T4: Valvular Heart Disease Flashcards
atrioventricular valves include
-Mitral
-Tricuspid
semilunar valves include
-Aortic
-Pulmonic
stenosis
constriction or narrowing
in a stenosed valve..
-Valve orifice is smaller
-Forward blood flow is impeded
-Pressure differences reflect degree of stenosis, BLOOD CANT PUMP OUT
regurgitation
incompetence/ insufficiency
in a valve with regurgitation..
-Incomplete closure of valve leaflets
-Results in backward flow of blood
mitral valve stenosis
narrowing of the mitral valve from scarring, usually caused by episodes of rheumatic fever
what do the majority of mitral valve stenosis cases result in
rheumatic heart disease
Rheumatic endocarditis causes scarring of
the valve leaflets and the chordae tendineae.
mitral valve stenosis results in
decreased blood flow from left atrium to left ventricle
-↑ Left atrial pressure and volume
-↑ Pressure in pulmonary vasculature
because mitral valve stenosis causes an overloaded left atrium, it places the patient at risk for
atrial fibrillation
atrial fibrillation increases the risk for
blood clots
The stenotic mitral valve takes on what kind of shape
a “fish mouth” shape because of the thickening and shortening of the mitral valve structures.
clinical manifestations of mitral valve stenosis
-EXERTIONAL DYSPNEA
-Loud S1
-Murmur
-Fatigue
-Palpitations
-Hoarseness, hemoptysis
-Chest pain, seizures/stroke
Mitral valve regurgitation
*allows blood to flow backward from the left ventricle to the left atrium due to incomplete valve closure during systole.
In chronic Mitral valve Regurgitation, the additional volume results in
- left atrial enlargement, left ventricular dilation and hypertrophy, and finally a decrease in CO.
Mitral Valve Regurgitation damage is caused by
-MI
-Chronic rheumatic heart disease
-Mitral valve prolapse
-Ischemic papillary muscle
acute clinical manifestations of mitral valve regurgitation
Thready peripheral pulses and cool, clammy extremities
chronic clinical manifestations of mitral valve regurgitation
-Asymptomatic for years until development of some degree of left ventricular failure
-Weakness, fatigue, palpitations, progressive dyspnea
-Peripheral edema, S3, murmur
mitral valve prolapse
Abnormality of mitral valve leaflets and the papillary muscle or chordae
-Leaflets prolapse back into left atrium during systole
clinical manifestations of mitral valve prolapse
-Most patients asymptomatic for life
-Dysrhythmias can cause palpitations, light-headedness, and dizziness
-Infective endocarditis
-Chest pain unresponsive to nitrates
-Murmur d/t regurgitation
-Severe MR uncommon
how do we treat the symptoms of mitral valve prolapse
with B-blockers
patient teaching for mitral valve prolapse
-Antibiotic prophylaxis if MR present
-Take drugs as prescribed
-Healthy diet; avoid caffeine, hydrate
-Avoid OTC stimulants
-Exercise
-When to call HCP or EMS
which population mostly gets mitral valve prolapse and why
women because of hormones
what is the most discriminating test or having an MI
troponins
HINT HINT what medications can we give for mitral valve prolapse
metoprolol; b blocker s
aortic valve stenosis
narrowing of the aortic valve resulting in Obstruction of flow from left ventricle to aorta
-Left ventricular hypertrophy and ↑ myocardial oxygen consumption
aortic valve stenosis leads to
↓ CO, pulmonary hypertension, and HF
aortic valve stenosis can be caused by
-Congenital stenosis usually discovered in childhood, adolescence, or young adulthood
clinical manifestations of aortic valve stenosis
-Angina
-Syncope
-Exertional dyspnea
(reflecting left ventricular failure)
auscultatory findings in aortic stenosis
§Normal to soft S1
§Diminished or absent S2
§Systolic murmur
§Prominent S4
why do we use nitro cautiously in aortic valve stenosis
-Reduces preload and BP
-Can worsen chest pain
aortic valve regurgitation is…
life threatening
what can cause ACUTE aortic valve regurgitation
TRAUMA, IE, aortic dissection IFE THREATENING !!
