S3 EXAM 2 VALVE DISORDERS Flashcards
WHAT HAPPENS- CALCIFICATION
AS PEOPLE AGE, CALCIFICATION INCREASES
Pathophysiology
Acquired valvular dysfunction- interference of blood flow to & from heart
Stenosis- valves thicken by fibrosis or calcification deposits—-leaflets fuse—–become stuff—valve opening narrows— prevents normal blood flow
Insufficiency or regurgitation- valve unable to close completely—- backflow of blood
Prolapse- valve leaflets enlarge & prolapse (slipping of a body part from usually position)
MITRAL STENOSIS
Blood flow prevented from flowing from LA to LV
L arterial pressure rises–—- L atrium dilates—-pulmonary artery pressure increases—- RV hypertrophies
1st- pulmonary congestion—-R sided HF
Later- L ventricle receives insufficient blood & CO decreases
Symptoms- asymptomatic at 1st– valve opening more narrower pressure in lung increases —what symptoms would you assess?
R sided HF assessment
Palpitations- AF
Rumbling, apical murmur
Mitral Regurgitation or Insufficiency
Valve cannot close completely during systole
Causes RHD, endocarditis, MI, connective tissue disease, dilated cardiomyopathy
Progression slow
Symptoms
Normal BP, AF, changes respirations due to LV failure. Eventually leads to R sided HF
High pitched murmur at apex-radiates to left axilla- S3 heart sound
Mitral Valve Prolapse
Valvular leaflets enlarge & prolapse into L atrium
Etiology
Usually, asymptomatic but CP (sharp localized to left side of chest), palpitations, exercise intolerance
Midsystolic click, late systolic murmur heard apex of heart
Aortic Stenosis
Most common cardiac valve dysfunction- all countries with aging population
Aortic orifice narrows—obstructs blood flow out of ventricle—stenosis worsens—CO becomes fixed—-symptoms develop
When surface area of valve becomes 1 cm or less, urgent surgery needed
Causes: congenital , rheumatic disease
Symptoms
Narrow pulse pressure
Diamond shaped systolic crescendo-decrescendo murmur
Aortic Regurgitation
Aortic leaflet valves do not close properly during diastole- annulus may be dilated, loose or deformed
Causes
Asymptomatic for years
Develop LV failure
Palpitations later-esp. when lies on left side
Bounding arterial pulse, pulse pressure widened
High pitched, blowing, decrescendo-diastolic murmur
Pulmonic Valve Disorders
Stenosis- obstruction blood flow from RV into pulmonary system
Right sided heart failure symptoms
Harsh, systolic crescendo-decrescendo murmur- heard left intercostal space
Regurgitation- murmur- high-pitched decrescendo blowing sound heard left sternal border
Tricuspid Valve Issues
Stenosis- blood flow obstructed from RA to RV
Stroke volume, CO & tissue perfusion decrease
Low pitched rumbling diastolic murmur- heard 4th intercostal space, left sternal border over xiphoid process
Regurgitation- blood flows back into RA during systole- R sided heart failure
Low pitched blowing systolic murmur heard over tricuspid area
Assessment
History-what are we looking for?
Physical assessment- what are we looking for?
Diagnostic tests
Management
Interventions- yearly monitoring / drug therapy
Maintain cardiac output
Non-Surgical Management
Drug therapy
Rest
Monitor for development of AF- what drugs might be used?
Anticoagulants
Balloon Valvuloplasty
Invasive, nonsurgical
Aortic or Mitral
Post op procedure care
Function longer than prosthetic valves
Closed Surgical Valvuloplasty
Performed on any valve with stenosis
General anesthesia
Midsternal incision- small hole cut in heart & surgeon puts his finger in or a dilator to open the commissure
No direct visualization of valve
Valve Replacements
Prosthetic (synthetic)
Biologic (tissue)
Xenograft(from other species) last 7-10 years
Cadaver(Homografts/ Allografts) last 10-15
years
Pulmonary autographs (relocation of patient’s own pulmonary valve to aortic position) (Ross Procedure) last more than 20 years
Mechanical- replace aortic valve (high pressure within aorta)
Pre-operative Care
Procedure similar to open heart surgery
Planned procedure
Preop dental exam
Pre op teaching
Oral anticoagulants- stop 72 hours prior to surgery
