Valve disorders

Question 1

Stenosis (open valve)

Answer 1

Doesn’t fully open

Question 2

Regurgitation (closed valve)

Answer 2

Doesn’t close fully causing a back flow of blood

Question 3

Causes of valve disorders

Answer 3

• Congenital Heart Disease
• Rheumatic Heart Disease
• Infective endocarditis
• Ischemia caused by ACS

Question 4

Mitral valve stenosis

Answer 4

Valve thickens & calcifies, can’t open normally→ increasing workload of the cardiac chamber pumping though the stenosed valve

Question 5

Mitral valve regurgitation (insufficiency)

Answer 5

Can’t close normally→ with each contraction, the LV forces blood back into the left atrium.

Question 6

Mitral Valve Disorders – Clinical Manifestations

Answer 6

• Exertional dyspnea progressing to orthopnea.
• Progressive fatigue caused by decrease in cardiac output.
• Cardiac murmur (diastolic), palpitations.
• Systemic embolization.
• Atrial fibrillation (concern is maintaining cardiac output)

Question 7

Aortic valve stenosis

Answer 7

Can’t open normally → increased (afterload) work of the LV as it attempts to propel blood through the narrowed valve. Considered a disease of “wear & tear” with aging

Question 8

Aortic valve regurgitation

Answer 8

Can’t close normally → increased (afterload) work of the LV as blood leaks back into the LV after contraction

Question 9

Aortic Valve Disorders – Clinical Manifestations

Answer 9

• Syncope and vertigo.
• Nocturnal angina with diaphoresis (condition interferes with coronary artery filling).
• Dysrhythmia, systolic murmur in stenosis.
• Dyspnea and increasing fatigue, heart failure (exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea).
• With severe disease, the nurse notes a “bounding” arterial pulse and widened pulse pressure; client feels palpitations and may have nocturnal angina with diaphoresis.
• Upon auscultation, a high-pitched, blowing, decrescendo diastolic murmur with aortic regurgitation can be noted

Question 10

Risk factors

Answer 10

• CAD, HTN, HF
• Rheumatic heart disease, inflammation, infections
• IV drugs
• Age, congenital malformations

Question 11

Procedures

Answer 11

Conservative Medical Management
Valve repair
Valve replacement

Question 12

Biological valves

Answer 12

• Less thrombogenic
• Don’t last as long (7-10 years)

Question 13

Mechanical valves

Answer 13

• Lasts longer (20-30 years)
• ↑ risk of thromboembolism
• Life long anticoag

Question 14

Patients who have had valve replacements with prosthetic valves require lifetime prophylactic anticoagulation therapy to prevent thrombus formation.

True or False

Answer 14

True

Question 15

What type of murmur?

Harsh, systolic crescendo-decrescendo systolic murmur at the 2nd right intercostal space

Answer 15

aortic stenosis

Question 16

What type of murmur?

High pitched, blowing, decrescendo diastolic murmur at 3rd left intercostal space

Answer 16

aortic regurgitation

Question 17

What type of murmur?

High pitched holosystolic murmur at the apex with radiation to the left axilla, severe if S3 is heard

Answer 17

mitral regurgitation

Question 18

What type of murmur?

Rumbling, apical diastolic murmur at the apex

Answer 18

mitral stenosis

Question 19

What type of murmur?

Mid-systolic and late systolic murmur at the apex

Answer 19

mitral valve prolapse