Valvular Heart Disease

Question 1

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• Are usually asymptomatic
• Sx’s usually r/t pulmonary congestion & right-sided HF initially

Answer 1

Mitral stenosis

Question 2

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• Usually a slow progression so pts remain sx-free for decades
• Sx’s of left ventricular failure (weakness, ↓ CO)
• Rt HF later (JVD, pitting edema)
• Severe ___ → S3 sound

Answer 2

Mitral regurgitation

regurgitation

Question 3

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• Most pts asymptomatic
• If have sx’s, include CP, palps, exercise intolerance r/t dysrhythmias

Answer 3

Mitral valve prolapse (MVP)

Question 4

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• Most common valve dysfunction in the US
  > Congenital bi/uni cuspid __ __ and rheumatic dz of MV in young & middle age
  > Atherosclerotic & degenerative changes in older adults
• Classic sx’s only develop >it worsens & CO becomes fixed/can’t increase to meet increased needs during exertion
• Progresses to LVF, then late is Rt HF

! Urgent surgery needed when surface <1cm

Answer 4

Aortic stenosis

aortic stenosis

Question 5

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• Pts remain asymptomatic for many yrs b/c of ventricular compensation
• When sx’s do develop r/t Lt ventricular failure, sx’s are exertional dyspnea, orthopnea, PND; palps w/severe dz

Answer 5

Aortic regurgitation

Question 6

! Major concern of valvular dz is maintaining CO if AFIB develops
> Concern w/Afib is the clots in the atria which may break off & become emboli (moving clots); can travel to the brain & cause a stroke

Answer 6

• Prophylactic abx therapy <invasive dental or resp procedures, but NOT for GI procedures; i.e., upper GI endo, colonoscopy, or procedures for GU instrumentation
• Pts who have valve replacement w/prosthetic valves require lifetime prophylactic anticoagulation