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Complex Care > Cardiac valvular diseases > Flashcards

Cardiac valvular diseases Flashcards

1
Q

How is a valvular disease defined?

A

by the valve that is affected and the functional alteration

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2
Q

What is stenosis and what impact does it have on the blood flow and pressure?

A

Stenosis is narrowing of the valve orifice. It impedes blow flow through the valve which causes an increased pressure on the side of the valve that blood is flowing into and decreased pressure on the other side of the valve

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3
Q

What is regurgitation and what impact does it have on blood flow?

A

The valve does not close completely so blood flows backwards

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4
Q

What are the AV valves?

A

Mitral and tricuspid valves

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5
Q

What are the semilunar valves?

A

aortic and pulmonary valves

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6
Q

What are the valves doing during systole?

A
  1. AV valves are closed during systole
  2. Semilunar valves are open during systole

This allows blood flow out of the ventricles and into the rest of the body

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7
Q

What are the valves doing during diastole?

A
  1. AV valves are open during diastole
  2. Semilunar valves are closed during diastole

This allows blood flow into the ventricles

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8
Q

What is the mitral valve located?

A

between the left atrium and the left ventricle

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9
Q

Where does the majority of the SV come from?

A

the left ventricle

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10
Q

Mitral valve stenosis overview

A

Mitral valve is unable to open efficiently d/t mitral valve stenosis during left atrial systole
This means blood can’t get out of the left atria to fill the left ventricle d/t the small opening and pressure build in left atrium

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11
Q

What is mitral valve stenosis caused by?

A
  1. Most cases causes by rheumatic heart disease

2. Congenital heart disease

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12
Q

What is going on with the mitral valve during mitral valve stenosis?

A

There is scarring of the valve leading to adhesion

The valve becomes thickened and shorter

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13
Q

What does the mitral valve look like with mitral valve stenosis?

A

fish eye appearance

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14
Q

Mitral valve stenosis manifestations

A
  1. Exertional dyspnea
  2. Heart sounds - loud S1, low pitched diastolic (after S2) murmur
  3. Atrial fibrillation
  4. Embolization from Afib –> stroke
  5. Decreased CO
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15
Q

Why is there Exertional dyspnea with mitral valve stenosis? How does the patient present?

A
  1. There is increased pressure in the pulmonary valve –> decreased lung compliance d/t backing up into pulmonary vessels
  2. SOB while walking
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16
Q

What can Exertional dyspnea lead to? What does it manifest as?

A

Exertional dyspnea can increase to the point of pulmonary hypertension
Manifests as spitting up blood (hemoptysis)

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17
Q

What is making the sound. of a murmur?

A

sound of blood going where it is not supposed to

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18
Q

Where is the heart sounds for mitral valve stenosis best heard?

A

you can best hear the loud S1, and low pitched diastolic murmur at the apex of the heart

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19
Q

Why is there decreased CO with a mitral valve stenosis

A

Because there left ventricle is not filling

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20
Q

What is the difference between a diastolic and a systolic heart murmur?

A
  1. Diastolic - heard after S2

2. Systolic - heard after S1

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21
Q

Rheumatic heart disease `

A
  1. Causes from strep A bacteria that is not treated and progresses into rheumatic fever
  2. RF leads to rheumatic heart failure
  3. Causes scarring and deformity of heart valves- mitral valve is the most common valve to be affected
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22
Q

What increased the risk for rheumatic heart disease?

A
  1. Children who are frequently reinfected with strep A and don’t get treated
  2. Third world countries that do not have access to antibiotics
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23
Q

Mitral valve prolapse is the..

A

most common valvular disease in the United States

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24
Q

What is mitral valve prolapse disease?What is it caused by?

A

Leaflets buckle into the left atrium during systole

Causes by abnormality in the leaflet, chord tenineae or papillary muscles

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25
Q

Do patients with mitral valve prolapse disease have symptoms?

A

They can be asymptomatic or symptomatic
Asymptomatic - common and pt. is monitored for progression into mitral valve regurgitation
Symptomatic: need a valve replacement right away

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26
Q

What is mitral valve prolapse characterized by

A

systolic murmur
innocent murmur because it is very common for people to have
Just monitor for a period of time once found with ECHO

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27
Q

What does mitral valve prolapse lead to?

A

Leading cause of mitral valve regurgitation

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28
Q

What is mitral valve regurgitation?

