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    Valvular Heart Disease

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    Charlz Zipagan
    This document discusses various types of valvular heart disease including mitral stenosis, mitral regurgitation, mitral valve prolapse, aortic stenosis, and aortic regurgitation. For each condition, it describes the etiology, pathophysiology involving changes in blood flow and pressures, clinical assessments, and management approaches including nonsurgical and surgical options. Surgical management involves procedures like balloon valvuloplasty, direct commissurotomy, and mitral valve annuloplasty to repair or replace dysfunctional valves.

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    Valvular Heart Disease

    Uploaded by

    Charlz Zipagan
    17 views27 pages
    This document discusses various types of valvular heart disease including mitral stenosis, mitral regurgitation, mitral valve prolapse, aortic stenosis, and aortic regurgitation. For each condition, it describes the etiology, pathophysiology involving changes in blood flow and pressures, clinical assessments, and management approaches including nonsurgical and surgical options. Surgical management involves procedures like balloon valvuloplasty, direct commissurotomy, and mitral valve annuloplasty to repair or replace dysfunctional valves.

    Original Description:

    CARE OF THE CLIENTS WITH VALVULAR DISORDERS

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    This document discusses various types of valvular heart disease including mitral stenosis, mitral regurgitation, mitral valve prolapse, aortic stenosis, and aortic regurgitation. For each condition, it describes the etiology, pathophysiology involving changes in blood flow and pressures, clinical assessments, and management approaches including nonsurgical and surgical options. Surgical management involves procedures like balloon valvuloplasty, direct commissurotomy, and mitral valve annuloplasty to repair or replace dysfunctional valves.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    17 views27 pages

    Valvular Heart Disease

    Uploaded by

    Charlz Zipagan
    This document discusses various types of valvular heart disease including mitral stenosis, mitral regurgitation, mitral valve prolapse, aortic stenosis, and aortic regurgitation. For each condition, it describes the etiology, pathophysiology involving changes in blood flow and pressures, clinical assessments, and management approaches including nonsurgical and surgical options. Surgical management involves procedures like balloon valvuloplasty, direct commissurotomy, and mitral valve annuloplasty to repair or replace dysfunctional valves.

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    of 27

    CHARLES Z. ARIOLA JR., MSN., LPT, RN.

    INSTRUCTOR I
    MITRAL STENOSIS

    - it usually results from rheumatic carditis which


    causes valve thickening by fibrosis and
    calcification.
    - it is commonly caused by RHEUMATIC FEVER
    - nonrheumatic causes include tumor, calcium
    accumulation and thrombus formation
    PATHOPHYSIOLOGY
    VALVE LEAFLETS FUSE AND BECOME STIFF

    CHORDAE TENDINAE CONTRACT AND SHORTEN

    NARROWING OF THE VALVE OPENING

    ALTERATION OF NORMAL BLOOD FLOW FROM LEFT ATRIUM TO LEFT


    VENTRICLE

    INCREASE IN ATRIAL PRESSURE

    DILATION OF LEFRT VENTRICLES


    PATHOPHYSIOLOGY...cont
    INCREASE IN PULMONARY ARTERY PRESSURE

    RIGHT VENTRICLE HYPERTROPHY

    PULMONARY CONGESTION AND RIGHT-SIDED HEART FAILURE

    LEFT VENTRICLE RECEIVES INSUFFICIENT BLOOD VOLUME

    DECREASED CARDIAC OUTPUT


    ASSESSMENT

    1. Pt with mild stenosis is usually asymptomatic


    2. dyspnea on exertion
    3. paroxysmal nocturnal dyspnea
    4. orthopnea
    5. palpitations
    6. dry cough
    ASSESSMENT... cont

    7. hemoptysis
    8. pulmonary edema
    9. Right-sided heart failure signs and symptoms
    10. pulse may be normal, rapid or irregularly
    irregular as atrial fibrillation
    MITRAL REGURGITATION

    - It is commonly caused by Rheumatic Heart


    Disease
    - it affects women more often than men
    - Nonrheumatic causes include Ischemic Heart
    Disease affect men other than women
    PATHOPHYSIOLOGY
    FIBROSIS AND CALCIFICATION OF VALVE

    PREVENTS CLOSURE OF MITRAL VALVE DURING


    SYSTOLE

    NARROWING OF THE VALVE OPENING

    BLOOD FLOWS BACK INTO LEFT ATRIUM WHEN


    LEFT VENTRICLE CONTRACTS
    PATHOPHYSIOLOGY...cont
    DURING DIASTOLE, RGURGITANT OUTPUT AGAIN FLOWS FROM LEFT
    ATRIUM TO LEFT VENTRICLE ALONG WITH NORMAL BLOOD FLOW

    INCREASE IN VOLUME AND PREESSURE

    LEFT ATRIAL AND VENTRICULAR DILATION AND


    HYPERTROPHY
    ASSESSMENT
    1. fatigue
    2. dyspnea on exertion
    3. orthopnea
    4. palpitation
    5. atrial fibrillation
    6. neck vein distention
    7. hepatomegaly
    8. pitting edema
    9. high-pitch systolic murmur
    MITRAL VALVE PROLAPSE

