NCM112j - CARDIO

VALVULAR HEART DISEASE

Acquired Valvular Disease of the  Diastolic murmur:
Heart  Atrial fibrillation - is an abnormal heart
 Mitral stenosis rhythm (arrhythmia) characterized
 Mitral insufficiency, regurgitation by rapid and irregular beating of
 Mitral valve prolapse. the atrial chambers of the heart. It
 Aortic stenosis often begins as short periods of
 Aortic insufficiency abnormal beating, which become
 Tricuspid stenosis longer or continuous over time.
 Tricuspid insufficiency  Systemic embolization
b. Mitral Regurgitation
Acquired Valvular Disease of the  Is ejection of blood from the left
Heart ventricle to the left atrium.
 Valvular Damage  Incomplete closure of the mitral valve
 Interfere with valvular function by during systole,  allows blood to flow
stenosis or by impaired closure that back into the left atrium  increase
allows backward leakage of blood left atrial pressure  leads to
(valvular insufficiency), regurgitation development of left ventricular
or incompetence). hypertrophy due to inefficient
 Stenosis is when the valve opening emptying.
becomes narrow and restricts blood
flow.
 Prolapse is when a valve slips out of
place or the valve flaps (leaflets) do
not close properly.
 Regurgitation is when blood leaks
backward through a valve, sometimes
due to prolapse.
Causes of mitral regurgitation:
1. Mitral Valve Disease
 Valve distortion or shortening or
a. Mitral stenosis: narrowing of the
damage to chordae tendinae by mitral
mitral valve.
valve prolapse
 Progressive thickening and
 Chronic rheumatic heart disease
contracture of valve cusps with
 Infective endocarditis
narrowing of the orifice and
 Penetrating /non penetrating trauma
progressive obstruction to blood flow.
Clinical manifestations: Mitral
 Left atrium has difficulty in emptying
regurgitation
itself through narrowed orifice into the
1. Fatigue, dyspnea
left ventricle; therefore, it dilates and
2. Orthopnea, Paroxysmal nocturnal
hypertrophies.
dyspnea, peripheral edema
 Pulmonary circulation becomes
3. Systolic murmur
congested.
4. Atrial fibrillation
 Causing abnormally high pulmonary
c. Mitral Valve Prolapse
arterial pressure.
 the valve flaps bulge into the upper
Clinical manifestations: Mitral
left chamber during each heartbeat.
stenosis
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NCM112j - CARDIO
VALVULAR HEART DISEASE
 Can cause blood to leak backward, a  Mitral Regurgitation: Mitral Valve
condition called mitral valve Replacement
regurgitation.
Clinical manifestations: Mitral
Valve Prolapse
 Tachycardia, lightheadedness, 2. Aortic Valve Diseases
syncope, fatigue, weakness, dyspnea, a. Aortic stenosis
chest discomfort, anxiety, palpitations  Is narrowing of the orifice of aortic
 Regurgitation murmur valve (between aorta and left
ventricle)
Collaborative Management  Obstruction to the aortic outflow
a. Mitral stenosis places a pressure load on the left
 Oral diuretics ventricle that results in hypertrophy
 Sodium- restricted diet and failure.  Left atrial pressure
 Digitalis for atrial fibrillation increases.  increased Pulmonary
 Beta-blockers to decrease heart rate vascular pressure  right ventricular
 Anticoagulants to prevent failure
embolization  Cause: congenital abnormalities
b. Mitral regurgitation calcifications or rheumatic fever.
 Diuretics and reduction of sodium- Collaborative management:
intake a. Aortic stenosis
 To reduce cardiac workload.  Avoid vigorous exercise
c. Mitral valve prolapse  Prophylactic antibiotic for invasive
 Beta- blockers to relieve syncope, procedures.
palpitations, and chest pain. b. Aortic regurgitation
 Antibiotic prophylaxis for invasive  Valve flaps fail to completely seal the
procedures aortic orifice during diastole and thus
permit backflow of blood from the
Surgical Management aorta into the left ventricle.
Mitral stenosis  The left ventricle increases the force
a. Closed mitral valvotomy - of contractions to maintain an
introduction of a dilator through the adequate cardiac output resulting to
mitral valve to split the commissures. hypertrophy.
b. Open mitral valvotomy – direct  The low aortic diastolic pressures
incision of the commissures. result in decreased coronary artery
c. Mitral valve replacement perfusion.
d. Balloon valvuloplasty – balloon tip Caused by:
catheter is percutaneously inserted,  Rheumatic endocarditis
threaded to the affected valve, and  Congenital malformation
positioned across the narrowed  Marfan’s erythematosus
orifice.  SLE
 The balloon is inflated/ deflated Signs and symptoms of aortic
causing a “cracking“ of the calcified regurgitation
commissures and enlargement of the  Palpitations
valve orifice.  Permanent pulsations in the neck
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VALVULAR HEART DISEASE
 Sinus tachycardia (a regular cardiac  Echocardiography - may show
rhythm in which the heart beats faster abnormalities of valve structures,
than normal). chamber size and thickness
 Premature ventricular contractions  Chest X-ray – may show cardiomegaly
 Corrigan’s or water – hammer pulse and pulmonary vascular congestion
(sudden sharp pulse followed by a  Cardiac catheterization and
swift collapse of the diastolic pulse) angiography – to confirm diagnosis
 Collaborative management same and determine severity.
as in aortic stenosis Complications
Surgical management  CHF
Aortic stenosis  Possible right – sided heart failure
 Replacement of aortic valve with  Dysrhythmias
prosthetic or tissue valve
 Balloon valvuloplasty Nursing Interventions
 Maintaining Adequate Cardiac
Tricuspid Valve Diseases Output
1. Tricuspid stenosis  Assess frequency of existing murmur
 Is restriction of the tricuspid valve or new murmur
orifice due to commissural fusion and  Assess for signs of left and /or right
fibrosis. ventricular failure
Caused by:  Monitor. Treat dysrhythmias as
 Rheumatic fever ordered,
 Diseases of the mitral valve  Prepare client for surgical
Clinical manifestations interventions
 Dyspnea, fatigue, pulsations in the  Improving tolerance
neck,  Maintain bedrest (if with CHF
 hepatomegaly, peripheral edema, symptoms)
 diastolic murmur.  Allow patient to rest between
Management intervention.
 diuretics, digitalis therapy and  Begin activities gradually. i. e. sitting
surgery. for brief periods.
 For tricuspid stenosis –  Assist or perform hygiene needs for
valvuloplasty or replacement patient to reserve strength for
ambulation.
2. Tricuspid Regurgitation  Strengthening coping abilities
 Allows the regurgitation of blood from  Instruct about: specific valvular
the right ventricle into the right atrium dysfunction, possible etiology,
during ventricular systole. therapies to relieve symptoms
Cause:  Adopting lifestyle to cope with illness
 Dilatation of right ventricle  Include family members in discussion
 Rheumatic fever with patient
Diagnostic evaluation  Discuss surgical interventions as
 ECG – May show dysrhythmias. treatment modality, if applicable.
 Assess patients coping mechanism to
deal with illness,
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NCM112j - CARDIO
VALVULAR HEART DISEASE