Mitral and Aortic Valve Disease Flashcards
the following flashcards are going to be based off the textbook and the nclex ready book
before we begin can you tell me the flow of the heart? (12 steps )
Right side
1. SVC/IVC
2. right atrium
3. tricuspid valve
4. right ventricle
5. pulomary valve
6. pulmonary artery
left side
1. pulmonary veins
2. left atrium
3. mitral valve
4. left ventricle
5. aortic valve
6. aorta
what are the two AV valves?
mitral and tricuspid
what are the two semilunar valves?
aortic and pulmonic
what do the two av valves and the two semilunar valves help do to the body?
help control the blood flow through the heart
Typically the pressure on either side of an open valve is normally equal. However, in a stenotic valve, what happens?
the valve opening is smaller due ot the limited leaflet opening. The forward flow of blood is impared. This creates a difference in pressure on the 2 sides of the open valve.
How can we tell the amount of stenosis that is happening to our patient with a valve problem?
It is seen through the pressure difference between the valves
In regurgitation, what is happening to the valve?
It is often referred to as insufficiency and incompetence
The valve is unable to close completely and backward flow of blood happens
what are some common causes for why patients end up developing valve disorders?
congential heart condtiiosn
heart disease when getting older
hypertension
autoimmune disorders
what are the 3 mitral conditions we are going to be discussing?
mitral valve stenosis
mitral valve regurgitation
mitral valve prolapse
what is the most common cause on why patients develop mitral valve stenosis?
rheumatic IE
how does rheumatic heart disease cause a patient to have mitral valve stenosis?
it causes scarring of the valve leaflets and the chordae tendinae. Contracture and adhesions develop between the commissures. Then the valve takes on this fish mouth shape and because of this scarring that thickens and shortness.
- these deformities block the blood flow and create a pressure difference between the left atrium and left ventricle during diastole
what are some clinical manifestations associated with mitral valve stenosis?(5)
chest pain ( hoarseness when talking )
activity intolerance ( external dyspnea )
diastolic murmur
right ventricle failure s/s ( pulmonary hypertension )
afib on ekg
what is the main cause for patients to develop mitral valve regurgitation?
Defect in any of the heart structures or myocardial infarction
what is the patho that is going on when it comes to mitral valve regurgitation?
mitral valve regurgitation allows the blood to flow backward from the left ventricle to the left atrium, because of the incomplete closure of the valve during systole
so what is the difference between mitral stenosis and mitral regurgitation regarding the way the blood flows through the heart?
stenosis - the blood is unable to cross over due to the narrowing between the left atrium and the left ventricle during diastole and causes an unequal amount of pressure between both of ventricle and atrium
regurgitation - the blood returns back from the left ventricle to the left atrium during systole
due to the fact that regurgiation is backing up into the left atrium, for the mitral valve regurgitation, what is something that we usually end up seeing in these patients?
and left under-treated what can happen
pulmonary edema - if not treated cardiogenic shock
what are the 4 signs and symptoms we typically see for a patient with mitral valve regurgitation?
pulmonary edema
pleural effusion
enlarged organs
ascites
i am not sure if we are going to be tested on prolapse
so just a small overview
mitral valve prolapse is an abnormality with the mitral valve leaflets and the papillary muscles or chorade that allows the leaflets to prolapse or buckle back into the left atrium during systole.
- typically this is benign but it can have some serious complications
A characteristic of MVP is regurgitation murmur that is louder during systole
M-mode and 2D echo can confirm MVP
typically patients can manage there pain, that include chest pain that occurs in clusters and during periods of stress
- but they don’t respond to nitrates
- however beta blockers and staying hydrate aids
- avoid caffeine
if you develop with symptoms, typically you need to wait for valve surgery
what is the main cause behind aortic valve stenosis?
rheumatoid factor, or degeneration of the body
what is the patho behind why degeneration of the body or having the RF can really cause a patient to develop aortic valve stenosis?
the calcification and fusion causes the valve leaflets to stiffen and retract, resulting in stenosis
what part of the heart does aortic valve stenosis really affect?
think of the like the chambers of the heart
usually results in what?
the blood is blocked from the left ventricle to the aorta during systole ends up resulting in left ventricule hypertrophy and increased myocardial oxygen consumption.
- it the disease progresses the compensation fails and Cardiac output is reduced.
what are 4 clinical manifestation often assocaited with aortic valve stenosis disease?
angina
systolic murmur
syncope
faituge
( orthopnea )
its a small note in the textbook, but why are we cautiously using nitro to help patients with angina when they also have aortic valve stenosis?
reduce blood pressure and worsen chest pain
- remember the patho, because we already are struggling to get blood out the body, lowering the blood pressure can decrease that even more
what is aortic valve regurgitation mainly caused by?
trauma
primary disease of the aortic valve leaflets
what is happening in the heart with aortic valve regur?
backward blood flow from the ascending aortia into the left ventricle during diastole
to review everything regarding the heart
what is happening in mitral valve stenosis
what is happening in mitral valve regur
what is happening in aortic valve stenosis
whatis happening in aortic valve regur
mitral stenosis - narrowing of the left atrium and left ventricle that results in pressure during diastole
mitral regur - backward blood from the left ventricle into the left atrium during systole
aortic stenosis - narrowing of the left ventricle to the aorta during systole
aortic regur - backward blood flow from the aorta into the left ventricle during diastole
what are the 3 main clinical manifestation of aortic valve regur?
tachycardia
dyspnea
fatigue
what is the diagnostic study behind valvular heart disease?
chest x-ray
echo
ecg
heart cath
cbc
for conservative therpay for these patients, meaning how to prevent future complications or worsening symptoms, using non-surgical things
what would we recommend to patients?
RF antibiotic therpay
sodium restiction
drug therapy
why are we placing these patietns on a sodium diet?
remember sodium swells the body, and puts more effort into the heart to try to get rid of water, when its already struggling to get rich oxygen blood out of the body, or when you have too much fluid it backsup in regurg
what type of drug therpay would we recommend to these patients?
vasodilatores
beta blockers
digoxin
diuretics
some patietns may suggest doing a percutaneous transluiminal balloon valvuloplasty which is what and for what type of valve problem?
only for stenosis, and we place a balloon into the valve to help open and encourage blood flow
we usually prefer doing a valve repair over a valve replacement due to the fact that it has less risks and fewer complications post-op. patients are able to go home, less pain and lower infection.
what are the two types of valve replacement we can do for our patients?
mechanical and biological valves
whats the difference between mechanical and biological valves?
mechanical is made out of parts
biologic is from an animal, like pig(porcine), cow(bovine) or human
why would biological be better for some patients (2) reasons?
- they produce more natural pattern of blood flow
- those who can not take life long anti-coagulations ( pregnancy patients fro example )
why would mechnical be better for some patients (2) reasons?
- last longer
- and more durable ( less likely to worsen with age or experience calcification )
however the biggest compliaction and thing we have to do for a patient with a mechanical valve is what?
life long therpay of anticoagulat due to the fact that clots are more likely to occur
the normal range for warfarin for patients is 2-3, however with patients with valve problems what is the dosage that is fine for them when they go to check INR?
2.5-3.5
patietns should AVOID dental procedures for at least ___after surgery and take antibiotics before dental exams
6 months
