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Ductile Disfunction of the Heart (VSD) (8.2.1.42) **Disorder** : Valvular Regurgitation of the Heart (6.1.1) **Cause** : _Valvular_ _anatomy_ and _valvular_ _mechanics_ **Drugs** : NSAIDs (especially those with analgesic effects) **Nursing** : Decrease pain with analgesics; decrease stress with sedatives; control fever **Patient-education** : • Teach patient to understand the need for monitoring symptoms and vital signs • Encourage activity as tolerated; avoid strenuous activities • Teach how to avoid risk situations for pulmonary embolism and blood clots • Teach about cardiac rehabilitation and return to physical activities as tolerated • Teach cardiac pacing and defibrillator use in patients with congenital heart defects; may be needed during surgery **Genetic/chromosomal** : _ALAS2, COL5A1, COL5A2, TOR1A_ **Psychosocial factors** : Depression (6.2.1), anxiety (6.2.1) Pericarditis (Heart Inflammation) (4.5) **Pericarditis, acute** **Predisposing Factors** --- **Etiology** | **Chronic Inflammation** Congenital heart defects (2.1.3) | Infectious (bacterial, viral, fungal, parasitic) Autoimmune diseases (3.1) Viral (human immunodeficiency virus, herpes simplex) Rheumatic fever | Neoplasms (3.2) Granulomatous (eg, tuberculosis, fungi, syphilis) _See_ **Bacterial Endocarditis and Pericarditis, Acute**. **Pulmonary embolism** | Deep venous thrombosis (6.1.4) Aneurysms (5.4) Tumors (5.4) | _See_ **Thrombophlebitis**. **Risk Factors** --- **Genetic/chromosomal** _HLA-DRw3_ | _Factor V Leiden mutation_ _Prothrombin 20210 G>A_ _Factor XI deficiency_ _Factor V Leiden, prothrombin G20210A, HBS Ag carrier_ _Prothrombin 20210 G>A_ | MTHFR mutations (eg, 677TT genotype) Homozygous factor V Leiden mutation Homozygous factor V Leiden mutation, positive family history of deep venous thrombosis and pulmonary embolism, postmenopausal women, oral contraceptive use **Environmental/Lifestyle** Increased age | Prior pulmonary embolism Chronic venous stasis _See_ **Varicose Veins** _See_ **Varicose Veins**. Hypertension (6.2.1) | Cigarette smoking Arterial occlusive disease (5.2.1) | History of cancer and surgery to the pelvis or abdomen History of prolonged immobilization _See_ **Varicose Veins**. **Pregnancy and Childbirth (8.1, 10.1, 11.3)** Dilation and evacuation (spontaneous abortion) (8.1.2) | Miscarriage, antepartum bleeding Placenta previa (8.2.1) Abruptio placentae (8.3) | Severe, prolonged, or forceful contractions with delivery Retained placenta Low birth weight Premature baby (8.1.1) | Birth defect (8.1.1.1) Polyhydramnios (5.4.3) | Uterine bleeding (8.1.2) Uterine ruptures (10.1) | Multiple gestation (8.2) Maternal complications (8.2) Amniotic fluid embolism (8.2.1) | Placenta previa (8.2.1) Placental abruption (8.3) | Hemorrhagic disorders (5.4.2) Placental insufficiency (8.1.1.2) | Hyperemesis gravidarum (8.1.2) Uterine bleeding (8.1.2) | Birth defects (8.1.1.1) Polyhydramnios (5.4.3) Premature baby (8.1.1) | Gestational hypertension (6.2.1) Preterm labor (8.1.1) Low birth weight (8.1.1) Premature baby (8.1.1) _See_ **Maternal Morbidity**. Early infant death syndrome (5.4) | Low birth weight (8.1.1) Early infant death syndrome (5.4) **Diagnostic Considerations** (2.1) **Dietary** (2.1.3) | Alcohol and nicotine Excessive salt intake _See_ **Alcohol**. **Environmental** (2.1.3) | Cigarette smoke (3.3.1) Radiation (2.1.3) | **Genetic** (2.1.3) | Alpha-1-antitrypsin deficiency (3.2.2.6) Congenital absence of the pulmonary valves (7.2.2) Congenital malformations of the heart, great arteries, or heart valves (7.2.2) Leber congenital amaurosis (7.2.2) Leucine zipper transcription factor 1 ( _LUZP1_ ) gene mutations (8.1.3) **Physical Assessment** | ---|--- **Age** | All ages **Gender** | Female (3.3.1, 3.3.2) Male (3.3.1, 3.3.2) **History** | _Acute presentation_ : Fever, dyspnea, chest pain _Chronic presentation_ : Persistent cough, pulmonary infection, peripheral edema _Acute presentation_ : Pain _Chronic presentation_ : Pain, exertional dyspnea, orthopnea _Acute presentation_ : Anorexia, fatigue, weight loss, palpitations _Chronic presentation_ : Fatigue, weight loss, palpitations _Acute presentation_ : Paresthesia, paresthesia, paresthesia **Physical Exam** | Oxygen saturation (2.2.4) Percussion Chest movement Tactile fremitus (7.1.2) | Chest pain (3.3.1) Pale, cyanotic skin Skin tenting Pulmonary rales Pleuritic, pericardial, or subpleural chest pain (4.5.1.1) | Bounding arterial pulses Hiccups Chest pain (3.3.1) Cyanosis Pallor No rales Scleroderma (4.5.2) Palpitations (6.2.1) | Peripheral edema (3.3.2) Cyanosis (4.5.1.1) Pallor (4.5.1.1) Rales (3.3.1) Shortness of breath (3.3.2) | Pain (3.3.1, 3.3.2) Hypoxia (3.3.1, 3.3.2) Anxiety (6.2.1) | **Assessment Modifiers** (6.2.1) _Chronic presentation_ : Dyspnea, orthopnea, ascites, enlarged liver _Acute presentation_ : Fatigue, weight loss **Causes** (1.2) | **Acute** Congenital anomalies (7.2.1) Miscarriage, placental abruption (8.1.2) Pulmonary embolism (8.1.1) _See_ **Acute Pericarditis**. **Chronic** Chronic obstructive pulmonary disease (COPD) (6.3.1.1) _See_ **Miscarriage**. **History of Child Abuse or Neglect** Battered child syndrome (6.1.4) | Sexual child abuse Sexual exploitation of children (6.1.4) | Physical child abuse Neglect Wide intrauterine growth restriction (6.2.1) | Maternal smoking (2.1.3, 2.1.6)