IN PARTIAL FULFILMENT FOR THE REQUIREMENT IN THE SUBJECT NCM 112, LEC
VALVULAR HEART DISEASE
Submitted to:
Sir Dale Dela Cruz, RN
Submitted By:
Baliga, Jessie Pol
Cera, Rosemarie
Galagal, Jelena
Ordillo, Lyka
Vasquez, Rochelle Valvular Heart Disease- refers to any dysfunction or abnormality of one or more of the heart's valves. These Four Valves are: The aortic, mitral, tricuspid, Pulmonary valves. These valves control the blood flow through the heart's chambers to the rest of the body.
Definition of terms ● Stenosis- constriction or narrowing. ● Regurgitation- incomplete closure of the valve leaflets result in the backward flow of blood. ● Prolapse- valve bulges backward into the chamber it is supposed to seal, typically seen with mitral.
Principal Causes and Risk factors
● Age ● History of Rheumatic Fever ● High Blood Pressure ● Previous Heart Attack ● Chronic Kidney Disease ● Family History ● Lifestyle Factors: ● Radiation Exposure ● Congenital ● Degenerative ● Rheumatic carditis
TYPES 1. Mitral Stenosis: Narrowing of the mitral valve opening, restricting blood flow from the left atrium to the left ventricle.
2. Mitral Regurgitation: Incomplete closure of the mitral valve, causing blood to leak backward from the left ventricle into the left atrium.
3. Mitral Prolapse: A condition where one or both mitral valve leaflets bulge (prolapse) into the left atrium during systole, potentially leading to regurgitation.
4. Aortic Stenosis: Narrowing of the aortic valve, obstructing blood flow from the left ventricle into the aorta.
5. Aortic Regurgitation: Leakage of blood back into the left ventricle from the aorta due to improper closure of the aortic valve.
6. Tricuspid Stenosis: Narrowing of the tricuspid valve, obstructing blood flow from the right atrium to the right ventricle.
7. Tricuspid Regurgitation: Incomplete closure of the tricuspid valve, causing blood to flow backward from the right ventricle into the right atrium.
8. Pulmonary Stenosis: Narrowing of the pulmonary valve, restricting blood flow from the right ventricle to the pulmonary artery. 9. Pulmonary Regurgitation: Leakage of blood back into the right ventricle from the pulmonary artery due to improper closure of the pulmonary valve.
CLINICAL MANIFESTATIONS ● Dyspnea on exertion, orthopnea ● Acute pulmonary edema ● Weight gain Fatigue is due to reduce cardiac output ● Irregular / Rapid Heartbeats ● Fainting ● Chest Pain ● Discomfort during activity ● Cyanosis ● Crackles in the lungs ● Restlessness ● Weakness ● Atrial Fibrillation ● Decreased exercise intolerance ● Hemoptysis can occur.
PATHOPHYSIOLOGY Valvular Stenosis 1. Caused by etiological factors: Congenital Defects, Rheumatic heart disease, aging, Infections, radiation therapy, and autoimmune diseases 2. Valve narrows 3. Increased pressure and heart thickening 4. Decreased blood flow-leads to symptoms like tiredness, shortness of breath, and reduced ability to exercise. 5. Backwards pressure- In cases like mitral stenosis, the increased pressure can back up into the lungs, causing congestion and breathing difficulties. 6. The heart tries to compensate- by thickening its walls and beating faster 7. Eventual failure- Over time, these compensatory mechanisms fail, leading to worsening heart function and more severe symptoms, such as heart failure and chest pain (angina).
