cardiovascular module: cardiac valvular disorders adult medical-surgical nursing

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CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

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Page 1: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS

Adult Medical-Surgical Nursing

Page 2: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Cardiac Valvular Disorders: Description

The cardiac valves are: AorticPulmonary MitralTricuspidDisorders lead to poor blood flow through the

heart, and may lead to ↓ cardiac output

Page 3: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Cardiac Valvular Disorders: Classification

Stenosis

Incompetence

Page 4: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Cardiac Valve Stenosis

Narrowing of the valve

Increases demand on the myocardium to pump blood through the valve

Page 5: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Cardiac Valve Incompetence

Incompetence/ regurgitation: A damaged valve which leaks and does not

close properly

Leads to:Backflow of blood during systole and

increased back pressure↓ cardiac output

Page 6: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Cardiac Valvular Disorder: Aetiology

CongenitalAgeing: wear and tear Rheumatic heart disease or bacterial

endocarditis:An auto-immune response following

Rheumatic fever (less common now) or streptococcal throat infection

→ endocarditis and chronic bacterial vegetation around valve/ valves

Page 7: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Cardiac Valvular Disorder: Diagnosis

History and clinical findingsChest XrayECGEchocardiographyCardiac catheterisation: reveals degree of

closure / incompetence

Page 8: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Prevalent Conditions

Mitral stenosis

Mitral incompetence

Aortic stenosis

Aortic incompetence

Page 9: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Mitral Stenosis

Page 10: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Mitral Stenosis: Pathophysiology

Narrowing of mitral valve:This causes left atrium to force blood to left

ventricle → dilatation/ hypertrophy of left atriumAtrial fibrillation: risk of thrombus/ emboli

Backflow/ congestion in pulmonary circulation leads to:

Increased workload of right ventricle →Right heart failure

Page 11: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Mitral Stenosis: Clinical Manifestations

Fatigue/ dizziness (low cardiac output)Respiratory problems: Dyspnoea, cough, frequent chest infections,

haemoptysisAtrial fibrillation (dysrythmia): weak often

irregular pulse (risk of emboli)

Diastolic murmur on auscultation

Page 12: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Mitral Stenosis: Medical Management

Treat congestive heart failure:Diuretics, Digoxin, vasodilators (reduce

afterload)Anti-dysrythmicsAnticoagulants (longterm to prevent emboli)Antibiotics prior to dental or surgical

procedures (to prevent endocarditis)

Page 13: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Mitral Stenosis: Surgery

Valvotomy

Valve replacement:An animal or human valveAn artificial valve (prosthesis)**With an artificial valve long-term

anticoagulants required (risk of thrombus)

Page 14: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Mitral Incompetence

Page 15: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Mitral Incompetence: Pathophysiology

The mitral valve does not close and leaks causing:

Backflow of blood during systole from left ventricle to left atrium

→ cardiac output is reduced→ increased pressure, dilatation and

hypertrophy of left atriumPulmonary congestion → Right heart failure

Page 16: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Mitral Incompetence: Clinical Manifestations

Maybe symptomless

Fatigue and weaknessPalpitations on exertionDyspnoea and coughSystolic murmur at apex on auscultation

Page 17: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Mitral Incompetence: Surgery

Surgical intervention is necessary as progressively cardiac output is reduced and pulmonary congestion increased:

Valvuloplasty (repair)Valve replacement

Medical management of symptoms

Page 18: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Aortic Stenosis

Page 19: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Aortic Stenosis: Pathophysiology

Narrowing of the aortic valve Causes increased filling and effort of the left

ventricle (forcing blood through) →

Left ventricular hypertrophy Left ventricular failure (maybe acute

pulmonary oedema)

Page 20: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Aortic Stenosis: Clinical Manifestations

Faintness/ dizziness (low cardiac output) Angina:O2 demand of hypertrophied left ventricleSlow forceful systole reduces diastole and

filling time for coronary circulationDyspnoea:If LVF: Copious blood-stained frothy sputum

Page 21: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Aortic Stenosis: Auscultation

Loud systolic murmur over aortic area and vibration of turbulent blood felt by a hand over the apex

Page 22: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Aortic Stenosis: Management

Medical:Treat angina and symptoms of LVF: Vasodilators, Digoxin, diuretics,

anticoagulantsAntibiotics prior to dental work or surgery to

prevent endocarditis

Surgery:ValvotomyValve replacement

Page 23: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Aortic Incompetence

Page 24: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Aortic Incompetence: Pathophysiology

Aortic valve is damaged and leakingBlood regurgitates from aorta during

diastole into left ventricle → dilatationLeft ventricle hypertrophies to force

emptying into the aorta → increased systolic BP Arterial vasodilatation to compensate (↓ peripheral resistance): ↓ diastolic BP(↑ pulse pressure) → LVF

Page 25: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Aortic Incompetence: Clinical

Manifestations

Forceful heartbeatDyspnoea on exertion and fatigueParoxysmal nocturnal dyspnoea and

orthopnoea (may lead to LVF)↑ pulse pressure, “water-hammer” pulse

(rapid strong pulse which then collapses)Diastolic murmur on auscultation

Page 26: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Aortic Incompetence: Management

Medical management of LVFAntibiotic cover for dental or surgery to

prevent endocarditis

Surgery: Aortic valve replacement(This is the preferred management)Anticoagulants long-term if artificial valve

Page 27: CARDIOVASCULAR MODULE: CARDIAC VALVULAR DISORDERS Adult Medical-Surgical Nursing

Nursing Responsibilities

Physical examinationECG monitoringWeight, vital signs, fluid balanceICU nursing post-surgeryPatient education on diet, degree of exercise

and rest, medicationsPsychological/ emotional support