NUR 146 - WEEK 11 - Valvular Disorders Flashcards
What is the purpose of valves in the cardiovascular system?
To maintain unidirectional blood flow
- Valves open and close passively in response to pressure gradients and movement of blood
Regurgitation:
What is it?
Valve doesn’t close completely
- Blood flows backward through valve
- Can affect any valve
Stenosis:
What is it?
Valve does not open completely
- Results in reduced blood flow through valve
- Can affect any valve
Prolapse:
What is it?
Stretching of the valve leaflet into the atrium during systole
- Typically only affects the mitral valve
Mitral Valve Prolapse (MVP):
What is it?
s/s
A portion of one or both leaflet balloons back into atrium during systole
s/s: Often asymptomatic
- Fatigue
- SOB
- Weakness
- Palpitations
Mitral Valve Prolapse (MVP):
Medical management
Nursing management
Medical:
- Symptom management
- Stop smoking
- Limit caffeine/stimulants (vasoconstrict & tachycardia)
- Antiarrythmic medications prn
Mitral Regurgitation:
What is it?
Cause?
s/s or clinical manifestations
Blood flows backward from left ventricle to left atrium
Cause:
USA = Mitral valve prolapse
Other countries = Rheumatic heart disease
s/s: Chronic mitral regurg may be asymptomatic
- Dyspnea
- Fatigue, weakness
- Cough
- Palpitations
- Can lead to left atrial congestion (blood buildup) & hypertrophy –> pulmonary congestion
Mitral Regurgitation:
Heart assessment
Medical management
Surgery
Assessment:
- Systolic murmur - blowing sound at apex
Medical management:
- Similar to HF
- Afterload reduction “easier for heart to do it’s job”
- meds: ACE inhibitors, ARBs
Surgery:
- Valvuloplasty or valve replacement
Aortic Stenosis:
What is it?
Cause?
What does it result in?
s/s
Risk factors
Narrowing of aortic valve; “not enough blood can get out!”
Cause:
- Often d/t calcification on valve leaflets
Result:
Reduced blood from left ventricle to aorta –> stenosis becomes progressively worse
s/s: Signs of Left sided heart failure
- Exertional dyspnea
- Orthopnea
- Dizziness
- angina
- hypotension
- decreased pulse pressure <30 mmHg
Risk factors:
- Age
- Diabetes, HTN, high cholesterol, smoking
Aortic Stenosis:
Assessment findings
Prevention
Medical Management
Prevention:
- Management of diabetes, HTN, hypercholesterolemia
Medical:
- TAVR (Transcatheter aortic valve replacement)
- Treatment of Left ventricle failure
Valvular Heart Disorders:
Patient Education
Nursing Management
Patient education:
- Increased risk of infection
- Medifcation regimen (ACE inhibitors, beta blockers, etc)
Nursing:
- Monitor vital signs, heart and lung sounds
- Monitor for complications: signs of HF, arrhythmias, dizziness, syncope
Valvuloplasty:
What is it?
Surgical options
Repair of cardiac valve
Options:
- Balloon valvuloplasty
- Open commissurotomy
- Annuloplasty
- Leaflet repair
Balloon Valvuloplasty:
What is it / How is it done?
What does it treat?
Procedure:
Balloon is brought through via cardiac cath, balloon is then brought inside diseased valve inflated and deflated.
Used to treat:
Cardiac cath lab, patient given light sedation
Treats Mitral and Aortic stenosis
Mitral valvuloplasty:
- Patient expected to have mitral regurgitation after procedure
Complications:
- Emboli –> stroke
- Bleeding at insertion site
Aortic Valvuloplasty:
- Patient expected to have aortic regurgitation after procedure
Complications:
- Emboli –> stroke
- Arrhythmias
- Bleeding at insertion site
Open commissurotomy:
What is it?
Open heart surgery using cardiopulmonary bypass
Annuloplasty:
What is it?
Indication?
Patient education
Open heart surgery to repair annulus
Places ring around valve
Indication:
- Mitral valve regurgitation
Patient requires antibiotics before dental work for rest of life
Leaflet repair:
What is it?
Indication
Open procedure to remove damaged or excess portion of leaflets
Indication:
Mitral valve regurgitation
Which valvular treatment requires patients to have antibiotics before any dental treatment for the rest of their life?
Annuloplasty & Mechanical valve replacement
Valvuloplasty:
Nursing care
Similar to cardiac cath or open heart
TAVR (Transcatheter Aortic Valve Replacement:
What is it?
Balloon is brought in with prosthetic valve, balloon is inflated and placed over stenotic aortic valve
Used to treat aortic stenosis
Valve replacement:
What is it?
- Open surgery using general anesthesia and cardiopulmonary bypass
- Preferred method of treating valves with more severe disease
Valve replacement:
Types of valves
Mechanical:
- Thought to be more durable
- Preferred for younger patients
- Downside: long term anti-coagulants, antibiotics before dental work
Tissue Valves
Bioprosthesis:
- Made from animal tissue
- Don’t require long term anti-coagulation
Homograft:
- Obtained from cadaver
Autograft:
- Uses patient’s own valves from pulmonic valve; pulmonic replaced with homograft
Valve replacement:
Nursing Care
Similar to care of patient after surgical valvuloplasty
- Monitor hemodynamic stability
- Cardiac monitoring for arrhythmias
How often should patients with treated valvular disorders undergo echocardiograms?
Every few months, and eventually every 1-2 years
Heparin:
What to monitor?
Antidote?
Misc
Monitor:
PTT - therapeutic range = 1.5-2.5 x control
Antidote = protamine sulfate
Misc:
Very short half life; should be on drip
