a chest x-ray will detect pulmonary congestion and heart size, while a Doppler ultrasound will evaluate the pressures inside the heart. Most of the time, mild valvular disorders can be managed symptomatically until it becomes necessary to replace or repair the valve. A valvuloplasty is a valve repair surgery, while valve replacement can involve an artificial valve or a porcine, pig-derived or bovine, cow-derived valves. Those with valvular disease often require antibiotic prophylaxis to prevent bacterial vegetations from developing during certain surgical or dental procedures. Patients with a prosthetic valve will require long-term anticoagulation therapy, especially if the person has a mechanical valve. The target IRN should be quite high in order to avoid thromboemboli from occurring. The only accepted anticoagulant for those who have prosthetic valves is warfarin. The newer anticoagulants are insufficient, although heparin can be used if warfarin is not recommended, such as with a pregnant patient. Patients who also have stents will require aspirin, clopidogrel, and warfarin at the same time.
PERICARDITIS Pericarditis represents an inflammation of the pericardium, usually with accumulation of fluid in the pericardial sac. The inflammation can be due to infection, trauma, myocardial infarction, cancer, or metabolic disease. The patient will have pain or tightness in their chest, worse with deep inspiration. If there is constriction or decreased cardiac output associated with this, there will be symptoms of cardiac tamponade. Remember that the pericardium has two layers: the visceral layer attached to the myocardium and the parietal layer covering the heart. The pericardial sac contains a very small amount of fluid under normal circumstances. These layers are stretchsensitive so it doesn’t take much extra fluid to cause increased pain. Pericarditis may be acute, subacute, or chronic. Acute pericarditis develops quickly and often leads to a pericardial effusion and secondary inflammation of the outer myocardial layers. Subacute pericarditis comes on within weeks to months and can be an extension of acute disease. Chronic pericarditis happens after six months of inflammation. The 24
