Valve Disease Flashcards
Mitral Valve stenosis
stenosis ( valve opening becomes smaller = increased pressure in chamber that blood is trying ot leave)
Contractures develop with adhesions between leaflets
Mitral valve stenosis CM
a. Exertional dyspnea
b. Loud S1, diastolic murmur
c. Fatigue
d. Palpitations
e. Hoarseness, hemoptysis
f. Atrial fibrillation with risk for stroke
Mitral Valve Regurgitation
Regurgitation (incompetence or insufficiency) – incomplete closure of valve leaflets (blood backsup in the preceding structure)
Blood flows back from LV into LA
Mitral Valve Regurgitation Acute CM
(1) Weak, thready pulses
(2) Cool, clammy extremities
Mitral Valve Regurgitation Chronic CM
(1) Weakness, fatigue, palpitations, dyspnea
(2) Orthopnea, paroxysmal nocturnal dyspnea
(3) Peripheral edema
(4) Audible S3, murmur
Aortic Valve Stenosis
Obstruction of blood flow from LV to aorta during systole
Aortic Valve Stenosis CM
a. Angina
b. Syncope
c. Exertional dyspnea
d. Decreased or absent S2, systolic murmur,
prominent S4
What does you use to treat angina for aortic valve stenosis
Use nitroglycerin cautiously to treat angina (reduces preload and BP [hypotension] and can worsen chest pain)
Aortic Valve Regurgitation
Backward blood flow from ascending aorta into LV during diastole = results in volume overload.
Aortic Valve Regurgitation Acute CM
a. Severe dyspnea
b. Chest pain
c. Hypotension
d. Cardiogenic shock
e. Life-threatening emergency
Aortic Valve Regurgitation Chronic CM
a. May be asymptomatic for years
b. Exertional dyspnea, orthopnea, paroxysmal
dyspnea
c. Angina
d. “water-hammer” pulse (if severe)
e. Soft or absent S1, S3 or S4, murmur
Tricuspid valve stenosis CM
a. Fluttering discomfort in neck
b. Fatigue
c. Right upper quadrant pain
Pulmonic Valve Stenosis CM
a. Syncope
b. Dyspnea
c. Angina
Complications of Valve Disease
- Heart failure
- Infective endocarditis
- Embolic disease
- Dysrhythmias
Diagnostic studies
a. Echocardiogram/TEE – helps diagnose and monitor valvular heart disease progression
b. Chest x-ray – shows heart size, pulmonary circulation, & valve calcification.
c. ECG
d. Heart catheterization
Medical (conservative) Management
a. Depends on valve involved and disease severity
b. Prevent exacerbation of HF, pulmonary edema,
thromboembolism, and recurrent RVF and IE
c. Drugs to treat/control HF
(1) Vasodilators (nitrates, ACEI)
(2) Positive inotropes (digoxin)
(3) Diuretics
(4) Beta blockers
d. Sodium/fluid restriction
e. Anticoagulation therapy
f. Anti-dysrhythmic drugs (Amiodarone)
Percutaneous transluminal balloon valvuloplasty (PTBV)
Balloon tipped catheter inserted via femoral artery and inflated to separate valve leaflets
Valve repair
(1) Commissurotomy (valvulotomy)
(2) Valvuloplasty – repairs the valve by suturing torn leaf’s (primarily for mitral or tricuspid regurgitation)
(3) Annuloplasty
Valve replacement
(1) Mechanical (artificial)
(a) Require life-long anticoagulation
(2) Biologic (tissue)
(3) Transcatheter aortic valve implantation (TAVI. TAVR)- option for pts with severe, symptomatic AS who are at intermediate risk or higher for surgical aortic valve replacement.
Nursing Interventions
(1) Assessment (Medical management
(a) Vital Signs HR, BP, temperature
(b) Heart sounds (murmurs, S3, S4)
(c) Dysrhythmias (atrial fib, PVCs)
(d) Breath sounds (crackles, wheezes, hoarseness)
(e) Skin (diaphoresis, flushing, cyanosis, clubbing,
Peripheral edema)
(f) GI ( ascites, hepatomegaly, unexplained weight
gain)
Assessment (Surgical Intervention)
(a) Hemodynamic Monitoring (follow care for CABG)
(b) Dysrhythmias
(c ) Lab values including INR (2.5-3.5 are therapeutic for pts with mechanical valves)
(d) Post op - Heart sounds
(i) Click with mechanical valve
(ii) New murmur
(e) Postop complications like CABG surgery – esp. bleeding, heart failure
Teaching
(a) Medication information & compliance
(b) Medic Alert bracelet recommended
(c) Prophylactic antibiotics for dental procedures
(d) Good oral hygiene
(e) Stop smoking
(f) Conserve energy, rest periods, avoid strenuous
activities (exercise plan to limit activities that cause
fatigue or dyspnea)
Teaching after surgical intervention
(a) Strict adherence to anticoagulation regimen
(b) Anticoagulation precautions:
(c) Cardiac Rehabilitation
(d) Follow-up with HCP and notify if signs infection, HF
or bleeding
