Valvular Heart Disease

1. Valvular Heart Disease NPN 200 Medical Surgical I

2. Types • Mitral Stenosis • Mitral Regurgitation • Mitral Valve Prolapse • Aortic Stenosis • Aortic regurgitation • Tricuspid valve is affected infrequently • Tricuspid stenosis – causes Rt HF • Tricuspid regurgitation –causes venous overload

3. Tricuspid Valve

4. Rheumatic Heart Disease • Inflammatory process that may affect the myocardium, pericardium and or endocardium • Usually results in distortion and scarring of the valves

5. Subjective symptoms Prior history of rheumatic fever General malaise Pain – may or may not be present Objective symptoms Temperature Murmurs Dyspnea polyarthritis Rheumatic Heart Disease, cont.

6. Rheumatic Heart Disease • Diagnosis • H/P • WBC and ESR • C-reactive protein • Cardiac enzymes • EKG • Chest x-ray • Echo • Cardiac cath • Cardiac output

7. Rheumatic Heart Disease • Nursing Care • Vital signs • Rest and quiet environment • Give antibiotics, digitalis, and diuretics • Provide adequate nutrition • Monitor I/O • Explain treatment and home care

8. Mitral Stenosis • Usually results from rheumatic carditis • Is a thickening by fibrosis or calcification • Can be caused by tumors, calcium and thrombus • Valve leaflets fuse and become stiff and the cordae tendineae contract • These narrows the opening and prevents normal blood flow from the LA to the LV • LA pressure increases, left atrium dilates, PAP increases, and the RV hypertrophies • Pulmonary congestion and right sided heart failure occurs • Followed by decreased preload and CO decreases

9. Mitral Stenosis, cont. • Mild – asymptomatic • With progression – dyspnea, orthopneas, dry cough, hemoptysis, and pulmonary edema may appear as hypertension and congestion progresses • Right sided heart failure symptoms occur later • S/S • Pulse may be normal to A-Fib • Apical diastolic murmur is heard

10. Mitral Regurgitation • Primarily caused by rheumatic heart disease, but may be caused by papillary muscle rupture form congenital, infective endocarditis or ischemic heart disease • Abnormality prevents the valve from closing • Blood flows back into the right atrium during systole • During diastole the regurg output flows into the LV with the normal blood flow and increases the volume into the LV • Progression is slowly – fatigue, chronic weakness, dyspnea, anxiety, palpitations • May have A-fib and changes of LV failure • May develop right sided failure as well

11. Mitral Valve Prolapse • Cause is variable and may be associated with congenital defects • More common in women • Valvular leaflets enlarge and prolapse into the LA during systole • Most are asymptomatic • Some may report chest pain, palpitations or exercise intolerance • May have dizziness, syncope and palpitations associated with dysrhythmias • May have audible click and murmur

12. Aortic Stenosis • Valve becomes stiff and fibrotic, impeding blood flow with LV contraction • Results in LV hypertrophy, increased O2 demands, and pulmonary congestion • Causes – rheumatic fever, congenital, arthrosclerosis • Atherosclerosis and calcification is primary cause in the elderly • Complications – right sided heart failure, pulmonary edema, and A-fib • S/S – Early: dyspnea, angina, syncope Late: marked fatigue, debilitation, and peripheral cyanosis, crescendo- decrescendo murmur is heard

14. Aortic Regurgitation • Aortic valve leaflets do not close properly during diastole • The valve ring that attaches to the leaflets may be dilated, loose, or deformed • The ventricle dilates to accommodate the ^ blood volume and hypertrophies • Causes: infective endocarditis, congenital, hypertension, Marfan’s • May remain asymptomatic for years • Develop dyspnea, orthopnea, palpitations, ,and angina • May have ^ systolic pressure with bounding pulse • Have a high pitch, blowing, decrescendo diastolic murmur

15. Assessment for Valve Dysfunction • Subjective symptoms • Fatigue • Weakness • General malaise • Dyspnea on exertion • Dizziness • Chest pain or discomfort • Weight gain • Prior history of rheumatic heart disease

16. Assessment, cont. • Objective symptoms • Orthopnea • Dyspnea, rales • Pink-tinged sputum • Murmurs • Palpitations • Cyanosis, capillary refill • Edema • Dysrhythmias • Restlessness

17. Diagnosis • History and physical findings • EKG • Chest x-ray • Cardiac cath • Echocardiogram

18. Medial Treatment • Nonsurgical management focuses on drug therapy and rest • Diuretic, beta blockers, digoxin, O2, vasodilators, prophylactic antibiotic therapy • Manage A-fib, if develops, with conversion if possible, and use of anticoagulation

19. Interventions • Assess vitals, heart sounds, adventitious breath sounds • ^ HOB • O2 as prescribed • Emotional support • Give medications • I/O • Weight • Check for edema • Explain disease process, provide for home care with O2, medications

20. Surgical Management of Valve Disease • Mitral Valve • Commissurotomy • Mitral Valve Replacement • Balloon Valvuloplasty • Aortic Valve Replacement

21. Mechanical Valve

22. Mechanical Valve

23. Porcine Valve

24. Tissue Valve

25. Tissue Valve