Valvular Heart Disease

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Valvular Heart Disease

• NPN 200
• Medical Surgical I

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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

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Tricuspid Valve
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Rheumatic Heart Disease

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

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Rheumatic Heart Disease, cont.

• Subjective symptoms
• Prior history of rheumatic fever
• General malaise
• Pain may or may not be present

• Objective symptoms
• Temperature
• Murmurs
• Dyspnea
• polyarthritis

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Rheumatic Heart Disease

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

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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

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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

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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

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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

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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

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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

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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, Marfans
• 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

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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

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Assessment, cont.

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

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Diagnosis

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

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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

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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

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Surgical Management of Valve Disease

• Mitral Valve
• Commissurotomy
• Mitral Valve Replacement
• Balloon Valvuloplasty
• Aortic Valve Replacement

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Mechanical Valve
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Mechanical Valve
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Porcine Valve
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Tissue Valve
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Tissue Valve