Valvular Heart Disease

  1. What is mitral stenosis?
    • Impedes blood flow from left atrium to left ventricle during diastole
    • Results in left atrial enlargement and pressure; pulmonary congestion
    • Etiology: usually rheumatic heart disease
  2. Clinical manifestations of mitral stenosis
    • Dyspnea
    • Atrial fibrillation
    • Emboli from stagnant blood in left atrium
    • Opening snap
    • Diastolic murmur at apex (murmur occurs after S2, before S1 during diastole)
    • Left atrial hypertrophy
    • Back up into lungs, causing pulmonary edema
  3. What is mitral regurgitation?
    • Backward flow of blood into left atrium during systole
    • Etiology: MI, papillary muscle dysfunction, sever MVP (mitral valve prolapse), infective endocarditis, rheumatic heart disease
  4. What is acute mitral regurgitation?
    • Usually MI
    • Flash pulmonary edema
    • New systolic murmur at apex (mitral valve should be closed during systole)
    • Complications: left anterior descending
  5. What is chronic mitral regurgitation?
    • Left atrium, left ventricle dilation (hypertrophy)
    • Pulmonary congestion
    • Holosystolic murmur at apex
    • Will eventually lead to left ventricular failure with CHF
  6. What is mitral valve prolapse?
    • Most common valve abnormality
    • Structural abnormality in valve leaflet or papillary muscles results in prolapse of valve leaflets into left atrium during systole (leaflets are longer than normal, so they push up into atria)
    • Usually benign
    • Can cause mitral regurgitation or endocarditis
    • Etiology: usually hereditary
    • Usually identified on echo
  7. Clinical manifestations of mitral valve prolapse
    • Can be asymptomatic
    • Mid-systolic click (leaflets snapping up) with late systolic murmur
    • Chest pain (not anginal)
    • SVT(supraventricular tachycardia)
    • PVCs (premature ventricular contraction)
    • Palpitations
    • V-tach
    • Dizziness
  8. Treatment for mitral valve prolapse
    • No treatment if minimally symptomatic
    • Avoid stimulants, caffeine
    • Beta blockers for palpitations
  9. What is aortic stenosis?
    • Narrowing of aorta
    • Obstruction of outflow from left ventricle during systole
    • Decreased cardiac output
    • Increased afterload, contractility and preload
    • Myocardial hypertrophy
    • Increased myocardial O2 demand
    • Inability to increase cardiac output with exertion
    • Etiology: most common senile calcification, congenital in younger, rheumatic heart disease
  10. Clinical manifestation of aortic stenosis
    • Angina
    • CHF
    • Syncope
    • S4 harsh systolic murmur at base (2nd ICS right sternal border)
    • Patient will not tolerate tachycardia very well (incr in HR results in decr in preload, time in diastole, and O2 demand to myocardium)
    • Patient will not tolerate hypovolemia either
  11. Treatment of aortic stenosis
    • Beta blockers
    • Avoid nitrates (decrease in preload will reduce outflow needed to force valve open; increases HR)
  12. What is aortic regurgitation?
    • Retrograde blood flow from aorta back into left ventricle during diastole
    • Causes left ventricle dilation/hypertrophy
    • Valve does not close completely during diastole
    • Eventually leads to dilated left atrium and pulmonary congestion
    • Acute etiology: endocarditis, trauma, aortic dissection, life threatening emergency can lead to CV collapse
    • Chronic etiology: rheumatic heart disease, congential bicuspid aortic valve
  13. Clinical manifestation of aortic regurgitation
    • Water hammer pulse (quick collapse in diastole; strong collapsing pulse)
    • Diastolic murmur at base
    • CHF
    • Exertional dyspnea
    • Orthophnea
    • Paroxysmal noctural dyspnea
    • High SBP, low DBP (heart has to really fill up and push hard to get blood out, then it collapses)
  14. Diagnosing valvular heart disease
    • Echocardiogram (information on valve structures, functions and chamber size)
    • Cardiac cath (quantifies size of valve and chamber pressures; used prior to planned surgical correction)
    • Multiple valve disorders can co-exist (i.e. can have both aortic stenosis and mitral regurgitation)
    • Intensity of a murmur does not necessarily indicate severity of a valve problem (may not be enough blood to create a loud murmur)
  15. Treatment of valvular heart disease
    • Conservative (monitor cardiac function, prevent endocarditis, treat CHF)
    • Percutaneous transluminal balloon valvuloplasty (cardiac cath ballon separates stenotic valve leaflets; opens up valve)
    • Valve repair (open with sternotomy with cardiopulmonary bypass; surgeon repairs damaged valve without use of prosthetics)
    • Mechanical valves (increased risk of thromboembolism; requires life long anticoagulation therapy; INR s/b 2.5 to 3.5)
    • Biological valves (less thrombogenic but do not last as long as mechanical valves; less likely to shred red blood cells)
    • With valve replacement, concerned with clotting and vegetation caused by endocarditis
  16. Nursing care for valvular heart disease
    • Assessment: vitals, O2 sat, heart sounds, lung sounds, cardiac output
    • Treatment of CHF
    • Post-op valve repair or replacement: similar to post CABG patient; manage volume post-op, cardiac output, manage invasive lines, manage airway
    • Patient education: anticoagulation, endocarditis prophylaxis (especially for mechanical valves)
Card Set
Valvular Heart Disease
Med Surg I Valvular Heart Disease