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valvular heart disease Flashcards

1
Q

how to define valvular heart disease

A
  • Defined by the valve
    that is affected and
    the functional
    alteration
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2
Q

what is stenosis

A

-Narrowing
of the valve orifice
impeding blood flow
through the valve.

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3
Q

how does stenosis impair blood flow

A
  • due to the smaller opening of the valve
  • causes a pressure difference on both sides of the valve
  • higher pressure going in direction of BF
  • lower pressure on the other side
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4
Q

what is regurgitation

A
  • The valve does not close
    completely and blood
    flows backward.
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5
Q

during systole what valves are opened

A
  • open: semi lunar valves (aortic and pulmonic)

- this allows BF out of the vents

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6
Q

during systole which valves are closed?

A

-mitral and tricuspid (AV valves)

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7
Q

during diastole which valves are open

A
  • mitral and tricuspid (AV valves)

- this allows blood to flow into the vents

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8
Q

during diastole which vents are closed?

A
  • semi lunar (aortic and pulmonic)
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9
Q

what is mitral valve stenosis

A
  • scarring of the valves = adhesions
  • valve is thickened and shorter = no longer open good
  • blood flow is blocked and pressure builds up in the left atrium (left vent wont fill all the way)
  • pressure will increase in pulmonary vasculature and left atrium which causes symptoms

*mitral valve cannot open good during left atrial systole

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10
Q

causes of mitral valve stenosis

A
  • rheumatic (and congenital) heart disease
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11
Q

manifestations of mitral valve stenosis

A
  • exertional dyspnea
  • loud S1
  • low pitched diastolic murmur
  • a-fib
  • embolization for A-Fib
  • decreased CO
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12
Q

in mitral valve stenosis what causes exertional dyspnea

A

the pressure in the pulmonary vasculature which causes decreased lung compliance
-the pressure in the pul veins = hypertension = hemoptysis (spitting up blood)

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13
Q

what causes the heart sounds in mitral valve stenosis

A

-sound of blood going somewhere its not supposed to be (too much blood in atria)

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14
Q

what causes A-fib in mitral valve stenosis

A
  • increased left atrial pressure
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15
Q

what causes decreased CO in mitral valve stenosis

A
  • from the l vent not filling
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16
Q

when is diastolic murmur heard

A
  • after s2
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17
Q

when is systolic murmur heard

A
  • after s1
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18
Q

what causes rheumatic heart disease

A
  • Strep A bacteria (strep throat) that isnt treated and progressed to rheumatic fever
  • RF leads to rheumatic heart disease
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19
Q

what does rheumatic heart disease cause

A

-Causes scarring and deformity of heart valves – typically

mitral valve

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20
Q

who is at increased risk for RF

A
  • children who are constantly infected with strep
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21
Q

mitral valve prolapse

A
  • Leaflets buckle into the left atrium during systole
  • usually benign but can have serious
    complications
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22
Q

causes of mitral valve prolapse

A
  • abnormality in the leaflet,
    chordae tendineae, or papillary muscles
  • usually benign but can have serious
    complications
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23
Q

mitral valve prolapse is the leading cause of….

A

mitral valve regurgitation

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24
Q

treatment for mitral valve prolapse

A
  • usually benign but can have serious
    complications
  • usually just monitored
  • if have for a long time and symptomatic = mitral valve replacement
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25
Q

what is mitral valve prolapse characterized by

A
  • systolic murmur (thats usually innocent)

- lost of people have

26
Q

what to avoid with mitral valve prolapse

A
  • stimulants like caffeine
27
Q

mitral valve regurgitation

A
  • Mitral valve does not close completely during systole
  • Blood flows backward from the left ventricle to the left atrium during systole = decrease in SV
  • left atrial pressure will increase = deficient blood going to the body and increased LA pressure
  • Left ventricle and Left atrium work harder to maintain CO
28
Q

what caused the sounds in mitral valve regurgitation

A
  • blood flowing backwards from left vent to left atrium
29
Q

causes of mitral valve regurgitation

A
  • defect in mitral valve or other cardiac

structures that regulate blood flow

30
Q

conditions that can lead to mitral valve regurgitation

A
  • MI, Rheumatic
    heart disease, mitral valve prolapse, papillary muscle
    dysfunction, or endocarditis.
31
Q

acute manifestations of mitral valve regurgitation

A
  • thready peripheral pulse
  • cool, clammy extremities
  • pulmonary edema
  • new systolic murmur
32
Q

what usually causes an acute onset mitral valve regurgitation

A
  • HF (post MI)

