Valvular Heart Disease

Valvular Heart Disease
NPN 200
Medical Surgical I
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
Tricuspid Valve
Rheumatic Heart Disease
• Inflammatory process that may affect the
myocardium, pericardium and or endocardium
• Usually results in distortion and scarring of the
valves
Rheumatic Heart Disease, cont.
• Subjective symptoms • Objective symptoms
– Prior history of – Temperature
rheumatic fever – Murmurs
– General malaise – Dyspnea
– Pain – may or may not – polyarthritis
be present
• Diagnosis
– H/P
– WBC and ESR
– C-reactive protein
– Cardiac enzymes
– EKG
– Chest x-ray
– Echo
– Cardiac cath
– Cardiac output
• Nursing Care
– Vital signs
– Rest and quiet environment
– Give antibiotics, digitalis, and diuretics
– Provide adequate nutrition
– Monitor I/O
– Explain treatment and home care
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
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
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
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
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
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
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
Assessment, cont.
• Objective symptoms
– Orthopnea
– Dyspnea, rales
– Pink-tinged sputum
– Murmurs
– Palpitations
– Cyanosis, capillary refill
– Edema
– Dysrhythmias
– Restlessness
Diagnosis
• History and physical findings
• EKG
• Chest x-ray
• Cardiac cath
• Echocardiogram
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
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
Surgical Management of Valve
Disease
• Mitral Valve
– Commissurotomy
– Mitral Valve Replacement
– Balloon Valvuloplasty
• Aortic Valve Replacement
Mechanical Valve
Mechanical Valve
Porcine Valve
Tissue Valve
Tissue Valve

Valvular Heart Disease

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