VALVULAR heart DISEASE Stenosed valve Insufficient (incompetent) Incidence Decreasing steadily 5% of the population is affected women > men I. MITRAL valve DISEASE Etiology and Risk Factors Rheumatic heart disease infectious endocarditis connective Tissue abnormality.
VALVULAR heart DISEASE Stenosed valve Insufficient (incompetent) Incidence Decreasing steadily 5% of the population is affected women > men I. MITRAL valve DISEASE Etiology and Risk Factors Rheumatic heart disease infectious endocarditis connective Tissue abnormality.
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VALVULAR heart DISEASE Stenosed valve Insufficient (incompetent) Incidence Decreasing steadily 5% of the population is affected women > men I. MITRAL valve DISEASE Etiology and Risk Factors Rheumatic heart disease infectious endocarditis connective Tissue abnormality.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOCX, PDF, TXT or read online from Scribd
Incidence Decreasing steadily One of the most common cardiac abnormalities mitral valve prolapsed 5% of the population is affected Women > men
I. MITRAL VALVE DISEASE
Etiology and Risk Factors Rheumatic Heart Disease Infectious Endocarditis Connective Tissue Abnormality Myocardial Ischemia - blood flow in the heart
A. Mitral Stenosis - Valve becomes calcified and immobile - Valvular orifice narrows (normally 4 6 cm 2 )
Pathophysiology:
Blood is not adequately pumped from LA to LV during diastole Inadequate filling of LV (preload) Pressure in LA elevates Cardiac Output Back pressure elevates Pulmonary Venous & Pulmonary Capillary Pressures Pulmonary HTN RV hypertrophy as it needs to pump blood harder MITRAL STENOSIS Right-Side Heart Failure RV failure can result Hypertrophy Curu, Lorelyn June P. BSN III-1 Page 2
Manifestations Dyspnea, orthopnea, exercise tolerance, PND Hemoptysis Diastolic murmur Systemic congestion Opening snap is heard (apex) diaphragm Atrial fibrillation common in mitral stenosis Mural thrombi Irregular pulse
Diet Na restricted diet
Surgical Management Percutaneous Balloon Valvuloplasty Temporarily redues backflow by enhancing forward blood flow into the aorta
Note: Mechanical mostly prescribed for children - after 10 years it becomes 30% inefficient - need anti-coagulant therapy
Tissue for adults - less durable - for clients with bleeding tendency - for pregnant women - no anti-coagulant therapy needed
B. Mitral Regurgitation
Pathophysiology
Backflow of blood from LV to LA Reduced amount of blood flow to LV Large amount of blood received by the LA during systole LV must pump harder to pressure CO LA hypertrophy/ LA pressure LV hypertrophy Pulomonary congestion LV failure RV hypertrophy since it has to pump against a higher resistance CO pulmonary congestion Right-side Heart Failure Systemic congestion Curu, Lorelyn June P. BSN III-1 Page 3
Manifestation Symptoms of CO Fatigue, dyspnea, orthopnea, PND Systolic murmur: blowing & high pitched, heard immediately after S 1
Changes in the mean capillary pressure S 3 gallop: rapid in flow rate across mitral orifice Manifestations of right-sided heart failure Atrial fibrillation: irregular heart beat
Management Pharmacologic Management Diuretic To decrease cardiac workload
Digitalis Nitrates tx of angina ACE inhibitors
Diet Na restricted diet
Activity Restriction of physical activities that produce fatigue and dyspnea
Anterior & posterior cusps of mitral valve billow upward into the atrium during systolic contraction Chordae tendineae lengthen allowing the valve cusps to stretch upward Cusps enlarges & thickens Regurgitation Curu, Lorelyn June P. BSN III-1 Page 4
Management Beta blockers Aspirin Antibiotics
Diet Eliminate caffeine & alcohol from the diet
Surgical Mgt Mitral valve replacement
II. AORTIC VALVE DISEASE In aortic stenosis the orifice of the aortic valve becomes narrowed Aortic regurgitation (insuffient) allows blood to leak back from the aorta to the left ventricle Both aortic stenosis and regurgitation overwork the left ventricle ventricle hypertrophy