* dangerous and poorly tolerated

33
Q

manifestations of chronic mitral valve regurgitation

A
  • fatigue
  • palpitations
  • SOB
  • peripheral edema
  • audible 3rd heart sound (heard at apex)
34
Q

chronic mitral valve regurgitation pt may be…

A

-asymptomatic for years

35
Q

Aortic stenosis

A
  • blood is not getting to the body due to the stiffening of the aortic valve = decreased CO, decreased SV = HF signs
  • Blood flow is obstructed to the aorta from the
    left ventricle during systole = not enough blood entering the aorta
  • Left ventricle must work harder to push blood through narrow valve= hypertrophy
  • Leads to decreased cardiac output and heart
    failure
36
Q

causes of aortic stenosis

A
  • congenital
  • acquired: rheumatic heart disease
  • age (> 65)
37
Q

aortic stenosis manifestations

A 
1. Signs of Left
Ventricular failure: 
-Angina 
-Syncope 
-Exertional Dyspnea
2. Systolic Murmur w/
absent S2 
* Poor prognosis if
obstruction is not
fixed
38
Q

What is hard about the presentation of aortic stenosis?

A

-can look like heart attack but if you give nitro that will decrease their bp even more = BAD

39
Q

aortic regurgitation

A

-Backward blood flow from the aorta into the Left
ventricle during diastole = decreased SV and CO
-Volume overload in left ventricle = hypertrophy
-Blood backs up into the left atrium and pulmonary
vasculature

40
Q

acute manifestations of aortic regurgitation

A
  • Severe chest pain
  • Dyspnea
  • Hypotension
41
Q

Chronic manifestations of aortic regurgitation

A
  • Water hammer pulse
  • Early diastolic murmur
  • Fatigue
42
Q

water hammer pulse

A
  • strong quick beat immediately collapses

- pulse with kick your hand and then collapses

43
Q

acute aortic regurgitation

A

-life threatening due to

cardiovascular collapse

44
Q

chronic aortic regurgitation

A
  • patients may be asymptomatic for

years

45
Q

history assessment

A

Rheumatic heart disease, IE, congenital defects, MI, cardiomyopathy, strep infections. Pt may be asymptomatic for years.

46
Q

physical exam: ss of HF

A
  • (L): crackles, wheezes, orthopnea, dyspnea, hemoptysis, fatigue.
  • (R): hepatomegaly (from backup of blood in liver= increased liver enzymes), edema (peripheral)
47
Q

physical exam: ss of A fib

A

-pulse irregularly irregular, S/S of stroke, palpitations, ECG changes

48
Q

physical exam: ss of cardiac

A

-S3, murmur (systolic or diastolic)

49
Q

Dx

A
  • echo or TEE
  • cardiac cath
  • ECG
  • CXR
  • CT scan
50
Q

echo or tee for DX

A

-Regular Echo typically ordered first, may also get TEE.

TEE reveals valve structure, function and size of atria and ventricles.

51
Q

cardiac cath for DX

A

Looks at pressure changes in the heart chambers,
measures pressure changes across the valves, measures valve
openings.

52
Q

ECG for DX

A
  • Changes in rhythm can show chamber enlargement and

ischemic changes, a-fib

53
Q

CXR for DX

A
  • Pulmonary congestion, enlargement of pulmonary arteries,

enlarged heart chambers

54
Q

CT scan for DX

A

Evaluates the for aortic disorders

55
Q

treatment

A

-depends on valve involved and severity. (chronic= wait and see. acute = replacement immediately)
-The heart and compensatory mechanisms can
compensate, but pt. may eventually become
symptomatic.
- Medical management is first line in treatment of S/S;
surgical intervention may be required.
-Prevent exacerbations of HF, pulmonary edema,
thromboembolism, IE. Prevent recurrence of rheumatic
heart disease and IE.

56
Q

MEDICAL MANAGEMENT

A

-Heart Failure the most common reason for ongoing medical care.
-Treat Heart Failure: Vasodilators, B-blockers, diuretics, low Na diet, inotropic drugs
- Anticoagulation therapy in presence of a-fib (Dysrhythmias are common especially atrial)
-Treat with antidysrhythmic drugs, cardioversion. Meds used to control
ventricular rate with a-fib

57
Q

Surgical management

A
  • Monitor patient heart size, and ejection fraction (ECHO)
  • Essentially, when heart size increases, and EF decreases, consider surgery for valve replacement.
  • Other signs: HF, angina, syncope
  • Percutaneous Transluminal Balloon Valvuloplasty (PTBV) -Transcutaneous Aortic Valve Replacement (TAVR)
  • Prosthetic Valves
58
Q

ptbv ( Percutaneous Transluminal Balloon ValvuloplastY)

A
  • ALTERNATIVE TO VALVE REPLACEMENT
  • bandaid
  • for mitral or aortic stenosis
  • balloon tip cath placed into the valve –> inflate and deflate to loosen valve up
59
Q

Transcutaneous Aortic Valve Replacement (TAVR)

A

-fed up through femoral artery and replace valve w/out opening heart

60
Q

Prosthetic Valves

A
  • Most patients are required to take anticoagulation medication
  • Thromboembolism form easily on artificial valves

complex care 2 (8 decks)

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