Indicators of pericarditis upon physical examination include abnormal heart sounds such as muffling and friction rub, crackles in lungs and decreased breath sounds.

Diagnostic screening tools used to diagnose pericarditis include electrocardiogram, echocardiogram, chest x-ray, computerized tomography, and magnetic resonance imaging. Blood work may also be performed to rule out heart attack or congestive heart failure. Blood levels including complete blood count, C-reactive protein, and erythrocyte sedimentation rate may be evaluated.

Physical and diagnostic findings include friction rub, diffuse ST-elevation, and PR depression on electrocardiogram, enlarged heart, fluid surrounding pericardium, cardiac tamponade, and/or congestive heart failure on echocardiogram.

Vasculitis

Vasculitis is a condition that involves inflammation of blood vessels such as arteries, veins, and capillaries. Vasculitis causes thickening, weakening, narrowing, and scarring of the blood vessels leading to abnormal blood flow and cardiovascular complications and organ system damage. Vasculitis can be classified as primary vasculitis, having no known cause and secondary vasculitis, caused by another comorbid condition or pharmacologic approaches.

The incidence of Vasculitis in the general population is rare, even though there are various types of the condition and it can affect variety of end organ systems. Women, children, current or ex-smokers as well as individuals with chronic hepatitis B or hepatitis C are at increased risk for certain types of vasculitis. The course of disease is difficult to predict and can go into remission, recur or remain chronic.

Causes and risk factors

Various diseases and conditions can be classified as vasculitis or can lead to the condition. Some conditions that are commonly associated with vasculitis include Behçet syndrome, Buerger’s syndrome, Churg-Strauss syndrome, cryoglobulinemia, giant cell arthritis, Henoch-Schönlein purpura, hypersensitivities, Kawasaki disease, microscopic polyangiitis, polyarteritis nodosa, polymyalgia rheumatica, rheumatoid conditions, lupus, Sjögren’s syndrome, Takayasu’s arteritis, and Wegener’s granulomatosis. Pharmacologic approaches that can lead to vasculitis include antibiotics and diuretics.

Vasculitis can affect men, women, and children. Its cause remains unclear, but certain risk factors have been associated with the condition. Individuals most affected by vasculitis include current or ex-smokers, children, young women, middle-aged adults and individuals with chronic hepatitis B and/or hepatitis C.

Symptoms

The symptoms of vasculitis vary depending on which blood vessels and end organ systems are affected by the condition. The symptoms are also dependent on the extent and degree of vasculitis. Patients may experience few symptoms or have more extensive symptoms depending on the organ systems that are involved.

The most common symptoms among individuals diagnosed with vasculitis include weight loss, fever, general aches and pains, skin changes such as purple or red spots, shortness of breath, ulcers, abdominal pain, bloody stool, sinus infections, chronic middle ear infections, ulcers in nostrils, blurring or vision loss, headaches, confusion, changes in behavior, strokes, muscle and joint pain, loss of appetite, numbness, tingling, and weakness.

Diagnosis and screening

Physical examination, medical history, and diagnostic screening tools are used to diagnose vasculitis. However, the symptoms and physical findings of vasculitis resemble those of other conditions and can be difficult to diagnose.

Blood tests used for diagnosis of vasculitis and to rule out other conditions include erythrocyte sedimentation rate, C - reactive protein, antinuclear antibodies, complement levels, antineutrophil cytoplasmic antibody, and complete blood count such as red blood cells and platelets. A urinalysis may also be performed to detect any abnormalities such as increased protein in urine or presence of red blood cells.

Endocarditis

Endocarditis is defined as inflammation of the endocardium, which is the inner lining of the heart chambers and valves. Endocarditis can lead to cardiovascular disease, improper functioning of heart valves and chambers, as well as sudden death. The disease can be classified as infective or noninfective, but noninfective endocarditis is very rare and uncommon in clinical practice. Endocarditis is most common in individuals with damaged hearts either from heart attack or disease.

In the United States, the incidence of endocarditis is 1.4 to 4.2 cases per 100,000 individuals per year. Men are more prone to endocarditis than women. More than half of cases of endocarditis occur in individuals ages 50 years or older.

Causes and risk factors

The main cause of endocarditis is bacterial infection that resides in the endocardium. Bacteria entering the blood stream and attaching to the walls of the endocardium typically cause endocarditis. Other causes of endocarditis include common activities such as teeth brushing or chewing food, infection or other medication conditions such as skin sores, gum disease, inflammatory bowel disease and sexually transmitted disease, insertion of contaminated catheters or needles and/or certain dental or respiratory tract procedures.

Individuals most at risk for developing endocarditis include those who have had a heart attack, have damaged heart valves or underlying heart abnormalities. Others at risk include those with artificial heart valves, congenital heart defect, and prior history of endocarditis. Also, individuals with healthy hearts but use illicit drugs with needles or are hospitalized with IV tubes may be at risk for endocarditis.

