Intro to Valvular Disease

1. Intro to Valvular Disease Valvular Disease

2. Valvular Heart Disease • Heart contains • Two atrioventricular valves • Mitral • Tricuspid • Two semilunar valves • Aortic • Pulmonic

3. Valvular Heart Disease • Types of valvular heart disease depend on • Valve or valves affected • Two types of functional alterations • Stenosis • Regurgitation

4. Valvular Heart Disease • Valvular disorders occur in children and adolescents primarily from congenital conditions and in adults from degenerative heart disease

5. Valvular Heart Disease HeartPoint: HeartPoint Gallery http://www.heartcenteronline.com/myheartdr/common/articles.cfm?ARTID=187 Flashcards about Ch 19 NETI KQ- on your own

6. Risk Factors • Rheumatic Heart Disease MI • Congenital Heart Defects • Aging • CHF

7. Valvular surgery Heart Surgery Innovations - Google Video 11:22 valves 20 beating heart 20 aortic valve

8. Pathophysiology • Stenosis- narrowed valve, increases afterload • Regurgitation or insufficiency- increases preload. The heart has to pump same blood • **Blood volume and pressures are reduced in front of the affected valve and increased behind the affected valve. • This results in heart failure • All valvular diseases have a characteristic murmur murmurs

9. Mitral Valve Stenosis

10. Fig. 37-9 Fish mouth

11. Mitral Stenosis • Dec. flow into LV • LA hypertrophy • Pulmonary pressures increase • Pulmonary hypertension • Dec. CO • * early symptom is DOE • Later get symptoms of R heart failure • A fib is common- anticoagulants • Usually secondary to rheumatic fever

20. Mitral Regurgitation • Regurg of blood into LA during systole • LA dilation and hypertrophy • Pulmonary congestion • RV failure • LV dilation and hypertrophy-to accommodate inc. preload and dec CO

21. Mitral Regurgitation

23. MitraClip Repair MitraClip 3D Animation

24. Mitral Valve Prolapse • A type of mitral insufficiency • Usually asymptomatic- click murmur • May get atypical chest pain related to fatigue • Tachydysrhythmias may develop • Risk for endocarditis may be increased

25. Mitral Valve Prolapse Fig. 37-10

27. Mitral Valve Prolapse • Usually benign, but serious complications can occur • Mitral valve regurgitation • Infective endocarditis • Sudden death • Cerebral ischemia

28. Mitral Valve Prolapse • Clinical manifestations • 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

29. Mitral Valve Prolapse • Dysrhythmias • Paroxysmal supraventricular tachycardia • Ventricular tachycardia • Palpitations • Lightheadedness • Dizziness

30. Mitral Valve Prolapse • May or may not be present with chest pain • If pain occurs, episodes then to occur in clusters, especially during stress • Pain may be accompanied by dyspnea, palpitations, and syncope • Does not respond to antianginal treatment

31. A&P 1 Heart part 1 Midsytolic click & late systolic murmur

32. MVP video Infections & Injuries of the Heart Live Search Videos: mitral valve prolapse

33. Aortic Stenosis Aortic Stenosis Minimally Invasive Aortic Heart Valve Replacement

34. Aortic Stenosis

35. Aortic Stenosis • Increase in afterload • Reduced CO • LV hypertrophy • Incomplete emptying of LA • Pulmonary congestion • RV strain

38. Symptoms • Syncope • Angina • Dyspnea • This triad reflects left ventricular failure

39. Aortic Stenosis • May be asymptomatic for many years due to compensation • DOE, angina, and exertional syncope are classic symptoms • Later get signs of R heart failure • Untreated-poor prognosis- 10-20%sudden cardiac death

40. Aortic Valve Stenosis • Poor prognosis when experiencing symptoms and valve obstruction is not relieved • Nitroglycerin is contraindicated because it reduces preload

41. New Approach- Percutaneous AVR

42. Aortic Regurgitation

43. Aortic Regurgitation • Get increased preoad- 60% of SV can be regurgitated • Characteristic water hammer pulse • Regurgitation of blood into the LV • LV dilation and hypertrophy • Dec. CO Echocardiography

44. Aortic Valve Regurgitation • Clinical manifestations • Sudden manifestations of cardiovascular collapse • Left ventricle exposed to aortic pressure during diastole • Weakness

45. Aortic Valve Regurgitation • Severe dyspnea • Chest pain • Hypotension • Constitutes a medical emergency

46. Water Hammer pulse Pulse, water hammer: A jerky pulse that is full and then collapses because of aortic insufficiency (when blood ejected into the aorta regurgitates back through the aortic valve into the left ventricle ). Also called a Corrigan pulse or a cannonball, collapsing, pistol-shot, or trip-hammer pulse.

48. Tricuspid and Pulmonic Valve Disorders Result in R side heart failure

49. Diagnostic Tests • Echo- assess valve motion and chamber size • CXR • EKG • Cardiac cath- get pressures

50. Collaborative Care • Drug therapy • Digitalis • Diuretics • Antidysrhythmics • -Blockers • Anticoagulants