Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

26 Cards in this Set

  • Front
  • Back
Heart contains two atrioventricular valves and two semilunar valves
Types of valvular heart disease depends on:
 Valve or valves affected
 Two types of functional alterations
 Stenosis
 Regurgitation
vavlular heart disease
 Valve orifice is restricted-stiff or calcified
 Impending forward blood flow –valve only opens part way
 Creates a pressure gradient across open valve-takes more pressure to open valve
 Degree of stenosis reflected in pressure gradient differences
 Incomplete closure of valve leaflets “floppy valves” when ventricle fills some blood flows back into atria
 Results in backward flow of blood
Etiology and Pathophysiology
Majority of adult cases result from rheumatic heart disease
 Causes scarring of valve leaflets and chordae tendineae
 Contractures develop with adhesions between commissures of the leaflets-scarred valves leading to obstruction- increase Left Atrium pressure d/t inability to get into LV because stiff valve causing back up of blod into lungs
 Stenotic mitral valve assumes funnel shape due to thickening and shortening of valve structures-mitral valve get hypertrophic left atrium primarily with have atrium rhythm problems-afib, a flutter-
 Obstruction
 Increased left atrial pressure and volume
 Hypertrophy of pulmonary vessels
 Chronic left atrial pressure elevation
Less common causes include:
 Congenital mitral stenosis
 Rheumatoid arthritis
 Systemic lupus erythematosus
mitral valve stenosis
 Occasionally accompanied by hemoptysis
 Primary symptom because of reduced lung compliance
Palpitations from atrial fibrillation
Accentuated first heart sound
Opening snap-stenosed valve-opens with snap (louder than normal d/t increased pressure

Low-pitched rumbling diastolic-filling murmur d/t turbulence –mitral valve only partially open heard all the way through diastole louder at beginning of diastole.
Chest pain
 Emboli can arise from stagnant blood in left atrium
clinical manifestations valvular heart disease
(mitral valve: need capillary muscles)
Regurgiation- have floppy valve-blood goes back and forth
Valve patency depends on:

 Integrity of mitral leaflets
 Mitral annulus
 Chordae tendineae
 Papillary muscles
 Left atrium
 Left ventricle
 Abnormality of any of these structures can result in regurgitation
mitral valve regurgitation
 MI
 Chronic rheumatic heart disease
 Isolated rupture of chordae tendineae
 Mitral valve prolapse
 Ischemic papillary muscle dysfunction
 Infectious endocarditis
 MI with left ventricular failure places patient at risk for rupture of chordae tendineae
majority cases of Regurgitation attributed to
Asymptomatic for years until development of some degree of left ventricular failure
Initial symptoms include:
 Weakness
 Fatigue
 Dyspnea that gradually progress to orthopnea, paroxysmal nocturnal dyspnea, and peripheral edema
Brisk carotid pulses-not full pulse
Auscultatory findings of accentuated left ventricular filling leading to audible S3
Murmur is loud pansystolic or holosystolic at apex radiating to left axilla-goes all the way across systole
clinical manifestations valvular heart disease
leads to mitral valve regurgitaiton
Most common valve disease in U.S.
Many patients are asymptomatic
Can have ventricular prolapseand ventricular arrhythmia as well as chest pain with mitral valve prolapse
Need prophylactic antibiotics before invasive procedures to prevent infectious endocarditis
Structural abnormality of mitral valve leaflets and papillary muscles or chordae that allow leaflets to prolapse into left atrium during systole
Can occur in presence of:
 Redundant mitral valve leaflets
 Elongated chordae tendineae
 Enlarged mitral annulus
 Abnormally contracting left ventricular wall segments
Usually benign, but serious complications can occur
 Mitral valve regurgitation
 Infective endocarditis
 Sudden death
 Cerebral ischemia
Mitral Valve Prolapse
Most patients asymptomatic for life
Murmur from insufficiency that gets more intense through systole
 Late or holosystolic murmur
Clicks mid to late systole that may be constant or vary beat to beat
Paroxysmal supraventricular tachycardia
Ventricular tachycardia
 Palpitations
 Light-headedness
 Dizziness
May or may not be present with chest pain
 If pain occurs, episodes tend to occur in clusters, especially during stress
 Pain may be accompanied by dyspnea, palpitations, and syncope
 Does not respond to antianginal treatment
clinical manifestations Mitral Valve prolapse
Stiff valve
 Isolated aortic valve(if only problemis aortic stenosis) stenosis is almost always of nonrheumatic origin
 Results in obstruction of flow from left ventricle to aorta during systole
 Effect is left ventricular hypertrophy and increased myocardial oxygen consumption because of increased myocardial mass
 Leads to reduced CO and pulmonary hypertension
aortic valve stenosis
Symptoms of angina pectoris
Syncope-fainting d/t lack of CO
Decrease pulses
Sx. Chest pain, decreased CO
Heart failure
 Occur when valve orifice is 1/3 normal size
Poor prognosis when experiencing symptoms and valve obstruction is not relieved
Nitroglycerin is contraindicated because it reduces preload, which is necessary with stenosis to free stiffened valve so it can open
NO nitro if aortic valve stenosis
Auscultatory findings:
 Normal to soft first heart sound
 Diminished or absent second heart sound
 Systolic crescendo-decrescendo murmur that ends before second heart sound
 Prominent fourth sound: s4
Stiff or non compliant ventricle and blood hitting stiff ventricle makes extra heart sounds stemming form hypertrophy from aortic stenosis
clinical manifestations aortic valve stenosis
May result from disease of aortic valve leaflets, aortic root, or both
Caused by:
 Bacterial endocarditis
 Trauma
 Aortic dissection
 Constitutes life-threatening emergency
Chronic aortic regurgitation results from:
 Rheumatic heart disease
 Congenital bicuspid aortic valve
 Syphilis
 Chronic rheumatic heart conditions
aotic valve regurgitaiton
Physiologic consequence:
 Retrograde blood flow from ascending aorta to left ventricle-causing hypertrophy of LV and RA causing pulmonary HTN
 Results in volume overload
Initially, left ventricle compensates by dilation and hypertrophy
Myocardial contractility eventually declines
Pulmonary hypertension and right ventricular failure develop
aortic valve regurgitation
Sudden manifestations of cardiovascular collapse
Left ventricle exposed to aortic pressure during diastole
Severe dyspnea
 Constitutes medical emergency
acute manifestations of aortic valve regurgitation
Severe aortic regurgitation
 Pulses of “water-hammer” or collapsing with abrupt distention during systole and quick collapse during diastole
Auscultatory findings:
 Soft or absent S1
 Presence of S3 and S4
 Soft, high-pitched diastolic murmur
Systolic ejection murmur
Remains asymptomatic for years
Exertional dyspnea
Paroxysmal nocturnal dyspnea after considerable myocardial dysfunction occurs
Nocturnal angina with diaphoresis
chronic manifestations of aortic valve regurgitation
Very uncommon
Tricuspid valve stenosis
 Occurs almost exclusively in patients with rheumatic mitral stenosis
Seen in IV drug users
Right atrial output is obstructed
 Results in right atrial enlargement and elevated systemic venous pressure
Usually the result of pulmonary hypertension or right ventricular dysfunction
tricuspid valve disease
Peripheral edema
Murmur is presystolic or midsystolic
Pansystolic murmur may be heard during regurgitation
Clinical Manifestations tricuspid valve disease
Almost always congenital
Isolated abnormality has benign course but is associated with other valvular diseases
pulmonic valve disease
PMH-past medical history
PE-physical exam
ECG-if abnormal
Cardiac catheterization
Diagnosis of Valvular Heart Disease
Prevention of recurrent rheumatic fever and infective endocarditis
Treatment depends on valve involved and severity of disease
 Focus on preventing exacerbations of heart failure, acute pulmonary edema, thromboembolism, and recurrent endocarditis
Drug therapy

