Download Valvular Heart Disease

Valvular Heart
Disease
Valvular Disorders
Mitral stenosis
 Mitral regurgitation
 Mitral valve prolapse
 Aortic stenosis
 Aortic regurgitation

Definition
STENOSIS - Occurs when valve leaflets
close together and cannot fully open
or close
REGURGITATION or (Insufficiency) Heart valves cannot close completely
Acquired Defects

Decreasing order of occurrence
Mitral stenosis (most common)
 Mitral regurgitation
 Mitral valve prolapse
 Aortic stenosis
 Aortic regurgitation

Facts

5 million

~ 2/3 to ¾ women

~ 2/3 of women under 45
Mitral Stenosis
Most common cause: rheumatic fever
 Results from rheumatic carditis



Causing valve thickening by fibrosis
and calcification
Non-rheumatic causes
Atrial tumor
 Calcium accumulation
 Thrombus formation

What Happens
Valve leaflets fuse and become stiff
 Chordae tendineae contract and
shorten
 Valvular orifice narrows

Diagnostics
Echocardiogram
 Chest Xray
 EKG
 Cardiac cath

*( also TEE)
Clinical Manifestations

Mild stenosis


Asymptomatic
Beginning
Dyspnea on exertion (DOE)
 Orthopnea
 Paroxysmal nocturnal dyspnea (PND)
 Dry cough

Clinical Manifestations

Later



Hemoptysis
Pulmonary edema
Right-sided heart failure (DD:Cor Pulmonale)
•
•
•
•

Hepatomegaly
Neck vein distention (JVD)
Pitting edema
? One more ?
Apical diastolic murmur
Mitral Regurgitation
Mitral Regurgitation
(Insufficiency)
Fibrotic and calcific changes prevent
the mitral valve from closing
completely during systole.
 End result left atrial and ventricular
dilation and hypertrophy.

Causes
Rheumatic heart disease
 Degenerative calcification
 Left ventricular hypertrophy
 MI
 Congenital defects

Clinical Manifestations

Progresses slowly


Asymptomatic for decades
Chief complaints
Fatigue
 Chronic weakness
 DOE
 Orthopnea
.

Clinical Manifestations
…Continued…
Normal blood pressure
 Atrial fibrillation (75% of all clients).
 Changes in respiratory patterns
 High pitched systolic murmur at apex
 Third heart sound (S3 or S4)

Mitral Valve Prolapse
Mitral Valve Prolapse
Valvular leaflets enlarge and prolapse
into left atrium during systole
 Usually benign, but may progress to
mitral regurgitation
 Affects 5%-10% of the population
(most common in women 14-30).

Clinical Manifestations

Chief complaint
Atypical chest pain
(sharp localized L chest pain)
 Dizziness
 Syncope
 Tachydysrhythmias causing
palpitations
 Systolic murmur at apex

Aortic Stenosis
Aortic Stenosis
Aortic valve orifice narrows and
obstructs left ventricular outflow
during systole
 Results in left ventricular hypertrophy

Cardiac output becomes fixed and
symptoms develop
 Eventually, can lead to right heart
failure as well.

Causes
Congenital
 Rheumatic heart disease
 Atherosclerosis
 Degenerative calcifications

Clinical Manifestations
May be asymptomatic for years
 Classic manifestations:
DOE, angina, syncope
Other: narrow pulse pressure
systolic murmur

Aortic Regurgitation
Aortic Regurgitation
(Insufficiency)
Aortic leaflets do not close properly
during diastole with possible annulus
dilation, loosening, or deformity.
 Allows blood to flow back into left
ventricle from aorta during diastole.
 End result: left ventricular hypertrophy

Clinical Manifestations

Asymptomatic (early)


Left ventricle has good compensatory
mechanisms 
Progression

Chief complaints
•
•
•
•
•
DOE
Orthopnea
PND
Palpitations
Nocturnal angina with diaphoresis
Clinical Manifestations
•
•
•
•
High pitched diastolic murmur
Diminished diastolic pressure
Elevate Systolic blood pressure
Wide pulse pressure
Causes
Mostly results from rheumatic heart
disease
 Non-rheumatic conditions

Infective endocarditis
 Congenital aortic valve problems
 Hypertension
 Marfan’s syndrome

Assessment

Insidious or acute onset

History
Rheumatic fever?
 Recent infections?
 IV drug usage?
 Fatigue and activity tolerance?
 Family Hx?

Care for All
Valvular Disorders
Diagnostics
Echocardiogram *( also TEE)
 Chest Xray
 EKG (atrial fib most common)
 Cardiac cath

Interventions

Non-surgical management

Drug therapy
•
•
•
•
•
•
•

Diuretics
Digoxin
Oxygen
Ace Inhibitors
Vasodilators (stenosis)
Prophylactic antibiotic therapy
Anti coagulants for A-Fib
Rest
Interventions

Treating atrial fibrillation


Rate control: digitalis, diltiazem, sotalol,
amiodaron etc.
Rhythm control:
• Cardioversion:
• Pharmacology
• Electrical

Anti thrombo-embolic:
• Anticoagulant: Coumadin
• Antiplatelet: Asetosal
Interventions

Surgical management


Aortic stenosis requires surgical therapy as it
is the only definitive treatment
Valve replacements
• Prosthetic
• Biologic

Surgical repairs
• Balloon valvuloplasty –cath lab
• Reconstructive or “Valvuloplasty”:
•
a. Open commisurotomy
•
b. Annuloplasty repairs
Pre-Operative Care

Similar to CABG surgery
Pain
 Incisional care
 Prevent pulmonary complications
 STOP oral anticoagulants 72 hours
before procedure

Post-Operative Care
Respiratory care
 Monitor for hemorrhage
 Cardiac output reduction
 Discharge teaching

Complications

Fluid & Electrolyte imbalances

Hypotension

Bleeding

Cardiac tamponade
Complications

Altered cerebral perfusion

Hypothermia

Hypertension

Infection
Client Education
Disease process
 Medications

Anticoagulants
 Prophylactic antibiotics


Rest and activity plan