Valvular Disease And Repair

Question 0

What are the two most common causes of congenital heart valve disorders?

Answer 0

Anatomical malformation at birth and Marfan syndrome

Question 1

What are the two classifications for abnormality of valves?

Answer 1

Stenosis: a narrowing or construction that creates a pressure gradient

Regurgitation: incomplete closure of valve leaflets resulting in a backflow of blood

Question 2

What are some common causes of acquired heart valve disease?

Answer 2

Ischemic coronary artery disease /degenerative changes with age / rheumatic heart disease / infected endocarditis / neoplasm / thrombus

Question 3

What is the most common adult valve issue in the US?

Answer 3

Aortic stenosis. The most common causes are bicuspid valve and degenerative calcification.

Question 4

What three parameters or measurements in the left ventricle and aorta will change in an aortic stenosis patient?

Answer 4

Aortic systolic pressure gradient

Aortic valve area

Blood velocity

(All values increase as result of AS)

Question 5

What are classic signs and symptoms of aortic stenosis?

Answer 5

Angina, syncope, sudden cardiac death, development of heart failure; systolic murmur, crackles and edema

Left ventricular hypertrophy

Question 6

What hemodynamic parameters is essential to monitor in post op AVR patients?

Answer 6

Blood pressure

Hypertrophic left ventricle against newly reduced afterload leads to severe hypertension

Question 7

What treatment strategies (for low preload, bradycardia or heart block) should the nurse to consider in a hemodynamically unstable post AVR patient?

Answer 7

Low preload = volume repletion
Elevated heart rate or hypertension from hypertrophy = Beta blocker
Bradycardia = external pacing

Question 8

What is a characteristic sign of aortic regurgitation?

Answer 8

Wide pulse pressures. This is a result of left ventricular hypertrophy and increased sympathetic tone.

Question 9

What are common sequelae of mitral valve stenosis?

Answer 9

Pulmonary hypertension RV failure and tricuspid insufficiency

With a grossly impaired mitral valve dysfunction symptoms of low cardiac output and pulmonary venous congestion can be seen as well

Question 10

What hemodynamic parameters is essential to monitor in post op MVR patients?

Answer 10

Pulmonary hypertension

CVP (increased CVP is an indication of possible RV decompensation)

Question 11

What vasoactive drips are common post MVR?

Answer 11

Dobutamine - LV
Milrinone - RV function and decreased PVR
Levo