STENOSIS (VALVULAR DISORDERS) Flashcards
There will be less blood and less cardiac output
Tightening of the lumen/narrowing
STENOSIS
Blood goes back from atrioventricle
▪ When the ventricles are contracting, AV
valves should be close. But because there is
a defect, during contraction the blood
goes back
REGURGITATION
Close completely if no tehere is a small opening
INSUFFICIENCY
Most common is ___ side of heart
left
Common affected:
left valves due to
contraction against a high pressure.
▪ Aortic Valve and Mitral Valve
explain why have
Angina (Chest pain)
Since less blood is received by the heart; therefore, there will be anaerobic metabolism, which causes the production of lactic acid. And that lactic acid will irritate the nerve endings causing chest pain
If there is _____: there will be accumulation of blood in the atrium; the atrium will become enlarged (increasing the pre-load)
There will be a back flow of blood in the lungs leading to pulmonary congestion —> pressure in the lungs are high
The right ventricle is pushing against the high pressure in the lungs (increasing the workload; which increases the demand for blood because it becomes enlarged; however, the coronary artery will just give the same amount of blood)
Less blood —> less cardiac output
o Fatigue
o Dyspnea
Increasing pre-load in the left atrium
mitral stenosis
explain why have
dsypnea
Only small amount of blood is being sent to the aorta, the blood is accumulating in the left ventricles.
If there is aortic stenosis, the blood will flow back to the left atrium, then going back to the lungs the blood in the lungs can no longer enter the left atrium causing pulmonary congestion
The fluids or the blood entered already the alveoli
The blood in the upper and lower extremities goes inside the lungs; causing pulmonary congestion —> which causes difficulty of breathing, and it is relieved by standing up.
Sudden awakening for 1-2 hours of sleep with dyspnea; and when the patient stands up to get more air, and when they stand the fluids goes down because of gravity and now the patient can breathe normally.
PAROXYSMAL NOCTURAL DYSPNEA
The patient cannot do supine position (because there can be dyspnea)
Place 2-3 pillows in the head and the shoulders to elevate the head part
2 pillow orthopnea
4 pillow orthopnea (if 4 pillow are used)
Because the patient cannot breath in a supine position
ORTHOPNEA
Coughing out of blood
High pressure in the pulmonary veins can rupture and can cause hemoptysis
HEMOPTYSIS
Because the heart is contracting forcefully to give an enough cardiac output
PALPITATIONS
The doctors will insert their fingers or a small instrument to expand the mitral valve.
COMMISSUROTOMY
It will widen the mitral valve because of the balloon inserted in the right atrium.
VALVULOPLASTY
No contact sports
Easy to bleed
Soft bristles toothbrush
Remove clutters
Patient may be prone to risk for fall
Apply pressure to stop bleeding
WARFARIN
The aortic valves becomes narrowed
Most common cardiac valve dysfunction
Usually asymptomatic
Heart murmur is the most common early sign
Most common in males
Left ventricle will enlarged first if there is aortic stenosis.
Sudden cardiac death —> if not treated
Angina, Syncope, Exertional Dyspnea —> 3 cardinal symptoms
AORTIC STENOSIS
There is a backflow
Once, the atrium filled the ventricles with blood, the mitral valves do not close completely (insufficiency) —>some blood pushes at the ascending aorta, but some blood went back to the left atrium because of insufficiency.
Left atrium will become enlarged
If it is enlarged, there can be a backflow in the pulmonary veins causing pulmonary congestion
Less blood ejected from the left ventricle
Less cardiac output
MITRAL REGURGITATION
There is backflow of blood;
* Mitral and tricuspid should close, however in mitral valve it cannot close completely called Mitral Insufficiency
When right ventricle is contracting push blood towards aorta; since not closed pushing some blood went back to left atrium; so the chamber enlarged in left atrium
- Amount of blood from left ventricle which is less because some got back to left atrium
- Enlarging again left atrium, can result to thrombi there come a time it can have backflow of blood going to lungs
MITRAL REGURGITATION
EXPLAIN
Rheumatic fever
▪ Rheumatic fever is common in children, the cause is streptococci.
