Valvular Heart Disease

Beryl Ben C. Mergal, RN, MSN

Valvular Heart Disease

Valvular heart disease is any disease
process involving one or more of the valves
of the heart (the aortic and mitral
valves on the left and
the pulmonary and tricuspid valves on the
right)

Valvular Heart Disease

Types of Mechanical Disruption in valves
1. Valvular Stenosis :

=narrowing/hardening
of valve opening &
progressive
obstruction to blood
flow

Valvular Heart Disease

Types of Mechanical Disruption in valves
2. Valvular
Regurgitation
(Incompetency,
Insufficiency)
- impaired closure of the
valve causing BACKFLOW
of blood

Valvular Heart Disease

Types of Mechanical Disruption in valves
2. Valvular
Regurgitation
(Incompetency,
Insufficiency)
- impaired closure of the
valve causing BACKFLOW
of blood

Etiology

Endocarditis
Infarction
Cardiac dilation
Congenital Defects
History of Rheumatic Fever or RHD
idiopathic

Types of Structural Defects

Mitral stenosis
Mitral regurgitation
Mitral valve prolapse
Aortic Stenosis
Aortic Regurgitation / Insufficiency
Tricuspid stenosis
Tricuspid regurgitation
Pulmonic stenosis
Pulmonic regurgitation

Pathophysiology
Rheumatic Fever or infective Endocarditis
Inflammation of valve leaflets

Fibrosis and retraction of leaflets

Shortening of chordae tendinae
Narrowing of valvular orifice (n=4-6 cm2)
Mild stenosis-2 cm2
Severe stenosis-1 cm2

Decrease blood flow from left atrium to

left ventricle

Rupture of
small
bronchial
vessels

Increase LA pressure
Left atrial enlargement

Hemoptysis

Increase pulmonary venous pressure

Conduction
delay in the
atria

Increase right ventricular pressure

Right ventricular Enlargement

Notched or
m-shaped P
wave

Right Ventricular Failure

Stagnation
of blood in
the left
atrium
Thrombus

Embolism

Pulmonary
edema
LSHF

Orthopnea
PND

Signs and Symptoms

Fatigue
Shortness of breath
Irregular heartbeat or heart murmur
Swollen feet or ankles
Chest pain
Fainting (syncope)

Assessment
1. Increase intensity of S1
2. Opening snap after S2- apex
3. Diastolic low pitched apical rumble after
opening snap

Management
1. Diuretics
2. Digitalis
3. Anticoagulation
4. Balloon valvuloplasty
5. Surgery
mitral commissurotomy
mitral valve replacement

Causes
Acute:
Endocarditis, Ruptured chordae
tendineae
Chronic:
RHD, MVP, hypertrophy & MI,
congenital

Assessment

Holosystolic murmur
heard best at the apex and
radiates to the axilla; usually
accompanied by a thrill

Management
1. Digitalis
2. Diuretics
3. Vasodilators -Anticoagulation
4. Surgery
valve replacement or valve
repair

MITRAL VALVE PROLAPSE

Mitral Valve Prolapse

one or both valve
leaflets protrude
into the LA

Causes
Often unclear
Acute or chronic rheumatic
damage
inherited connective tissue
disorder

Clinical Manifestations

Possibly asymptomatic
Atypical chest pain r/t fatigue
Tachycardia & palpitations
Light-headedness, Dizziness,
Syncope
Palpitations
Anxiety

Assessment and Diagnostic

Findings
Mitral click extra heart sound often
the first and only sign of MVP
Mitral murmur

Management
Calcium Channel Blockers
Beta blockers
Treatment for HF
Surgery:
Mitral valve repair or replacement

AORTIC STENOSIS

Aortic Stenosis
Narrowing of the
orifice between the LV
& aorta

Pathophysiology
Narrowed aortic orifice
Increased back flow of
blood to left ventricle
during systole
Increased LV pressure
Syncope
LVH