Symptoms

Endocarditis can be acute or develop over an extended period. The signs and symptoms of endocarditis are dependent on the underlying cause of the disease. The most common symptoms include fever, chills, heart murmur, fatigue, aching joints and muscles, swelling of feet, legs or abdomen, night sweats, shortness of breath, paleness, persistent cough, unexplained weight loss, blood in urine, chills, nail abnormalities, weakness and tenderness of spleen.

Other signs include red and tender spots under the skin of the fingers as well as purple or red spots on other areas of the skin such as whites of eyes or inside the mouth.

Diagnosis and screening

The diagnosis of endocarditis involves physical examination, medical history, and diagnostic screening tools. Upon physical examination, clinical practitioners will use a stethoscope to determine the presence of heart murmur or other arrhythmia problems. They will also look for enlarged end organ systems such as spleen. Other diagnostic testing involves blood tests such as complete blood count, culture and erythrocyte sedimentation rate, serology, chest x-ray, echocardiogram, electrocardiogram and transesophageal echocardiogram. More invasive approaches such as cardiac catheterization may be performed to determine the extent of heart valve damage.

Practicing clinicians look for signs of endocarditis in individuals with high-risk conditions such as congenital heart disease, intravenous drug use, recent dental work, and/or rheumatic fever.

Renovascular disease

Renovascular disease is a condition that involves narrowing and/or blockage of renal arteries or veins. There are 3 different types of renovascular disease. The 3 different types of renovascular disease include renal artery occlusion, renal vein thrombosis, and renal atheroembolism.

Renal artery occlusion occurs when 1 or both of the renal arteries become blocked. Renal vein thrombosis occurs when 1 or both of renal veins become blocked. Renal atheroembolism occurs due to the buildup of lipids in blood vessels leading to the renal capillaries. All 3 conditions can lead to chronic renal failure and death.

Renal artery occlusion

Renal artery occlusion is a condition that involves narrowing or blockage of 1 or both of the renal arteries. Alternative names used for renal artery occlusion include acute renal arterial thrombosis, renal artery embolism, acute renal artery occlusion, and renal artery stenosis.

Renal artery occlusion is the primary cause of hypertension in approximately 1% to 10% of the 50 million individuals diagnosed with hypertension in the United States. Renal artery occlusion is more prevalent among elderly individuals with atherosclerosis. The disease is more common in Caucasian Americans than African Americans.

Causes and risk factors

Renal artery occlusion can be caused by a variety of other comorbid conditions including atheroembolic renal disease, atherosclerosis, fibromuscular dysplasia of the renal wall, trauma to abdomen, back or side, emboli residing in renal arteries and scar formation in the renal artery.

Other risk factors include hypertension, aging, renal insufficiency, extrarenal atherosclerosis, diabetes, presence of other comorbid conditions such as cardiovascular disease or renal disease and smoking. Caucasian, elderly individuals with atherosclerosis are at highest risk for the development of renal artery occlusion.

Symptoms

Most individuals with renal artery occlusion typically present with no symptoms. The reason that patients present with few or no symptoms is that the second kidney takes over for the lack of functioning by the impaired kidney.

Diagnosis is typically made upon routine physical examination or when being examined for other cardiovascular or renal conditions. Some signs associated with renal artery occlusion include high blood pressure, history of high blood pressure and/or bruits of the kidneys.

Diagnosis and screening

Physical examination, medical history, and diagnostic tools are used to diagnose renal artery occlusion. The disease typically presents with few or no symptoms and is usually diagnosed upon routine physical examination or when being examined for other cardiovascular or renal conditions.

Practicing clinicians will use a stethoscope to listen for bruits of the kidney and check blood pressure to see if patient presents with high blood pressure. Other diagnostic tools used to diagnose renal artery occlusion include magnetic resonance imaging, computerized tomography, kidney ultrasound, radionucleotide conventional arteriography, contrast nephrotoxicity, renogram, renal perfusion scintiscan, urine concentration testing, urine specific gravity, and renal arteriography.

Blood work includes complete blood counts, serum creatinine levels, and serologic levels such as antinuclear antibodies, C3, C4 and antinuclear cytoplasmic antibodies.

Renal vein thrombosis

Renal vein thrombosis is a condition in which the veins leaving the kidney become occluded by thrombus. The condition leads to a reduction in blood drainage by the kidney, which can cause further complications.

Renal vein thrombosis is a rare condition that typically presents with other conditions including nephrotic syndrome, kidney cancer and/or other blood clotting disorders. Renal vein thrombosis occurs more often in adults than in infants, adolescents, or toddlers. However, it is typically more serious in infants, adolescents, or toddlers.

In the United States, the prevalence of renal vein thrombosis remains unknown. It is most commonly associated with nephrotic syndrome, but prevalence rates among these patients vary greatly, ranging from 5% to 60% on average.

Causes and risks

Renal vein thrombosis is uncommon and rare condition but can occur after trauma to the abdomen and/or back as well as due to scar formation, stricture, and/or tumor. It is also, more commonly, associated with nephrotic syndrome.