A

Mitral valve does not completely close during ventricular systole therefore when left ventricle is contracting to get blood out to the body –> blood is regurgitating into the left atrium

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29
Q

Blood flow and pressures r/t mitral valve regurgitation

A
  1. increased pressure in left atrium
  2. Volume deficit of blood going out to the body
  3. Volume overload in LV d/t both normal SV and regurgitated volume going into LV
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30
Q

What happens to the left ventricle and left atria r/t mitral valve regurgitation?

A
  1. Both have to work harder to maintain CO
  2. Left ventricle hypertrophy
  3. LV dilates d/t increase preload
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31
Q

What is mitral valve regurgitation caused by?

A 
Deficit in mitral valve or other cardiac structures that relate to blood flow 
MI 
Rheumatic heart disease
Mitral valve prolapse,
Papillary muscle dysfunction
Endocarditis
32
Q

What should patients with a mitral valve prolapse avoid?

A

Any stimulants like coffee or any exacerbation of symptoms

Goal - remain generally healthy

33
Q

What are the clinical manifestations of an acute onset of mitral valve regurgitation?

A
  1. Thready peripheral pulse
  2. Cool, clammy extremities
  3. Pulmonary edema
  4. New systolic murmur

Dangerous and poorly tolerated

34
Q

What is an acute onset of mitral valve regurgitation usually a result of?

A

Heart failure post MI

35
Q

What does an acute onset of mitral valve regurgitation lead to?

A

left ventricular failure –> cariogenic shock

36
Q

Chronic mitral vavle regurgitation clinical manifestations are (6)

A
  1. Fatigued
  2. Palpitations
  3. SOB
  4. Peripheral edema
  5. Audible 3rd heart sound - holosystolic murmur
  6. Left atrial enlargement

Pts. may be asymptomatic for years

37
Q

What is a holosystolic murmur?

A

Regurgitant murmur and occurs when blood flows from a chamber in which pressure throughout systole is higher than pressure in the chamber that is receiving the flow

38
Q

Where is the holosystolic murmur best heard?

A

apex of heart or axilla around the heart

39
Q

What is the end results of all valvular diseases?

A

Heart failure

40
Q

What is aortic stenosis?

A

Aortic valve is stiff and narrowed so the blood is not getting to the body –> decreased SV and CO

41
Q

What does the aortic valve do?

A

Valve that gets blood to the body

Gatekeeper of all SV that the body receives with every heart beat

42
Q

What happens to the left ventricle with aortic valve stenosis?

A

It has to work harder to pump the blood through such a small opening –> hypertrophy

43
Q

What does aortic stenosis lead to? What do the s/s look like?

A

Decreased CO and heart failure.. therefore the s/s look like decreased CO and HF

44
Q

What are the causes of aortic stenosis?

A
  1. # 1 cause is age over 65 - sometimes the body just ages this way
  2. Congenital
  3. Acquired - result of rheumatic heart disease
45
Q

When do you start seeing symptoms with aortic stenosis?

A

when the valve becomes 1/3 of its normal size –> decreased SV enough to cause systemic s/s

46
Q

What are the signs of aortic stenosis?

A
  1. signs of left ventricular heart failure –> decreased cardiac output) - angina, syncope, Exertional dyspnea
  2. Systolic murmur with absent S2 - hear S1 then loud whoosh
47
Q

Is there a poor prognosis with aortic stenosis?

A

Yes, it the problem is not fixed

48
Q

What normally happens to the aortic valve during ventricular diastole?

A

it is normally closed to allow for ventricular filling

49
Q

What happens when aortic valve is not closed curing ventricular diastole?

A

The blood will flow backwards from the aorta and leak back into the ventricle instead of going to the body –> decrease stroke volume

50
Q

What happens to the left ventricle during aortic regurgitation?

A

hypertrophy d/t volume overload

51
Q

What does the blood go when it backs up during aortic regurgitation?

A

backs up into the left atrium and pulmonary vessels

52
Q

What is aortic regurgitation caused by?

A

disease of the aortic valve
trauma
aortic dissection
endocarditis

53
Q

What can exist in cases of rheumatic heart disease?

A

chronic aortic regurgitation

54
Q

What are the manifestations for acute aortic regurgitation?