Valvular Regurgitation 1. Etiology of regurgitation: can be mitral valve prolapse, rheumatic heart disease 2. Valve leaflets wont seal 3. Backward flow of the blood 4. Increased Volume and Pressure: the left atrium receives extra blood (from the lungs and the backflow from the ventricle), causing it to enlarge and increase in pressure 5. Pulmonary congestion: increased pressure can be transmitted back into the lungs, leading to congestion and symptoms like shortness of breath. 6. Increased workload: eg :The ventricle has to pump more blood with each beat to compensate for the blood that's leaking back into the atrium. 7. Reduced forward blood flow: despite the heart's efforts to compensate, the backward flow reduces the overall amount of blood that reaches the rest of the body. 8. Increased Heart rate: The heart may beat faster to try to maintain cardiac output. 9. Dilation of Ventricles; to accommodate the extra blood, but this can eventually lead to heart failure as the muscle becomes overstretched and weak. 10. Worsening Symptoms : if this continues,the heart's ability to compensate diminishes, leading to more severe symptoms, such as severe shortness of breath, swelling in the legs, and fluid buildup in the lungs (pulmonary edema).
DIAGNOSTIC TESTS ● Echocardiogram-Uses ultrasound to visualize and evaluate the function and structure of heart valves, detecting abnormalities such as stenosis or regurgitation. ● Electrocardiogram- Records the heart's electrical activity to identify rhythm disturbances or other issues that might arise from valvular heart disease. ● Chest X-ray- Provides images of the heart and lungs to assess heart size and shape, which can reveal signs of valve-related conditions such as heart failure or valve calcification. ● Cardiac Catheterization- Involves inserting a catheter into the heart to measure pressures and assess valve function and blood flow, often used to evaluate the severity of valve disease. ● Cardiac MRI(Magnetic Resonance Imaging)- Offers detailed images of heart valves and surrounding structures, useful for assessing valve function and detecting complex valve pathology. ● CT Angiography (Computed Tomography)- Uses CT scans to visualize heart valves and the surrounding blood vessels, helping to diagnose valve-related issues like stenosis or regurgitation and assess valve anatomy. ● Stress testing- Evaluates how the heart and its valves respond to increased physical exertion or stress, providing insights into the impact of valve disease on heart function under stress. ● Blood Test- Analyzes biomarkers and other substances in the blood that can indicate heart valve problems or associated conditions, such as elevated levels of brain natriuretic peptide (BNP) in heart failure.
LAB TESTS Narrowing or blockage of the valve or swelling of the upper heart chambers may be seen on:
Auscultation: example: S1 followed by a murmur
Chest X-Ray (CXR): Shows left atrial enlargement
ECG: Atrial fibrillation may develop in 50-80% of patients, causing pulses to
become irregular and faint
Echocardiogram (2D Echo): The most sensitive tool for diagnosis
Additional Imaging:
- Chest X-Ray - CT Scan of the Heart
- MRI of the Heart
NURSING DIAGNOSIS ● Activity Intolerance related to insufficient oxygenation as evidenced by weakness, fatigue, shortness of breath, BP changes. ● Excess fluid volume related to heart failure as evidenced by peripheral edema, weight gain, adventitious breath sounds, neck vein distention. ● Decreased cardiac output related to valvular incompetence as evidenced by murmurs, dyspnea, peripheral edema. ● Impaired gas exchange related to pulmonary congestion secondary left sided heart failure caused by valvular dysfunction evidenced by decreased of oxygen saturation ● Acute pain related to myocardial ischemia due to increased cardiac workload evidenced by chest pain. ● Risk for Ineffective tissue perfusion related to inadequate cardiac output and blood flow due to valvular dysfunction. ● Risk for infection related to invasive procedure or surgical interventions, such as valve replacement or repair, which may expose the patient to infection ● Deficient knowledge related to lack of experience and exposure to information about disease and treatment process as evidenced by verbalization of misconception about measures to prevent complications.
DRUG STUDY Anticoagulants- prevents blood clots especially in patients with atrial fibrillation or prosthetic valves.