Decreased
blood flow to
aorta

Decrease CO
Decreased
coronary
blood flow

Increased LA pressure

Angina
LAH

Increased pulmonary pressure

Increased RV pressure

RVH

Pulmonary
edema
Orthopnea
dyspnea

RVF

Edema

Ascites

Anorexia

Fatigue

CVP
JVP

Assessment
1. Systolic, harsh murmur
2. Gallavardin phenomenon
murmur also reflected to mitral area
which may give a false impression of a
mitral regurgitation

Medical Management
1. Palliative therapy
-digitalis, diuretics
-balloon valvuloplasty
2. Curative therapy
- aortic valve replacement

Balloon Valvuloplasty

Clinical Manifestations

Asymptomatic
Exertional dyspnea
Dizziness and syncope
Angina pectoris
Low blood pressure

AORTIC REGURGITATION

Aortic Regurgitation
is the flow of blood
back into the LV
from the aorta
during diastole

AORTIC REGURGITATION
Blood from aorta returns to the LV
during diastole + blood from LA

LV EDV & pressure

LV dilation

Stroke Volume
Persistent palpitations
Throbbing neck pulse
dizziness

PULMONARY CONGESTION

RV AFTERLOAD working against PVR

RSHF
SYSTEMIC CONGESTION
JVD, CVP, PERIPHERAL EDEMA,
ASCITES, HEPATOMEGALY,

Clinical Manifestations

Asymptomatic
Forceful heartbeat head or neck
Palpitations
Arterial pulsation that visible or palpable at the carotid or
temporal arteries
Exertional dyspnea
Fatigue
Progressive s/sx of LV failure
Orthopnea, PND
Cough

TRICUSPID STENOSIS

Tricuspid Stenosis
inability of the RA
to propel blood
across a stenosed
valve going to RV.

TRICUSPID STENOSIS
Blood flow obstruction from RA to RV
Impaired RV Filling
during diastole

RV Stroke volume
Decreased CO

Fatigue, weakness

Blood regurgitates back

to RA during systole

pressure in RA

RA dilates
RSHF
Systemic congestion

TRICUSPID REGURGITATION

Tricuspid Regurgitation

Back flow of blood from RV to RA during

systole

TRICUSPID REGURGITATION
Blood flow back from RV
to RA during systole
RV Stroke volume
Decreased CO

pressure in RA

RA dilates

Tissue perfusion

RSHF

Fatigue, weakness

Systemic congestion

Assessment & Diagnostic

Findings

ECG
Echocardiography
CXR
Cardiac catheterization

Valvular Heart Disorders

Nursing Management
Common Nursing Diagnoses
Decreased Cardiac Output
Activity intolerance
Risk for infection
Ineffective protection

Valvular Heart Disorders

Nursing Management
DECREASED CO
1. Monitor VS; report changes from baseline.
2. Monitor I & O; weigh daily, report weight gain
of 3-5 lbs within 24hrs
3. Restrict fluid intake as ordered
4. Monitor oxygen sat and ABG as ordered
5. Elevate head of bed; give o2 as ordered
6. Provide for physical, emotional and mental rest
7. Administer meds as ordered to reduce cardiac
workload

Valvular Heart Disorders

Nursing Management
Activity intolerance
1. Monitor VS before & during activities
2. Encourage self care & gradually increase
activities as allowed /tolerated
3. Provide assistance as needed
4. Consult with cardiac rehab specialist or PT
for bed exercises
5. Discuss ways to conserve energy at home.

Valvular Heart Disorders

Nursing Management
Ineffective protection
1.
2.
3.
4.

Anticoagulant therapy as ordered

Assess for bleeding (stools and vomitus);
Instruct to avoid using aspirin or other NSAIDs
Advised using soft-bristled toothbrush, electric
razor, and gentle touch.
5. Monitor Hgb, hct, & platelet count as ordered
6. Monitor & report >2.5 times PT or >3.5 times
INR (International Normalized Ratio) to the
physician

Invasive Management
Annuloplasty
tightening & suturing
the malfunctioning
annulus to reduce
regurgitation