A
  1. life-threatening d/t sudden cardiovascular collapse
  2. Severe chest pain
  3. Dyspnea
  4. Profound and immediate hypotension
  5. Can lead to cariogenic shock
55
Q

What are the manifestations for chronic aortic regurgitation?

A
  1. Asymptomatic for years
  2. Water hammer pulse
  3. Early diastolic (after S2) murmur
  4. Fatigue
56
Q

What is a water hammer pulse?

A

strong, quick beat that immediately collapses

If taking central pulse, it quickly kicks you and then goes away so you don’t feel the entire pulse

57
Q

Valvular disease - assessment of history includes? (7)

A
  1. Rheumatic heart disease
  2. Infective endocarditis
  3. Congenital defects
  4. MI
  5. Cardiomyopathy
  6. Strep infections
  7. May be asymptomatic for years
58
Q

Assessment of valvular disease physical exam includes

A
  1. S/S of HF
  2. S/S of a-fib
  3. Cardiac S/S: S3 or murmur and dysrhythmias
59
Q

S/S of HF are..

A

Left

  1. Crackles
  2. Wheezing
  3. Orthopnea
  4. Dyspnea
  5. Hemopytosis
  6. Fatigue

Right

  1. Hepatomegaly d/t back up of blood in the liver –> increased liver enzymes
  2. Peripheral edema
60
Q

What are the s/s of a-fib?

A

D/t pressure in the left atrium

  1. Pulse irregularly irregular
  2. s/s of stroke
  3. Palpitations
  4. ECG changes
61
Q

Diagnostics: ECHO to TEE

A

Regular ECHO first.
TEE ordered when looking for something specific and it reveals valve structures, function, and size of atria and ventricles

62
Q

Diagnostics: Cardiac cath

A

Looks at pressure changes in the heart chambers, measures the pressure changes across the valves and measures the valve openings

63
Q

Diagnostics: ECG

A

Changes in rhythm, show chamber enlargement, ischemic changes, a-fib

64
Q

Diagnostics: CXR

A

pulmonary congestion, enlargement of pulmonary arteries(from pulmonary back up), enlarged heart chambers

65
Q

Diagnostics: CT scan

A

evaluates for aortic disorders

66
Q

Treatment for a valvular disease depends on..

A

valve involved and severity
Acute and chronic are treated differently.
In acute, valve replacement immediately because it is needed to survive

67
Q

Can the heart compensate for a valve disorder?

A

yes the heart can compensate but patient may eventually become symptomatic

68
Q

Treatment options include..

A
  1. Medical management - 1st line to treat s/s

2. Surgical may be required

69
Q

How do you treat a patient with chronic valvular disease?

A
  1. Prevent exacerbations of HF
  2. Pulmonary edema
  3. Thromboembolism
  4. Infective endocarditis
  5. Prevent recurrence of rheumatic heart disease and infective endocarditis
70
Q

What is the end of the line for all valvular diseases?

A

All end with a valvular replacement

71
Q

Medical management includes

A
  1. Treat HF w/ vasodilators, beta-blocker, diuretics (decrease fluid and pressure in LV and rest heart as much as possible), low NA diet, inotropic drugs
  2. Anticoags for presence of a-fib
  3. Dysrhythmias are common and need treatment so treat w/ antidysrhythmic medications, cardioversion(meds before this), meds to control vent rate with a-fib
72
Q

What is the most common reason for ongoing medical care?

A

HF

73
Q

When do you need to give a patient a valve replacement?

A

Once they develop s/s of HF, when heart size increases, EF decreases, angina, syncope

74
Q

What do you use to monitor patients heart size and ejection fraction?

A

ECHO

75
Q

Percutaneous transluminal balloon Valuloplasty (PTBV)

A

Alternative to valve replacement
Used for mitral or aortic stenosis
Preformed in cardiac cath lab where they stick a catheter with a balloon on the tip and inflate/deflate over and over to decrease stiffness and loosen the leaflets
Works for a short time - bandaid for replacement

76
Q

Transcutaneous aortic valve replacement (TAVR)

A

done in the cath lab
Fed though femoral or radial artery and replace valve w/o opening the heart
W/ acute aortic valve problem- most have an emergency TAVR

77
Q

Prosthetic valve

A

Most pts. are required to take anticoags for the rest of their lives and will require regular coag labs (INR)
Thromboembolism form easy on artificial valve
At risk for infection

Complex Care (22 decks)

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