▪ If a child has sore throat or tonsilitis, the body will compensate by producing antibodies. The doctor will also prescribe an antibiotic. However, if tonsilitis keeps on returning, it will result to antigen-antibody complexes. Antigen-Antibody Complexes damages the heart. As for adult, it will now be called Rheumatic Heart Disease which causes valvular disorders.
▪ TREND: If the child always develops tonsilitis, remove it through tonsillectomy because antigen-antibody complexes may develop which can cause valvular disorders in the future
backflow of blood into left ventricle from the aorta during diastole
may caused by congenital valve abnormality, inflammatory lesions that deform aortic valve leaflets or dilation of aorta, preventing complete closure of the aortic valve
pathophy: blood flows back into left ventricles which will dilate to accomodate increased blood volume
aortic regurgitation
are thin, fibrous cords in the heart. They are attached to the papillary muscles, which are extensions of the heart muscle in the ventricles.
▪ Responsible for keeping the valves in their proper position, ensuring one-way blood flow through the heart
Chordae tendineae
Most common problem that may result to
valvular disorders is
Rheumatic Fever.
→ It is usually caused by Rheumatic Endocarditis, which progressively thickens the mitral valve leaflets and chordae tendineae, causing the leaflets to fuse together.
❖ MITRAL STENOSIS
Pathophysiology Explain
MITRAL STENOSIS
▪ When the mitral valve is open, it should be as wide as three fingers. However, if there is stenosis, it becomes as narrow as a pencil, allowing less blood to flow into the left ventricle. This causes an accumulation of blood in the left atrium, leading to enlargement and increased preload. The accumulated blood may then backflow into the lungs, causing pulmonary congestion. This increased pressure in the lungs causes the right ventricle to contract under a higher pressure, increasing the afterload and leading to its enlargement. Due to this enlargement and the accumulation of blood in the right ventricle, blood may backflow into the atria, resulting in right-sided heart failure.
▪ It causes enlargement of Left Atrium.
Clinical Manifestations of Mitral Stenosis:
- The first symptom is Dyspnea on Exertion (DOE) because of ______
- Fatigue – due to ______
- Palpitation – the heart is ______
- Dry Cough
- Orthopnea – the patient is having a hard time to _____
- Paroxysmal Nocturnal Dyspnea –
➢ At a supine position,
➢ During sleep, typically after 1 or 2 hours, the px suddenly - Hemoptysis – due to high pressure in the pulmonary veins caused by the ____
- pulmonary venous hypertension.
- less cardiac output delivered to different systems of the body.
- contracting forcefully to increase the cardiac output.
- breath at supine position, so elevate the bed.
➢ Two-pillow Orthopnea – if 2 pillows are
used.
➢ Positive of 4-pillow-orthopnea – if 4 pillows are used. - the fluid from the extremities goes to the lungs and enters the alveoli causing pulmonary edema.
wakes up experiencing shortness of breath. It is alleviated with upright position or standing up because by gravity the fluid goes down.
- accumulation of blood in the left atrium, this increased pressure can rupture the pulmonary veins
MITRAL STENOSIS
→ Medical Treatment
▪ Diuretic
▪ Digoxin – for HF
▪ Beta-Blockers or Calcium Channel Blockers
➢ Metoprolol & Verapamil
▪ Anticoagulants for AF
▪ If atrial fibrillation develops, cardioversion may be attempted to restore normal sinus rhythm.
➢ AF causes 400 to 600 HR making the blood viscous causing clot formation.
▪ Avoid strenuous activities because it can increase heart rate.
▪ Surgical interventions include valvuloplasty and commissurotomy to open the fused commissure of the valve.
