8/30/17

Valvular Heart Disease Valvular Heart Disease

Beryl Ben C. Mergal, RN, MOS, MSN
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 Valvular Heart Disease

Types of Mechanical Disruption in valves Types of Mechanical Disruption in valves

1. Valvular Stenosis : 2. Valvular
=narrowing/hardening Regurgitation
(Incompetency,
of valve opening & Insufficiency)
progressive - impaired closure of the
obstruction to blood valve causing BACKFLOW
flow of blood

Valvular Heart Disease Etiology

Types of Mechanical Disruption in valves Endocarditis

2. Valvular Infarction
Regurgitation
(Incompetency, Cardiac dilation
Insufficiency) Congenital Defects
- impaired closure of the
valve causing BACKFLOW History of Rheumatic Fever or RHD
of blood idiopathic

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Types of Structural Defects Pathophysiology

Rheumatic Fever or infective Endocarditis
Mitral stenosis
Mitral regurgitation Inflammation of valve leaflets

Mitral valve prolapse

Fibrosis and retraction of leaflets
Aortic Stenosis
Aortic Regurgitation / Insufficiency
Shortening of chordae tendinae
Tricuspid stenosis
Tricuspid regurgitation Narrowing of valvular orifice (n=4-6 cm2)
Mild stenosis-2 cm2
Pulmonic stenosis Severe stenosis-1 cm2
Pulmonic regurgitation

Decrease blood flow from left atrium to

left ventricle
Rupture of
Stagnation
Signs and Symptoms
small
Increase LA pressure of blood in
bronchial
the left
vessels
atrium Fatigue
Left atrial enlargement
Hemoptysis
Shortness of breath
Thrombus
Increase pulmonary venous pressure Irregular heartbeat or heart murmur
Embolism
Swollen feet or ankles
Conduction
Increase right ventricular pressure
delay in the Chest pain
atria
Right ventricular Enlargement
Pulmonary Fainting (syncope)
edema
Notched or
LSHF
m-shaped P
Right Ventricular Failure
wave Orthopnea
PND

Assessment Management

1. Increase intensity of S1 1. Diuretics

2. Opening snap after S2- apex 2. Digitalis
3. Diastolic low pitched apical rumble after 3. Anticoagulation
opening snap 4. Balloon valvuloplasty
5. Surgery
mitral commissurotomy
mitral valve replacement

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Causes Assessment

Acute: Holosystolic murmur

Endocarditis, Ruptured chordae
tendineae
heard best at the apex and
radiates to the axilla; usually
Chronic:
accompanied by a thrill
RHD, MVP, hypertrophy & MI,
congenital

Management

1. Digitalis
2. Diuretics
3. Vasodilators -Anticoagulation
4. Surgery
valve replacement or valve
MITRAL VALVE PROLAPSE
repair

Mitral Valve Prolapse Causes

one or both valve Often unclear

leaflets protrude
into the LA
Acute or chronic rheumatic
damage
inherited connective tissue
disorder

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Assessment and Diagnostic

Clinical Manifestations
Findings
Possibly asymptomatic Mitral click extra heart sound often
the first and only sign of MVP
Atypical chest pain r/t fatigue
Mitral murmur
Tachycardia & palpitations
Light-headedness, Dizziness,
Syncope
Palpitations
Anxiety

Management

Calcium Channel Blockers

Beta blockers
Treatment for HF
Surgery:
Mitral valve repair or replacement AORTIC STENOSIS

Aortic Stenosis Pathophysiology

Narrowed aortic orifice

Narrowing of the Increased back flow of

Decreased
blood flow to
orifice between the LV blood to left ventricle aorta
during systole
& aorta
Decrease CO
Increased LV pressure
Syncope
Decreased
LVH coronary
blood flow

Increased LA pressure
Angina

LAH

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Increased pulmonary pressure

Assessment
Pulmonary
Increased RV pressure edema
Orthopnea 1. Systolic, harsh murmur
dyspnea
RVH 2. Gallavardin phenomenon
murmur also reflected to mitral area
RVF which may give a false impression of a
mitral regurgitation
Edema Ascites Anorexia Fatigue CVP
JVP

Medical Management Balloon Valvuloplasty

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

Clinical Manifestations

Asymptomatic
Exertional dyspnea
Dizziness and syncope
Angina pectoris
Low blood pressure
AORTIC REGURGITATION

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AORTIC REGURGITATION
Aortic Regurgitation
Blood from aorta returns to the LV
during diastole + blood from LA
is the flow of blood
back into the LV
LV EDV & pressure
from the aorta
during diastole
LV dilation
Stroke Volume

Persistent palpitations
Throbbing neck pulse
dizziness

PULMONARY CONGESTION Clinical Manifestations

RV AFTERLOAD working against PVR Asymptomatic
Forceful heartbeat head or neck
Palpitations
RSHF Arterial pulsation that visible or palpable at the carotid or
temporal arteries
Exertional dyspnea
SYSTEMIC CONGESTION Fatigue
Progressive s/sx of LV failure
Orthopnea, PND
JVD, CVP, PERIPHERAL EDEMA, Cough
ASCITES, HEPATOMEGALY,

Tricuspid Stenosis

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

TRICUSPID STENOSIS

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TRICUSPID STENOSIS
Blood flow obstruction from RA to RV

Impaired RV Filling Blood regurgitates back

during diastole to RA during systole

RV Stroke volume pressure in RA

RA dilates TRICUSPID REGURGITATION

Decreased CO
RSHF
Fatigue, weakness
Systemic congestion

TRICUSPID REGURGITATION
Tricuspid Regurgitation
Blood flow back from RV
to RA during systole

RV Stroke volume pressure in RA

Decreased CO RA dilates

Tissue perfusion RSHF

Back flow of blood from RV to RA during

systole Fatigue, weakness Systemic congestion

Assessment & Diagnostic Valvular Heart Disorders

Findings Nursing Management

ECG Common Nursing Diagnoses
Echocardiography Decreased Cardiac Output
CXR Activity intolerance
Cardiac catheterization Risk for infection
Ineffective protection

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Valvular Heart Disorders Valvular Heart Disorders

Nursing Management Nursing Management
DECREASED CO Activity intolerance
1. Monitor VS; report changes from baseline. 1. Monitor VS before & during activities
2. Monitor I & O; weigh daily, report weight gain 2. Encourage self care & gradually increase
of 3-5 lbs within 24hrs
activities as allowed /tolerated
3. Restrict fluid intake as ordered
3. Provide assistance as needed
4. Monitor oxygen sat and ABG as ordered
5. Elevate head of bed; give o2 as ordered
4. Consult with cardiac rehab specialist or PT
6. Provide for physical, emotional and mental rest for bed exercises
7. Administer meds as ordered to reduce cardiac 5. Discuss ways to conserve energy at home.
workload

Valvular Heart Disorders

Invasive Management
Nursing Management
Ineffective protection Annuloplasty
1. Anticoagulant therapy as ordered tightening & suturing
the malfunctioning
2. Assess for bleeding (stools and vomitus);
annulus to reduce
3. Instruct to avoid using aspirin or other NSAIDs regurgitation
4. 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