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NSG 430 - Critical Care > T4: Valvular Heart Disease > Flashcards

T4: Valvular Heart Disease Flashcards

1
Q

atrioventricular valves include

A

-Mitral
-Tricuspid

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2
Q

semilunar valves include

A

-Aortic
-Pulmonic

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3
Q

stenosis

A

constriction or narrowing

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4
Q

in a stenosed valve..

A

-Valve orifice is smaller
-Forward blood flow is impeded
-Pressure differences reflect degree of stenosis, BLOOD CANT PUMP OUT

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5
Q

regurgitation

A

incompetence/ insufficiency

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6
Q

in a valve with regurgitation..

A

-Incomplete closure of valve leaflets
-Results in backward flow of blood

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7
Q

mitral valve stenosis

A

narrowing of the mitral valve from scarring, usually caused by episodes of rheumatic fever

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8
Q

what do the majority of mitral valve stenosis cases result in

A

rheumatic heart disease

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9
Q

Rheumatic endocarditis causes scarring of

A

the valve leaflets and the chordae tendineae.

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10
Q

mitral valve stenosis results in

A

decreased blood flow from left atrium to left ventricle
-↑ Left atrial pressure and volume
-↑ Pressure in pulmonary vasculature

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11
Q

because mitral valve stenosis causes an overloaded left atrium, it places the patient at risk for

A

atrial fibrillation

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12
Q

atrial fibrillation increases the risk for

A

blood clots

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13
Q

The stenotic mitral valve takes on what kind of shape

A

a “fish mouth” shape because of the thickening and shortening of the mitral valve structures.

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14
Q

clinical manifestations of mitral valve stenosis

A

-EXERTIONAL DYSPNEA
-Loud S1
-Murmur
-Fatigue
-Palpitations
-Hoarseness, hemoptysis
-Chest pain, seizures/stroke

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15
Q

Mitral valve regurgitation

A

*allows blood to flow backward from the left ventricle to the left atrium due to incomplete valve closure during systole.

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16
Q

In chronic Mitral valve Regurgitation, the additional volume results in

A
  • left atrial enlargement, left ventricular dilation and hypertrophy, and finally a decrease in CO.
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17
Q

Mitral Valve Regurgitation damage is caused by

A

-MI
-Chronic rheumatic heart disease
-Mitral valve prolapse
-Ischemic papillary muscle

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18
Q

acute clinical manifestations of mitral valve regurgitation

A

Thready peripheral pulses and cool, clammy extremities

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19
Q

chronic clinical manifestations of mitral valve regurgitation

A

-Asymptomatic for years until development of some degree of left ventricular failure
-Weakness, fatigue, palpitations, progressive dyspnea
-Peripheral edema, S3, murmur

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20
Q

mitral valve prolapse

A

Abnormality of mitral valve leaflets and the papillary muscle or chordae
-Leaflets prolapse back into left atrium during systole

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21
Q

clinical manifestations of mitral valve prolapse

A

-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

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22
Q

how do we treat the symptoms of mitral valve prolapse

A

with B-blockers

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23
Q

patient teaching for mitral valve prolapse

A

-Antibiotic prophylaxis if MR present
-Take drugs as prescribed
-Healthy diet; avoid caffeine, hydrate
-Avoid OTC stimulants
-Exercise
-When to call HCP or EMS

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24
Q

which population mostly gets mitral valve prolapse and why

A

women because of hormones

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25
Q

what is the most discriminating test or having an MI

A

troponins

26
Q

HINT HINT what medications can we give for mitral valve prolapse

A

metoprolol; b blocker s

27
Q

aortic valve stenosis

A

narrowing of the aortic valve resulting in Obstruction of flow from left ventricle to aorta
-Left ventricular hypertrophy and ↑ myocardial oxygen consumption

28
Q

aortic valve stenosis leads to

A

↓ CO, pulmonary hypertension, and HF

29
Q

aortic valve stenosis can be caused by

A

-Congenital stenosis usually discovered in childhood, adolescence, or young adulthood

30
Q

clinical manifestations of aortic valve stenosis

A

-Angina
-Syncope
-Exertional dyspnea
(reflecting left ventricular failure)

31
Q

auscultatory findings in aortic stenosis

A

§Normal to soft S1
§Diminished or absent S2
§Systolic murmur
§Prominent S4

32
Q

why do we use nitro cautiously in aortic valve stenosis

A

-Reduces preload and BP
-Can worsen chest pain

33
Q

aortic valve regurgitation is…

A

life threatening

34
Q

what can cause ACUTE aortic valve regurgitation

A

TRAUMA, IE, aortic dissection IFE THREATENING !!