what can cause CHRONIC aortic valve regurgitation
Rheumatic heart disease, congenital bicuspid aortic valve, syphilis, chronic rheumatic conditions
Aortic Valve Regurgitation
Backward blood flow from ascending aorta into left ventricle
Aortic Valve Regurgitation can cause
-left ventricular dilation and hypertrophy
-↓ Myocardial contractility
-Pulmonary hypertension and right ventricular failure
HINT HINT what is the difference between stenosis and regurgitation
regurg: valves dont close properly
stenosis: narrow
clinical manifestation of ACUTE aortic valve regurgitation
-Severe dyspnea (bc pulmonary HTN)
-Chest pain
-Hypotension
-Cardiogenic shock
-Life-threatening emergency
Clinical manifestations of CHRONIC aortic valve regurgitation
-May be asymptomatic for years
-Exertional dyspnea, orthopnea, paroxysmal dyspnea
-Angina
-“Water-hammer” pulse if severe
-Soft or absent S1
-S3 or S4
-Murmur
Tricuspid stenosis occurs almost exclusively in patients with
*RF or who abuse IV drugs.
Tricuspid stenosis results in
*right atrial enlargement and elevated systemic venous pressures.
clinical manifestations of tricuspid stenosis
-Peripheral edema
-Ascites
-Hepatomegaly
-Murmur (diastolic low-pitched murmur with increased intensity during inspiration)
pulmonic valve stenosis cause
almost always congenital
pulmonary stenosis results in
right ventricular hypertension and hypertrophy
clinical manifestation fro pulmonary stenosis
Fatigue and loud murmur
Valvular Heart DiseaseDiagnostic Studies
-CT scan of chest
-Echocardiogram
-Chest x-ray
-ECG
-Heart catheterization
management for valvular heart disease
-Prophylactic antibiotic therapy to prevent recurrent RF and IE
-Dependent on valve involved and disease severity
-Prevent exacerbations of HF, pulmonary edema, thromboembolism, and recurrent endocarditis
drugs to treat/control HF
-Vasodilators (e.g., nitrates, ACE inhibitors)
-Positive inotropes (e.g., digoxin)
-Diuretics
-β-blockers
-Sodium restriction
-Anticoagulation therapy
-Anti-dysrhythmic drugs
in people with valvular heart disease what must they do before the dentist
abx before the dentist to prevent endocarditis
Percutaneous transluminal balloon valvuloplasty
balloon tipped catheter inserted via femoral artery into the stenoic valve
-then inflated to separate valve leaflets
-split open fused commissures
if a patient has mechanical valves inserted what must they be on
lifelong anticoagulants
the type of valve repair/replacement depends on
(1) valves involved
(2) pathology and severity of the disease
(3) patient’s clinical condition.
what is the procedure of choice for patients with pure mitral stenosis
Mitral commissurotomy (valvulotomy)
Open surgical valvuloplasty involves
*repair of the valve by suturing the torn leaflets, chordae tendineae, or papillary muscles. It is primarily used to treat mitral or tricuspid regurgitation.
biologic (tissue)valve replacemetn are constructed form
bovine, porcine, and human (cadaver) heart tissue and usually contain some man-made materials
HINT HINT
mechanical vs biologic valves
mechanical: on anticoagulants forever but lasts longer
bio: no anticoagultion needed but less durable
objective data for valvular disease
-Fever
-Diaphoresis, flushing, cyanosis, clubbing, peripheral edema
-Crackles, wheezes, hoarseness
-S3 and S4
-Dysrhythmias
-↑ or ↓ in pulse pressure; hypotension
-Water-hammer or thready peripheral pulses
-Hepatomegaly, ascites
-Weight gain
health promotion for valve disease
-Diagnosing and treating streptococcal infection
-Prophylactic antibiotics for patients with history
-Encourage compliance
-Teach patient when to seek medical treatment
-Individualize rest and exercise
-Avoid strenuous activity
-Discourage tobacco use
-Ongoing cardiac assessments to monitor drug effectiveness
-Monitor INR 2.5-3.5
INR levels
2.5-3.5