PATHOPHYSIOLOGY
❖ AORTIC STENOSIS
▪ Forward Effect
▪ Backward Effect
— Left-Side Heart Failure —
▪ Forward Effect: Aortic stenosis occurs when the aortic valve narrows, reducing the amount of blood ejected from the left ventricle into the aorta during each heartbeat causing decreased CO. As a result, various body systems will receive lesssupply of oxygen and nutrients.
▪ Backward Effect: The restricted flow through the narrowed aortic valve leads to the accumulation of blood and an increase in pressure within the left ventricle. This increased pressure causes the left ventricle to work harder to pump blood effectively, resulting in the enlargement of the left ventricle. It demands more blood from the coronary artery, but the coronary artery can only deliver the same amount of blood, leading to decreased contractility of the left ventricle. Consequently, the blood from the left ventricle will backflow into the left atrium, and then the blood from the left atrium will backflow into the lungs, causing
pulmonary congestion. This condition is known as Left-Side Heart Failure.
→ Characteristics of Aortic Stenosis
▪ It causes enlargement of Left Ventricle.
▪ Most common cardiac valve dysfunction.
➢ more common in men
➢ can be asymptomatic for years
➢ hear murmur (most common early sign)
▪ Without treatment, the patient is at risk for:
➢ Heart Failure
➢ Dilated Cardiomyopathy
➢ Sudden Cardiac Death
Three Cardinal Symptoms of Aortic Stenosis
▪ Angina – due to less oxygenated blood going to the heart
▪ Syncope – due to less oxygenated blood going to different body systems
▪ Exertional Dyspnea – due to presence of blood in the lungs
→ Medical Management of Aortic Stenosis
▪ Transcatheter Aortic Valve Replacement is often preferred for patients who are at higher surgical risk or are not suitable candidates for open-heart surgery.
▪ One or Two Balloon Percutaneous Valvuloplasty for patients who are symptomatic and are not candidates for valve replacement.
→ It is a heart condition where the mitral valve does not close completely during contraction.
▪ As a result, some of the blood flows back into the left atrium
❖ MITRAL REGURGITATION
→ Etiology of Mitral Regurgitation
RICCC
▪ Rheumatic Fever
▪ Coronary Artery Disease
▪ Cardiomyopathy
▪ Congenital
▪ Infective Endocarditis
→ Clinical Manifestations of Mitral Regurgitation
▪ It is often asymptomatic.
▪ Severe and sudden congestive heart failure.
▪ Dyspnea, fatigue, weakness, palpitations, and cough.
→ Medical Management of Mitral Regurgitation
▪ ACE Inhibitors (e.g., Captopril, Lisinopril) or ARBs (e.g., Losartan, Valsartan)
▪ Direct Arterial Dilators (e.g., Hydralazine)
▪ Beta-Blockers (e.g., Carvedilol, Metoprolol)
▪ Mitral Valvuloplasty or Valve Replacement
→ It is a heart condition where the aortic valve does not close completely during contraction.
▪ As a result, some of the blood flows back into the left ventricle.
▪ Aortic Insufficiency
❖ AORTIC REGURGITATION
→ Etiology of Aortic Regurgitation
▪ Rheumatic Fever – most common
▪ Congenital Defect
▪ Calcification among elderly
▪ Trauma
▪ Long standing systemic hypertension
→ Clinical Manifestations of Aortic Regurgitation
▪ It develops without symptoms in most px.
▪ Visible or palpable arterial pulsations at the carotid or temporal arteries due to increased force and blood volume.
▪ As it worsens, DOE and fatigue follows; orthopnea, PND
→ Medical Management of Aortic Regurgitation
▪ Avoid physical exertion, competitive sports, and isometric exercise until the valve has been replaced.
▪ ACE Inhibitors & Calcium Channel Blockers
▪ Restrict sodium intake to prevent volume overload.
▪ Aortic valve replacement or valvuloplasty performed before left ventricular failure occurs. – done if severely damaged