35
Q

what can cause CHRONIC aortic valve regurgitation

A

Rheumatic heart disease, congenital bicuspid aortic valve, syphilis, chronic rheumatic conditions

36
Q

Aortic Valve Regurgitation

A

Backward blood flow from ascending aorta into left ventricle

37
Q

Aortic Valve Regurgitation can cause

A

-left ventricular dilation and hypertrophy
-↓ Myocardial contractility
-Pulmonary hypertension and right ventricular failure

38
Q

HINT HINT what is the difference between stenosis and regurgitation

A

regurg: valves dont close properly
stenosis: narrow

39
Q

clinical manifestation of ACUTE aortic valve regurgitation

A

-Severe dyspnea (bc pulmonary HTN)
-Chest pain
-Hypotension
-Cardiogenic shock
-Life-threatening emergency

40
Q

Clinical manifestations of CHRONIC aortic valve regurgitation

A

-May be asymptomatic for years
-Exertional dyspnea, orthopnea, paroxysmal dyspnea
-Angina
-“Water-hammer” pulse if severe
-Soft or absent S1
-S3 or S4
-Murmur

41
Q

Tricuspid stenosis occurs almost exclusively in patients with

A

*RF or who abuse IV drugs.

42
Q

Tricuspid stenosis results in

A

*right atrial enlargement and elevated systemic venous pressures.

43
Q

clinical manifestations of tricuspid stenosis

A

-Peripheral edema
-Ascites
-Hepatomegaly
-Murmur (diastolic low-pitched murmur with increased intensity during inspiration)

44
Q

pulmonic valve stenosis cause

A

almost always congenital

45
Q

pulmonary stenosis results in

A

right ventricular hypertension and hypertrophy

46
Q

clinical manifestation fro pulmonary stenosis

A

Fatigue and loud murmur

47
Q

Valvular Heart DiseaseDiagnostic Studies

A

-CT scan of chest
-Echocardiogram
-Chest x-ray
-ECG
-Heart catheterization

48
Q

management for valvular heart disease

A

-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

49
Q

drugs to treat/control HF

A

-Vasodilators (e.g., nitrates, ACE inhibitors)
-Positive inotropes (e.g., digoxin)
-Diuretics
-β-blockers
-Sodium restriction
-Anticoagulation therapy
-Anti-dysrhythmic drugs

50
Q

in people with valvular heart disease what must they do before the dentist

A

abx before the dentist to prevent endocarditis

51
Q

Percutaneous transluminal balloon valvuloplasty

A

balloon tipped catheter inserted via femoral artery into the stenoic valve
-then inflated to separate valve leaflets
-split open fused commissures

52
Q

if a patient has mechanical valves inserted what must they be on

A

lifelong anticoagulants

53
Q

the type of valve repair/replacement depends on

A

(1) valves involved
(2) pathology and severity of the disease
(3) patient’s clinical condition.

54
Q

what is the procedure of choice for patients with pure mitral stenosis

A

Mitral commissurotomy (valvulotomy)

55
Q

Open surgical valvuloplasty involves

A

*repair of the valve by suturing the torn leaflets, chordae tendineae, or papillary muscles. It is primarily used to treat mitral or tricuspid regurgitation.

56
Q

biologic (tissue)valve replacemetn are constructed form

A

bovine, porcine, and human (cadaver) heart tissue and usually contain some man-made materials

57
Q

HINT HINT
mechanical vs biologic valves

A

mechanical: on anticoagulants forever but lasts longer
bio: no anticoagultion needed but less durable

58
Q

objective data for valvular disease

A

-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

59
Q

health promotion for valve disease

A

-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

60
Q

INR levels

A

2.5-3.5

NSG 430 - Critical Care (42 decks)

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