VALVULAR DISORDERS
Reported By: Charlene Dorothy S. Tabigne
REVIEW
VALVULAR DISORDERS
2 Main Categories of Valvular Disorders:
Stenosis problem: valves cannot open
completely.
Regurgitation problem: valves doesnt close
properly.
CAUSES:
Heart valve tissue may degenerate with age.
Rheumatic fever
Bacterialendocarditis - an infection of the inner lining of the heart muscle
High blood pressure and atherosclerosis
Aheart attack
Calcifications (cholesterol and fats).
Annulus Dilation
Ventricular Attachment Chords (chordae tendineae & papillary muscles)
*Left sided valvular disorders are more common than right sided due to the effort
exerted by the left side of the heart to pump blood out of the heart to the body.
ASSESSMENT AND DIAGNOSIS:
History
Physical
Assessment:
EKG
CXR
Echocardiogram
JVD
S3 or S4
heart sounds
/ murmurs
Pulse
Changes
Edema
BP
MITRAL VALVE PROLAPSE
Portion of one or both leaflet balloons back into the atrium.
CLINICAL MANIFESTATIONS
Palpitations
Chest Pain
Fatigue
SOB
Mitral Click
MANAGEMENT:
Goal: to control symptoms
Avoid caffeine and alcohol
Anti-arrhythmic meds
Calcium channel Blockers / Beta-Blockers
Surgery: Mitral valve replacement / repair
NURSING MANAGEMENT:
Instruct patients about the need for prophylactic
antibiotic therapy before undergoing invasive
procedures that may introduce infectious agents
systemically.
Encourage patients to read product labels,
particularly in over-the-counter products such as
cough medicine.
Advise patient to avoid alcohol and caffeine.
MITRAL REGURGITATION
Blood flowing back from the left ventricle into the left atrium during
systole. Often, the leaflets of the valve cannot close due to thickening or
fibrosis of leaflets or chordae tendineae.
CLINICAL MANIFESTATIONS
Cough
Fatigue
Dyspnea
Palpitations
Sytolic Murmur
MANAGEMENT:
Same as congestive Heart Failure
Restrict activity level once heart failure develops
Antibiotic prophylaxis to prevent infectious
endocarditis
Afterload reduction:
ACE inhibitors (-pril)
Mitral valvuloplasty (repair or replacement)
MITRAL STENOSIS
An obstruction of blood flowing from the left atrium into the left ventricle
Often caused by rheumatic endocarditis which progressively thickens the
mitral valve leaflets and chordae tendineae. Eventually, the mitral valve
orifice narrows and progressively obstructs blood flow.
Normally, the mitral valve opening is as wide as the
diameter of three fingers. In cases of marked stenosis, the
opening narrows to the width of a pencil. The left atrium
has great difficulty moving blood into the ventricle
because of the increased resistance of the narrowed
orifice; it dilates (stretches) and hypertrophies (thickens)
because of the increased blood volume it holds. Because
there is no valve to protect the pulmonary veins from the
backward flow of blood from the atrium, the pulmonary
circulation becomes congested. As a result, the right
ventricle must contract against an abnormally high
pulmonary arterial pressure and is subjected to excessive
strain. Eventually, the right ventricle fails.
CLINICAL MANIFESTATIONS
Difficulty of Breathing on exertion (as a
result of pulmonary venous
hypertension)
Fatigue (low cardiac output)
Cough and repeated respiratory
infections
ASSESSMENT FINDINGS AND DX:
pulse is weak and
often irregular
because of atrial
fibrillation (caused
by the strain on the
atrium).
Diastolic Murmur
Diagnostic Tests:
Echocardiography
is used to diagnose
mitral stenosis.
Electrocardiograph
y (ECG) and cardiac
catheterization to
determine severity.
TREATMENT:
Congestive heart failure treatment
Anticoagulants to avoid thrombus formation
Prophylaxis antibiotic to prevent endocarditis
Avoid strenuous activities increased heart rate
decreases cardiac output and increases
pulmonary pressures with the backup of blood
from the left atrium to the pulmonary veins.