 Digitalis-if heart failure is sx.
 Diuretics-if heart failure is sx.
 Antiarrhythmics
 B-blockers
 Anticoagulants-prevent clot

Low-sodium diet
Percutaneous transluminal balloon valvuloplasty to split open fused commissures
Surgical therapy for valve repair or replacement(for stenosis to get valve to open more)
Prosthetic Valves
Mechanical-can hear click from valve-high risk emboli (lifetime anitcoagulant therapy)
Biological-bovine, pig, human-less durable; don’t last as long, anticoagulant not needed
Both risk: leaking and endocarditis
collaborative care of valvular heart disease
 Subjective

 Rheumatic fever
 Endocarditis
 Congenital defects
 MI
 Syphilis
 Staph or strep infections
 IV drug abuse
 Palpitations
 Activity intolerance
 Dizziness
 Dyspnea on exertion
 Hemoptysis
 Paroxysmal nocturnal dyspnea
 Angina

 Objective

 Fever
 Diaphoresis
 Peripheral edema
 Crackles
 Wheezes
 Abnormal heart sounds
 Ascites
 Hepatomegaly
 Cardiomegaly
 Valve calcification
 Pulmonary congestion on x-ray
 Calcification or vegetation of leaflets or prolapse
 Chamber enlargement

 Arrhythmias
 Conduction deficits on ECG
nursing assessment of valvular heart disease
 Activity intolerance
 Excess fluid volume
 Decreased cardiac output
 Ineffective therapeutic regimen management
nursing diagnosis of valvular heart disease
Patient will have:
 Normal cardiac function
 Improved activity tolerance
 Understanding of the disease process and preventive measures
planning valvular heart disease
 Prevention of rheumatic valvular disease by diagnosing and treating streptococcal infection and providing prophylactic antibiotics for patients with history
 Patient with history of endocarditis must also be treated with prophylactic antibiotics
 Teach when to seek medical treatment
 Design activity to patient’s limitations
 Discourage smoking
 Avoid strenuous activity
 Auscultatory assessment to monitor effectiveness of medications
 Medic Alert bracelet
 Teach importance of completing antibiotic regimen
 Teach drug side effects
 INR for anticoagualtion therapy
 Follow-up care
nursing implementation valvular heart disease
 Demonstration of cardiac tolerance to increased activity
 Normal BP, HR, and breath sounds
 No peripheral edema
 No fatigue
 Knowledge of S/S when to seek health care
 Knowledge of when to use prophylactic antibiotics
 Adherence to therapeutic regimen
evaluation of valvular heart disease