Cardiac Valve Disorders

Question 1

What changes are occurring when a heart valve is stenotic?

Answer 1

Heart valves are not able to open completely
Impedes the blood flow through the valve
Causes gradual hypertrophy and dilation of preceding valve

Question 2

What changes are occurring when a heart valve is regurgitating or insufficient?

Answer 2

Heart valves are not able to close completely
Leads to backward flow through the valve and dilation of preceding chamber

Question 3

What are some causes of cardiac valve malfunction?

Answer 3

Rheumatic fever
Infective endocarditis: vegetations
MI affecting myocardial muscles
Congenital heart dz
Deformity of valve cusp
Degeneration: calcification
“Wear and tear”
Hypertension
Atherosclerosis

Question 4

What are the clinical manifestations and type of murmur with Mitral prolapse?

Answer 4

May be asymptomatic
Atypical chest pain not related to activity
Dyspnea
Tachydysrhythmias may cause palpitations, lightheadedness, and syncope
Tachydysrhythmias may cause palpitations, lightheadedness, and syncope
Thrombi may form on valve leaflets

Question 5

What are the clinical manifestations and type of murmur with Mitral Regurgitation?

Answer 5

S/S: fatigue, DOE, orthopnea, palpitations, pulmonary congestion
Later: right sided HF
Murmur: loud, high pitched, rumbling (blowing) pansystolic murmur at the apex
May radiate to left axilla

Question 6

What are the clinical manifestations and type of murmur with Mitral Stenosis?

Answer 6

More common in females
S/S: weakness, fatigue, DOE, cough, PND, orthopnea, frequent respiratory infections
Later: rt sided HF
Palpable thrill
Murmur: opening snap with low pitched diastolic rumbling crescendo-decrescendo, apex (bell)

Question 7

What are the clinical manifestations and type of murmur with Aortic Regurgitation?

Answer 7

Asymptomatic for many years
DOE, orthopnea, PND, syncope, fatigue, throbbing pulse in neck (Musset’s sign), “head bob”, angina, palpitations
Water-hammer pulse: rapid upstroke then down stroke
Exercise intolerance
Murmur: high pitched blowing decrescendo, diastolic murmur, may have a thrill and ventricular heave, 3 ICS

Question 8

What are the clinical manifestations and type of murmur with Aortic Stenosis?

Answer 8

May be asymptomatic for years then S/S of Lt. sided HF
DOE, angina, exertional syncope
Pulmonary congestion and edema
Later: rt sided HF
Abnormal heart sounds: S3, S4
Murmur: palpable thrill, ejection click, systolic crescendo-decrescendo murmur

Question 9

What is a water hammer pulse and Musset’s Sign and what type of valve disorder causes
these symptoms?

Answer 9

Water hammer pulse: rapid upstroke then downstroke
Musset’s sign: throbbing pulse in neck
Aortic regurgitation

Question 10

What type of valve dysfunction results in a murmur radiating to the carotids?

Question 11

What are some diagnostic tests used to assess and evaluate cardiac valve problems?

Answer 11

Echocardiogram & TEE
Chest x-ray
ECG
Cardiac Catheterization- angiography
Exercise stress test- only if asymptomatic

Question 12

What is a major goal in the management of valve disorders?

Answer 12

Symptom management

Question 13

What are the actions of the medications are used to treat cardiac valve disease?

Answer 13

Diuretic Therapy: reduce pulmonary congestion, peripheral edema
Vasodilators (hydralazine): dilates the vessels for better blood flow
ACE inhibitors (lisinopril): reduce preload and afterload
Beta Blockers (metoprolol) & Calcium Channel Blockers (nifedipine)

Question 14

What are some nursing diagnosis important in management of cardiac valve disease?

Answer 14

Altered tissue perfusion - cardiopulmonary, cerebral, peripheral, renal
Ineffective breathing patterns or impaired gas exchange - pulmonary congestion
Activity intolerance/Impaired Mobility
Risk for Infection

Question 15

What is the purpose of the percutaneous balloon valvulotomy?

Answer 15

Used to relieve symptoms of stenosis with balloon inflation (catheterization lab procedure)

Question 16

What is the purpose of the commissurotomy procedure?

Answer 16

Surgical division of fused valve leaflet with debridement of localized calcium deposits
Procedure to open stenosed valves

Question 17

What is the purpose of the annuloplasty?

Answer 17

Repair of an enlarged valve annulus (the supporting ring of the valve)
Resize the ring using prosthesis or purse string sutures to reduce or gather excess tissue.

Question 18

What is the purpose of the chordoplasty? What is the purpose of the chordae tendineae?

Answer 18

Chordoplasty: Repair of chordae tendineae
The chordae tendineae pulls the valve open

Question 19

What are the various types of prosthetic valves used for heart valve replacement?

Answer 19

Mechanical or biological

Question 20

What are the advantages and disadvantages of biological cardiac valves?

Answer 20

Pros:
More normal blood flow with lower risk of thrombus formation
No long-term anticoagulation therapy…~3 months

Cons:
Less durable ~15 years need replaced. Better for older patient

Question 21

What are the advantages and disadvantages of mechanical cardiac valves?

Answer 21

Pros:
Very durable
Used for younger patients due to durability

Cons:
Higher risk of thrombus
Requires long-term anticoagulants

Question 22

What is the required medication regimen for post mechanical valve replacement
patients?

Answer 22

Long term warfarin (Coumadin)
Heparin until INR therapeutic for 48 hr

Question 23

What follow up is important for patients post heart valve
replacement?

Question 24

What patients are candidates for cardiac valve procedures in the cardiac cath lab versus
open surgery in the OR?

Answer 24

High risk patients are candidates for cardiac valve procedures in the cardiac cath lab