valvular heart disease
DESCRIPTION
Valvular Heart Disease. NPN 200 Medical Surgical I. Types. Mitral Stenosis Mitral Regurgitation Mitral Valve Prolapse Aortic Stenosis Aortic regurgitation Tricuspid valve is affected infrequently Tricuspid stenosis – causes Rt HF Tricuspid regurgitation –causes venous overload. - PowerPoint PPT PresentationTRANSCRIPT
Valvular Heart Disease
NPN 200Medical Surgical I
Types
• Mitral Stenosis• Mitral Regurgitation• Mitral Valve Prolapse• Aortic Stenosis• Aortic regurgitation• Tricuspid valve is affected infrequently
– Tricuspid stenosis – causes Rt HF– Tricuspid regurgitation –causes venous
overload
Tricuspid Valve
Rheumatic Heart Disease
• Inflammatory process that may affect the myocardium, pericardium and or endocardium
• Usually results in distortion and scarring of the valves
Rheumatic Heart Disease, cont.
• Subjective symptoms– Prior history of
rheumatic fever– General malaise– Pain – may or may
not be present
• Objective symptoms– Temperature – Murmurs– Dyspnea– polyarthritis
Rheumatic Heart Disease
• Diagnosis– H/P– WBC and ESR– C-reactive protein– Cardiac enzymes– EKG– Chest x-ray– Echo– Cardiac cath– Cardiac output
Rheumatic Heart Disease
• Nursing Care– Vital signs– Rest and quiet environment– Give antibiotics, digitalis, and diuretics– Provide adequate nutrition– Monitor I/O– Explain treatment and home care
Mitral Stenosis• Usually results from rheumatic carditis• Is a thickening by fibrosis or calcification• Can be caused by tumors, calcium and thrombus • Valve leaflets fuse and become stiff and the
cordae tendineae contract• These narrows the opening and prevents normal
blood flow from the LA to the LV• LA pressure increases, left atrium dilates, PAP
increases, and the RV hypertrophies• Pulmonary congestion and right sided heart
failure occurs• Followed by decreased preload and CO decreases
Mitral Stenosis, cont.
• Mild – asymptomatic• With progression – dyspnea, orthopneas,
dry cough, hemoptysis, and pulmonary edema may appear as hypertension and congestion progresses
• Right sided heart failure symptoms occur later
• S/S– Pulse may be normal to A-Fib– Apical diastolic murmur is heard
Mitral Regurgitation• Primarily caused by rheumatic heart disease, but
may be caused by papillary muscle rupture form congenital, infective endocarditis or ischemic heart disease
• Abnormality prevents the valve from closing• Blood flows back into the right atrium during
systole• During diastole the regurg output flows into the
LV with the normal blood flow and increases the volume into the LV
• Progression is slowly – fatigue, chronic weakness, dyspnea, anxiety, palpitations
• May have A-fib and changes of LV failure• May develop right sided failure as well
Mitral Valve Prolapse
• Cause is variable and may be associated with congenital defects
• More common in women• Valvular leaflets enlarge and prolapse into
the LA during systole• Most are asymptomatic• Some may report chest pain, palpitations
or exercise intolerance• May have dizziness, syncope and
palpitations associated with dysrhythmias• May have audible click and murmur
Aortic Stenosis• Valve becomes stiff and fibrotic, impeding blood flow with
LV contraction• Results in LV hypertrophy, increased O2 demands, and
pulmonary congestion• Causes – rheumatic fever, congenital, arthrosclerosis• Atherosclerosis and calcification is primary cause in the
elderly• Complications – right sided heart failure, pulmonary edema,
and A-fib• S/S – Early: dyspnea, angina, syncope Late: marked fatigue, debilitation, and
peripheral cyanosis, crescendo- decrescendo murmur is heard
Aortic Regurgitation• Aortic valve leaflets do not close properly during diastole• The valve ring that attaches to the leaflets may be dilated,
loose, or deformed• The ventricle dilates to accommodate the ^ blood volume
and hypertrophies• Causes: infective endocarditis, congenital, hypertension,
Marfan’s • May remain asymptomatic for years• Develop dyspnea, orthopnea, palpitations, ,and angina• May have ^ systolic pressure with bounding pulse• Have a high pitch, blowing, decrescendo diastolic murmur
Assessment for Valve Dysfunction
• Subjective symptoms– Fatigue– Weakness– General malaise– Dyspnea on exertion– Dizziness– Chest pain or discomfort– Weight gain – Prior history of rheumatic heart disease
Assessment, cont.
• Objective symptoms– Orthopnea– Dyspnea, rales– Pink-tinged sputum– Murmurs– Palpitations– Cyanosis, capillary refill– Edema– Dysrhythmias– Restlessness
Diagnosis
• History and physical findings• EKG• Chest x-ray• Cardiac cath• Echocardiogram
Medial Treatment
• Nonsurgical management focuses on drug therapy and rest
• Diuretic, beta blockers, digoxin, O2, vasodilators, prophylactic antibiotic therapy
• Manage A-fib, if develops, with conversion if possible, and use of anticoagulation
Interventions
• Assess vitals, heart sounds, adventitious breath sounds
• ^ HOB• O2 as prescribed• Emotional support• Give medications• I/O• Weight• Check for edema• Explain disease process, provide for home care
with O2, medications
Surgical Management of Valve Disease
• Mitral Valve– Commissurotomy – Mitral Valve Replacement– Balloon Valvuloplasty
• Aortic Valve Replacement
Mechanical Valve
Mechanical Valve
Porcine Valve
Tissue Valve
Tissue Valve