Etiology and Risk Factors Congenital defects of the aortic valve Calcification of the valve Rheumatic Fever
A. Aortic Stenosis
Pathophysiology
Note: Systole contraction Diastole relaxation
Narrowed aortic valve Blood not adequately pumped from LV to aorta Pressure in LV elevates during systole LV hypertrophy/Dilation Elevated End-Diastolic Pressure Decreased CO/LV Failure Left-Side Heart Failure/ Pulmonary Congestion Curu, Lorelyn June P. BSN III-1 Page 5
Manifestation Gradually and late in the course of the disease Angina pectoris in 66% (similar with CAD), dysrhythmias Syncope during exertion due to fixed CO during periods of increased demand Symptoms of left-sided heart failure In severe AS: palpitation, fatigue, and visual disturbances Systolic murmur Early ejection click & systolic thrill
Manifestation Even with severe AR, pts may be asymptomatic for a long time Palpitation, fatigue Prominent carotid artery pulsation and head-bobbing with each heartbeat (de Musset sign) Widening Pulse Pressure: high systolic in LV and low diastolic pressure in aorta Diastolic murmur Corrigans or water hammer pulse (sharp pulse then sudden collapse in diastolic pressure) Blood in the aorta flows back in the LV through an incompetent valve Volume overload in the LV Increased left ventricular end diastolic volume Hypertrophy & dilation of left ventricle Progression of condition leads to decline in contractility Curu, Lorelyn June P. BSN III-1 Page 6
III. TRICUSPID VALVE DISEASE Tricuspid stenosis & regurgitation Usually develops from rheumatic fever or in combination with other structural disorders of the heart right atrial pressure
A. Tricuspid Stenosis
Pathophysiology
Manifestation Dyspnea, fatigue, jugular vein distention, peripheral edema & weight loss Pulsation in the neck with prominent waves Diastolic murmur is heard best along the left lower sterna border
Management Diuretics Digitalis Beta blockers
B. Tricuspid Regurgitation
Pathophysiology
Inability of RA to propel blood across the stenosed valve RA Pressure/Systemic Venous Congestion Cardiac Output Backflow of blood from the RV back into the RA during systole RA pressure Systemic venous congestion Curu, Lorelyn June P. BSN III-1 Page 7
IV. PULMONIC VALVE DISEASE Usually a congenital defiect May be caused by RHD Caused by mitral stenosis, pulmonary emboli & chronic lung disease Pulmonic stenosis and regurgitation lead to in CO
A. Pulmonary Stenosis
Pathophysiology
Manifestation Murmur Right sided heart failure
B. Pulmonic Regurgitation Allows blood to flow back from the PA to the RV during diastole Most common cause: dilatation of the pulmonic valve ring due to pulmonary hypertension Charac. Murmur: GRAHAM STEELL MURMUR: begins after S 2 and the sound is accentuated with inspiration Tap is heard & palpable systolic pulsation on the left parasternal area
Manifestation SOB, fatigue, cyanosis, fainting Chest pain Poor weight gain & failure to thrive in infants Heart murmur
Narrowing of the entrance of the pulmonary artery Interferring with the blood flow out of the right side of the heart CO Curu, Lorelyn June P. BSN III-1 Page 8
Nursing Diagnosis 1. Decreased Cardiac Output (Valvular Dse) r/t reduced ventricular filling and/or emptying Assess VS Monitor I & O Restrict fluids as ordered Elevate the head of the bed Provide physical, emotional & mental rest Administer prescribed medications to reduce cardiac workload
2. Activity Intolerance r/t imbalance between O 2 supply and demand Monitor VS before, during and after exercise Encourage adequate rest Encourage self care activity levels gradually Assist with ADLs as needed Formulate a schedule with alternating rest and activities
3. Risk for Infetion r/t Inadequate primary defense Assess wounds and catheter sites for signs of infection Use antiseptic techniques for all invasive procedures Provide proper wound care
4. Risk for Fluid Volume Excess r/t Na and fluid retention 5. Anxiety r/t change in health status 6. Knowledge deficit regarding preventive measures against endocarditis 7. Risk for Non-compliance