Valvuloplasty
AORTIC REGURGITATION
Backflow of the blood into the left ventricle from the aorta during diastole.
CAUSES:
Inflammatory lesions that deforms leaflets of the
aortic valve, preventing them from completely
closing.
Infective endocarditis
Congenital abnormalities
Blunt chest trauma
Idiopathic
PATHOPHYSIOLOGY:
In aortic regurgitation, blood from the aorta returns to the left ventricle
during diastole in addition to the blood normally delivered by the left
atrium. The left ventricle dilates, trying to accommodate the increased
volume of blood. It also hypertrophies, trying to increase muscle strength
to expel more blood with abovenormal forceraising systolic blood
pressure. The arteries attempt to compensate for the higher pressures by
reflex vasodilation; the peripheral arterioles relax, reducing peripheral
resistance and diastolic blood pressure.
Marked
arterial
pulsation
s
visible or
palpable
at the
carotid
or
temporal
arteries
CLINICAL MANIFESTATIONS &
ASSESSMENT FINDINGS:
Exertiona
l dyspnea
and
fatigue
Breathin
g
difficultie
s
Widened
pulse
pressure
Water
hamme
r pulse
MANAGEMENT:
Prophylaxis antibiotic before invasive /
dental procedures to prevent endocarditis
ACE Inhibitors
Ca Channel Blockers
Aortic Valvuloplasty
AORTIC
STENOSIS
Narrowing of the orifice
between left ventricle
and the aorta.
Causes:
1. Congenital Leaflet
malfunction
2. Rheumatic
Endocarditis
3. Cusp Calcification
PATHOPHYSIOLOGY
There is progressive narrowing of the valve orifice, usually
over a period of several years to several decades. The left
ventricle overcomes the obstruction to circulation by
contracting more slowly but with greater energy than
normal, forcibly squeezing the blood through the very small
orifice. The obstruction to left ventricular outflow increases
pressure on the left ventricle, which results in thickening of
the muscle wall. The heart muscle hypertrophies. When
these compensatory mechanisms of the heart begin to fail,
clinical signs and symptoms develop.
CLINICAL MANIFESTATIONS:
Dizziness /
syncope
Angina Pectoris
Low to Normal
BP
Systolic
crescendodecrescendo
murmur
VALVULOPLASTY
The repair of cardiac valve. Types of valvuloplasty depends on the cause
and type of valve dysfunction.
KINDS OF VALVULOPLASTY:
Commissurotomy performed to separate the fused leaflets.
a. Closed Commissurotomy:
a1. Balloon valvuloplasty:
for mitral valve stenosis of younger patients
for aortic valve stenosis of elderly patients
CONTRAINDICATED for patients with left atrial or ventricular thrombus,
severe aortic root dilation, significant mitral valve regurgitation.
b. Open Commissurotomy performed with direct visualization, under
general anesthesia.
Annuloplasty repair of the annulus; the procedure narrows the
diameter of the valves orifice and is useful for the treatment of valvular
regurgitation.
CHORDOPLASTY
Repair of the chordae tendineae.
VALVE REPLACEMENT
TYPES OF VALVE REPLACEMENT:
Mechanical Valves
Biologic/Tissue Valve
Ball and cage design or disk design
More durable than tissue prosthetics
Used for younger patients or patients with renal failure, sepsis,
endocarditis who need valve replacement.
Complications: thromboemboli; requires long term use of anticoagulants.
Not as durable as mechanical prosthetics
Thromboemboli is less likely to generate; not requiring long term use of
anticoagulant.
MECHANICAL VALVES:
NURSING RESPONSIBILITIES
Assessment for sign and symptoms of heart failure
and emboli.
IV meds to increase or decrease BP and treat
disrhythmias.
Health Education about long term use of
anticoagulants; pervetion of infection for patients
with mechanical valve.