Valvular Heart Disease

Front 1

types

Back 1

stenosis
insufficiency or regurgitation
mixed lesions

Front 2

mitral stenosis

Back 2

valve leaflets fuse and becomes stiff- chordae tendinae contract and shorten-LA to LV blood flow impaired
-leads to LA dilates, LA pressure rises, PAP increases, RV hypertrophies- CO decreases

pulmonary congestion and right-sided HF occur initially. Later, when the left ventricle receives insuff blood volume, preload is decreased and CO falls.

Front 3

mitral stenosis s/s

Back 3

none if mild
-pulmonary congestion-(pressure in lungs increase-DOE, othopnea, paroxysmal nocturnal dyspnea, dry cough)leads to pul edema, hemoptysis

-RV failure
(rt sided HF can cause hepatomegaly, neck vein distention, pitting edema)

atrial enlargement

on palpitation, the pulse may be normal, tachycardic, or irreg- irreg(a-fib)This indicates decompensation-notify Dr.

A rumbling, apical diastolic rumbling is noted on auscultation.

Front 4

mitral regurgitation (insufficiency)

Back 4

calcifications and/or muscle weakness prevent valve closure during systole

blood flows back to LA during systole, when LV contracts.

Dec CO, LA dilation, pulmonary congestion, RV failure

The increased volume must be ejected during next systole. To compensate for the incr volume, the LA and ventricle dilate and hypertrophy

Front 5

mitral stenosis usually results from

Back 5

rheumatic carditis, which can cause valve thickening by fibrosis and calcification. Rheumatic fever is the most common cause of mitral stenosis. other causes- atrial myoxoma, calcium accumulation, thrombus formation

Front 6

mitral regurgitation s/s

Back 6

similar to stenosis
anxiety
atypical chest pain
murmur
S3

progresses slowly. Assessment may reveal normal BP, atrial fibrillation, or changes in respirations characteristic of left ventricular failure.

-high-pitched holosystolic murmur

Front 7

mitral valve prolapse

Back 7

occurs b/c the valvular leaflets enlarge and prolapse into the left atrium during systole. This abnormality is usually benign but may progress to pronounced mitral regurgitation.

W>M

Front 8

mitral valve prolapse s/s

Back 8

most asymptomatic; however may report chest pain, palpitations, or exercise intolerance. Chest pain usually atypical

-Dizziness, syncope and palpitations may be assoc. w/ a or v dysrythmias. OH

normal HR and BP

-murmur or click, palpitations, sharp L pain

Front 9

aortic stenosis

Back 9

aortic valve orfice narrows and obstructs left ventricular outflow during systole.

-increased volume in LV stretches muscles leading to hypertrophy

-decreased CO

-(LV fails) blood backs up in LA then pulmonary sys becomes congested
right-sided HF occurs later

Front 10

aortic stenosis s/s

Back 10

syncope, angina, dyspnea w/ activity (classic triad- result from dec CO)
-fatigue
-murmur

harsh, systolic crescendo-decrescendo murmur

predominant cause-congenital valvular disease or malformation

Front 11

aortic regurgitation

Back 11

aortic leaflets do not close properly during diastole, and the annulus may be dilated, loose or deformed.

deformed valve allows backflow of blood from aorta to ventricles during diastole

LV dilates (to comp) then hypertrophies
LV failure

Front 12

aortic regurgitation s/s

Back 12

remain asymptomatic for many yrs

-dyspnea, murmur, wide pulse pressure (bounding pulse) elevated systolic pressure and dec diastolic pressure

-orthopnea, paroxysmal nocturnal dyspnea

others: palpitations, nocturnal angina

high-pitched, blowing, decrescendo diastolic murmur.

usually results from nonrheumatic conditions such as infective endocarditis, congenital anatomic aortic valvular abnormalities, hypertension, and marfan syndrome.

Front 13

nursing dx that may apply to pts w/ valvular heart disease include:

Back 13

-decreased CO r/t to altered stroke volume
-impaired gas exchange r/t ventilation perfusion imbalance
-activity intolerance r/t immobility of the heart to meet metabolic demands during activity
-acute pain r/t physiologic injury agent (hypoxia)

Front 14

management of valvular disease

Back 14

good hx and exam
-diagnostic testing
-chest x-ray
-echocardiography-best for valve functioning, cardiac structure, movement of valve leaflets and size and function of cardiac chambers

-exercise tolerance testing-evaluate symptomatic responses, functioning capacity

-cardiac cath-for aortic/mitral stenosis-assess severity and effects on heart

-ECG-assess abn such as LV hypertrophy (mitral/aortic gurg), or RV hypertrophy (sev. mitral stenosis)

Front 15

interventions

Back 15

medications
-prevent or control HF (diuretics, beta blockers, digoxin, O2)
-prophylactic antibiotics (bact to vavles)

-convert Afib
-cardioversion
-Diltiazem (cardizem)
-amiodarone (cordarone)
-procainamide (pronestyl)
-beta blocker

Anticoagulants(A-fib)

balance activity
valve repair or replacement

Front 16

cardioversion

Back 16

synchronizes shock to simultaneously depolarize the myocardium

allows SA node to regain control

Front 17

Diltaizem (cardizem)

Back 17

action
-inhibits the movement of ca across the membrane of cardiac and arterial smooth muscle

-slows ventricular rate by blocking conduction through AV node
-dilates coronary arteries

S/E:bradycardia, dizziness, headache, flushing, can precipitate HF

Front 18

valve repair or replacement

Back 18

reparative
-valvuloplasty
-commissurotomy
-reconstruction

replacement
-prosthetic
-biologic: xenograft-(pig), cadaver