● WARFARIN ACTION INDICATION CONTRAINDICATION
Inhibiting the synthesis of Atrial fibrillation, venous Active bleeding, Severe Liver Vitamin K dependent clotting thromboembolism and disease, Pregnancy, factors II, VII, IX and X and prosthetic valves. Hypersensitivity, Recent major the coagulant protein C and S. Surgery/ Trauma.
Diuretics- to reduce fluid buildup and alleviate symptoms of the heart.
● FUROSEMIDE A loop diuretic that works by Congestive Heart Anuria, Severe Electrolyte inhibiting Na-K-2CI Failure(CHF), Edema, Imbalances, Severe Hepatic cotransporter in the ascending Managing fluid overload. Cirrhosis, Hypersensitivity. limb of the loop of Henle in the kidneys. Ace Inhibitors - to reduce blood pressure and decrease workload of the heart.
● ENALAPRIL Inhibiting the enzyme Heart Failure Hypersensitivity, Pregnancy, angiotensin- converting Hypertension History of Angioedema, enzyme (ACE), which is Preventing progression Bilateral Renal Artery responsible for converting Stenosis, Severe Renal angiotensin I to angiotensin II. Impairment.
● LISINOPRIL Inhibits angiotensin converting Heart failure, Hypertension, Hypersensitivity, Pregnancy, enzyme( ACE), which is Preventing Disease Progression History of Angioedema, responsible for converting Bilateral Renal Artery angiotensin I and angiotensin Stenosis, Severe Renal II. Impairment.
Beta Blockers- To lower heart rate and reduce heart strain.
● CARVEDILOL Block various receptors Bronchospastic conditions, chronic therapy of heart failure ( binding Sites) in the body second or third degree AV with reduced ejection fraction, including beta-1, beta -2 and block, Sick sinus syndrome, or hypertension, and left alpha1 receptors. severe bradycardia ventricular dysfunction following myocardial infarction in clinically stable patients.
Calcium Channel Blockers- Used for managing symptom and controlling blood pressure.
● AMLODIPINE Inhibits the transmembrane Hypertension, Chronic Allergic reaction to influx of calcium ions into Stable Angina, Vasospastic Amlodipine, Liver or vascular smooth muscle and angina Kidney disease, Heart cardiac muscle. Failure and Heart attack.
● DILTIAZEM Inhibits inflow of calcium Atrial Arrhythmia, Patients with 2nd or 3rd ions into the cardiac muscle Hypertension, Paroxysmal degree AV block during depolarization. supraventricular Hypotension or Cardiogenic tachycardia, and chronic Shock. stable angina. REHABILITATION TREATMENT 1. Medical Management: Use of medications to manage symptoms and complications of valvular heart disease, such as diuretics, antihypertensives, or anticoagulants. 2. Lifestyle Modifications: Changes in diet, exercise, and other habits to improve overall cardiovascular health and alleviate symptoms of valvular heart disease. 3. Physical Therapy: Customized exercise programs to improve cardiovascular fitness and strengthen the heart, tailored to individual needs following valvular disease treatment or surgery. 4. Patient Education: Providing information about valvular heart disease, treatment options, and self-care strategies to empower patients in managing their condition effectively. 5. Interventional Treatment: Procedures such as balloon valvuloplasty, valve repair, or valve replacement performed to directly address and correct structural problems with heart valves.
SURGICAL MANAGEMENT ● Closed Valvotomy: A surgical procedure to relieve mitral stenosis where a dilator is introduced through the left ventricular (LV) apex to separate the fused valve leaflets, improving blood flow through the mitral valve without direct vizualisation of the valve.
● Open Valvotomy: A procedure performed under direct vizualisation, where a surgeon makes an incision to access and separate the fused leaflets of the mitral valve, typically done in cases of severe mitral stenosis.
● Mitral Valve Replacement (MVR): A surgical procedure where the diseased or
malfunctioning mitral valve is removed and replaced with a mechanical or bioprosthetic valve. This procedure is used to treat severe mitral valve disease when valvotomy is not feasible or appropriate.