    - the etilogy is variable and is usually associated


    with Marfan Syndrome
    - it occurs when the leaflets enlarge and prolapse
    into the left atrium during systole.
    - it is benign and may progress with regurgitation
    PATHOPHYSIOLOGY
    PROLAPSE OF LEAFLETS DURING SYSTOLE

    PREVENTS CLOSURE

    BLOOD FLOWS BACK INTO LEFT ATRIUM WHEN


    LEFT VENTRICLE CONTRACTS
    PATHOPHYSIOLOGY...cont
    DURING DIASTOLE, RGURGITANT OUTPUT AGAIN FLOWS FROM LEFT
    ATRIUM TO LEFT VENTRICLE ALONG WITH NORMAL BLOOD FLOW

    INCREASE IN VOLUME AND PREESSURE

    LEFT ATRIAL AND VENTRICULAR DILATION AND


    HYPERTROPHY
    ASSESSMENT
    1. chest pain
    2. dizziness
    3. palpitations
    4. atrial tachycardia
    5. ventricular tachycardia
    AORTIC STENOSIS

    - often considered as disease of “wear and tear”


    - common cardiac dysfunction among countries
    - it is caused by atherosclerosis and degenerative
    calcification of the aortic valve
    PATHOPHYSIOLOGY
    NARROWING OF THE AORTIC VALVE ORIFICE

    OBSTRUCTION OF LEFT VENTRICULAR OUTFLOW


    DURING SYSTOLE

    INCREASED RESISTANCE TO EJECTION OR


    AFTERLOAD

    VENTRICULAR HYPERTROPHY
    PATHOPHYSIOLOGY...cont
    VETRICULAR FAILURE

    PULMONARY SYSTEM BECOMES CONGESTED

    RIGHT-SIDED HEART FAILURE


    ASSESSMENT
    1. dyspnea
    2. angina
    3. syncope on exertion
    4. fatigue
    5. orthopnea
    6. paroxysmal nocturnal dyspnea
    7. systolic murmur
    AORTIC REGURGITATION

    - results from nonrheumatic conditions such as


    infective endocarditis, hypertension, Marfan
    Syndrome
    - it is sometime caused by congenital anatomic
    aortic valvular abnormalities
    PATHOPHYSIOLOGY
    NON-CLOSURE OF THE VALVE LEAFLETS DURING DIASTOLE

    DILATION OR DEFORMATION OF THE VALVE RING

    BLOOF FLOWS BACK FROM AORTA TO LEFT VENTRICLE

    DILATION OF LEFT VENTRICLE

    VENTRICULAR HYPERTROPHY
    ASSESSMENT
    1. palpitations
    2. dyspnea
    3. orthopnea
    4. paroxysmal nocturnal dyspnea
    5. fatigue
    6. angina
    7. sinus tachycardia
    8. high-pitched and blowing murmur
    NONSURGICAL MANAGEMENT
    DRUG THERAPY
    1. Diuretics
    2. Beta-blockers given to improve symptoms of HF
    3. Digoxin
    4. Oxygen
    5. Nitrates are given cautiously because the potential syncope
    from a decrease in left ventricular volume
    6. Vasodilators such as Calcium Channel Blockers may be used to
    reduce the regurgitant flow for patients with aortic or mitral
    stenosis
    NONSURGICAL MANAGEMENT
    FOR ATRIAL FIBRILLATION
    1. IV Diltiazem (Cardizem, Apo-Diltiaz)
    2. Amiodarone (Cordarone, Pacerone)
    3. Procainamide Hydrochloride (Procanbid)
    4. Sodium Warfarin (Coumadin)
    5. Cardioversion
    SURGICAL MANAGEMENT
    BALOON VALVULOPLASTY
    - invasive nonsurgical procedure for stenotic mitral and aortic
    valve
    - for mitral valvuloplasty, the physician passes a baloon catheter
    via femoral vein, through atrial septum and to the mitral valve.
    - for aortic valvuloplasty, the physician advances catheter
    through the femoral artery and to the aortic valve
    NURSING RESPONSIBILITY
    1. monitor patient closely for bleeding at insertion site
    2. observe for signs of regurgitant valve by monitoring heart
    sounds, CO and heart rhythm.
    3. observe for signs of systemic emboli because of the possible
    dislodge of thrombi in the valve
    SURGICAL MANAGEMENT
    DIRECT (OPEN) COMMISSUROTOMY
    -open heart surgery that repairs a mitral valve that is narrowed
    from stenosis
    - patient is placed on a heart-lung bypass machine
    - the surgeon removes the calcium deposits and other scar issues
    from the valve leaflets
    SURGICAL MANAGEMENT
    MITRAL VALVE ANNULOPLASTY
    - reconstruction or reparative procedure for mitral insufficiency
    - the physician may suture the leaflets to make the annulus
    smaller

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