Valvular Heart Disease (Stenosis, Prolapse, Regurgitation) Flashcards
Where to listen to the different valves/heart sounds
aortic area - ____ _____ ICS
pulmonic - ____ ____ICS
Erb’s point - ____ ____ ICS (S1/S2 simultaneously)
tricuspid - ______ _____ ICS
mitral - ____ ____ ICS midclavicular line
All (aorta)
People (pulmonic)
Everywhere (Erb’s point)
Take (tricuspid)
Meds (mitral)
aortic area - right 2nd ICS
pulmonic - left 2nd ICS
Erb’s point - left 3rd ICS (S1/S2 simultaneously)
tricuspid - left 4th ICS
mitral - left 5th ICS midclavicular line
All (aorta)
People (pulmonic)
Everywhere (Erb’s point)
Take (tricuspid)
Meds (mitral)
3 valvular problems
stenosis
regurgitation
prolapse
constriction/narrowing
secondary to rheumatic heart disease (RHD)
the door won’t open all the way
the valve is stiff, non-compliant
stenosis
constriction/narrowing
- secondary to rheumatic heart disease (RHD)
- the door won’t open all the way
- the valve is stiff, non-compliant
incompetence/insufficiency
- secondary to aging & ineffective endocarditis
- the door won’t close all the way
regurgitation
incompetence/insufficiency
- secondary to aging & ineffective endocarditis
- the door won’t close all the way
the leaflets buckle
etiology unknown
most common valve problem in U.S
prolapse
the leaflets buckle
- etiology unknown
- most common valve problem in U.S.
clinical manifestations of valvular problems
- exertional dyspnea, weakness, fatigue
- chest pain
- murmur
- pulmonary or peripheral edema/HF
collaborative care with valvular heart disease
prevention of _______ (abx prophylaxis)
_______ restriction
meds to treat/control ___
anti_____ & anti_______ drugs
percutaneous comissurotomy / transluminal balloon valvuloplasty
percutaneous valve replacement
- prevention of rheumatic fever, RHD, IE (abx prophylaxis)
- sodium restriction
- meds to treat/control HF
- anticoags & anti-dysrhythmia drugs
- percutaneous comissurotomy / transluminal balloon valvuloplasty
- percutaneous valve replacement
surgical care for valvular heart disease (repair)
valve repair
- commissurotomy (valvulotomy / valvotomy; incisions)
- valvuloplasty (opens stiff valves; uses balloons)
- annuloplasty (surgery to repair/reshape valves)
2 options for valve replacement
mechanical
biologic
______ valves - lasts > 20 years; more durable
require lifelong anticoagulation
will hear click
mechanical
lasts > 20 years; more durable
require lifelong anticoagulation
will hear click
_________ valves - asts 8-10 years; less durable
no anticoagulation needed
no click
biologic (porcine) valves
lasts 8-10 years; less durable
no anticoagulation needed
no click
a procedure to tighten or reinforce the ring (annulus) around a valve in the heart, with or without the aid of prosthetic rings. It may be done during other procedures to repair a heart valve
annuloplasty - a procedure to tighten or reinforce the ring (annulus) around a valve in the heart, with or without the aid of prosthetic rings. It may be done during other procedures to repair a heart valve
post-op patient considerations after valve replacement
post-op recovery similar to ______
prosthetic valve - lifetime of prophylactic _______
if warfarin, therapeutic range of 2.5-3.5
limit _____, or don’t binge on (antidote to warfarin)
use electric razor prn
report bleeding or excessive bleeding
avoid ______ imaging procedure
medic alert bracelet/card
post-op recovery similar to CABG
prosthetic valve - lifetime of prophylactic anticoag
if warfarin, therapeutic range of 2.5-3.5
limit Vit. K, or don’t binge on (antidote to warfarin)
use electric razor prn
report bleeding or excessive bleeding
avoid magnetic resonance (mechanical valve)
medic alert bracelet/card
- This is where S2 (the closure of aortic and pulmonic heart valves) is heard best (base/top of the heart)
aortic area
- The best place to hear S1 and S2 simultaneously in one place
erbs point
