Week 4 - Valvular Heart Disease Flashcards
what are 2 functional disorders r/t heart valves
- stenosis
- regurgitation
what is stenosis
- what the valve opening is narrowed = impeded forward blood flow thru the valve
- d/t scar tissue or infection
what is regurgitation
- when the valve fails to close completely = backward flow of blood
what side of the heart do valve disorders occur more frequently in
- left side of the heart
symptoms of valvular heart disease depend on? (2)
- what the problem is
- how severe
what are often heard with valvular heart disease
- murmurs
what is mitral valve stenosis
- obstruction of blood flow from the left atrium to left ventricle
what does mitral valve stenosis cause (3)
- back up of blood into the L atrium and the lungs
- atrial enlargement/hypertrophy
- pulmonary congestion
what are symptoms of mitral valve stenosis (9)
- exertional dyspnea
- SOB
- fatigue
- palpitations (afib)
- hoarseness (atrial enlargement pressing the larygneal nerve)
- hemopytisis (pulm HTN)
- chest pain (decreased CO)
- seizures
- stroke
how can mitral stenosis lead to the formation of emboli
- develops in the L atrium due to stasis of the blood (bc cannot move forward)
what is aortic valve stenosis
- narrowing or stricture of the aortic valve which leads to obstruction of blood flow between the left ventricle and aorta
what does aortic valve stenosis cause (3)
- left vent. hypertrophy
- increased myocardial O2 consumption (bc increased myocardial mass)
- decreased CO
when do symptoms of aortic valve stenosis occur
- when the valve opening becomes approx 1/3 of its normal size
what are symptoms of aortic valve stenosis (3)
- angina
- syncope
- exertional dyspnea
what is contraindicated in the treatment of aortic valve stenosis? why?
- nitro
- bc ot decreases preload, and preload is necessary to help open the stiffened valve
what mitral valve regurgitation
- when incomplete valve closure during systole allows blood to flow backward from the L ventricle to the L atrium
what does mitral regurg cause (3)
- decreased ventricular filling = decreased CO
- ventricular hypertrophy
- both ventricle & atrium work harder to preserve CO
describe symptoms of mitral regurg
- often asymptomatic until development of left ventricular failure
what are symptoms of mitral regurg (6)
- thready peripheral pulse
- cool, clammy extremities
- dyspnea
- shock
- signs of left ventricular failure
- pulm edema
what are signs of L ventricular failure (6)
- weakness
- fatigue
- palpitations
- dyspnea
- orthopnea
- peripheral edema
what is aortic regurg
- incomplete valve closure which leads to blood backing up from the aorta to the L ventricle
what does aortic regurg cause
- L ventricular hypertrophy = ineffective pump = low CO
what are signs of aortic regurg (5)
- low CO
- shock
- profound dyspnea
- hypotension
- chest pain
what is the most common form of valve disease
- mitral valve prolapse
what is mitral valve prolapse
- abnormallity of the mitral valve leaflets & papillary muscle that allows the leaflets to collapse or buckle up into the L atrium during systole
what can mitral valve prolapse lead to
- mitral valve regurg
what can cause mitral valve prolapse (2)
- CT disorder
- genetic
describe symptoms of mitral valve prolapse(2)
- often asymptomatic
- broad spectrum of severity
list symptoms of mitral valve prolapse (8)
- murmur
- clicks heard during systole
- dysrhythmias
- palpitations
- light-headedness & syncope
- dizziness
- chest pain
- dyspnea
what can be used to diagnose valvular heart disease (6)
- history
- phys exam
- echo
- cardiac catheterization
- chest xray
- ECG
treatment for valvular heart disease depends on..
- valve involved
- severity
what are types of treatment done for valvular heart disease
- conservative therapy
- procedural or surgical valve replacement or repaier
what is the goal of conservative therapy for valvular heart disorders (4)
prevent exacerbations of:
- HF
- pulm edema
- thromboembolism
- recurrent endocarditis
if symptoms of HF develop during valvular heart disease, what meds are gievn (5)
- vasodilators
- positive intotropes
- beta blockers
- diuretics
- low sodium diet
what meds are given for valvular heart disease (3)
- anticoag
- antidysrhythmia
- digoxin
what are 2 types of procedures done for valve replacement or repair
- open surgery
- percutaneous
what determines what procedure is done for valve replacement or repair? what is preferred?
- clinical state of pt
- pt ability to tolerate procedure/surgery
- valve repair preferred
what does percutaneous valvuloplasty involve
- threading a balloon tipped catheter from the femoral artery to the stenotic valve so the balloon can be inflated to attempt to separate the valve leaflets
what are 2 types of percutaneous procedures done for valve repair/replacement
- percutaneous aortic valve replacement
- percutaneous transluminal balloon valvuloplasty
what is percutaneous aortic valve replacement
- involves inserting a bioprosthetic valve using a femoral arterial approach
what are 2 types of valves to consider for valve replacement
- mechanical
2. biologic
what are mechanical valves
- valves manufactured from artifical materials
ex. metal alloys, carbon, dacron
what are biologic valves
- valves constructed from animal or human tissues + some artifical tissue
ex. bovine, porcine, and human cardiac tissue
what is the benefit to mechanical valves
- durable
- last longer than biologic (~20 years)
what is the con to mechanical valves
- increased risk of thromboembolism = life long anticoag therapy and frequent monitoring of blood
what is the pro to biologic valves
- do not necessitate anticoag therapy
what is a con to biologic valves (4)
- less durable
- can calcify
- can cause stiffening of leaflets
- can cause tissue degeneration
what is the overall goal for pts with valvular heart disease (3)
- normal cardiac function
- improved activity tolerance
- understanding of the disease process and health maintenance measures
what should you teach a pt with valvular disease (11)
- must adhere to meds
- develop an approp exercise plan to increase cardiac tolerance
- restrict activities that regularly produce fatigue and dsypnea
- smoking cessation
- avoid strenuous physical activity
- if mechanical valve, need anticoag for rest of life
- monitor for S&S of excess fluid volume (S&S of HF)
- restrict salt
- avoid caffeine
- admin O2 as ordered
- need prophylactic antibiotics before all invasive surgical or diagnostic procedures & the dentist ***
why should a pt wit valvular disease avoid strenuous physical activity
- valve cannot handle the required increase in CO
what are some signs of excess fluid volume (3)
- weight gain
- periperal edema
- crackles to lung
why should a pt with valvular disease avoid caffeine?
- increased risk of dysrhythmias
