Valvular Heart Disease

Valvular Heart Disease

• Normal heart valves function to maintain the direction of blood flow through the atria and ventricles to the rest of the body

• Heart valves operate by passively opening and closing in response to pressure changes in the heart

• Valvular disease occurs when the valves are compromised and don’t open and close properly

Valvular Disease

• Two valvular problems:– Stenosis: thickening of the valve tissue narrowing– Insufficiency: valve unable to close completely

• Valvular heart disorders include:– Mitral stenosis, Mitral insufficiency– Aortic stenosis, Aortic insufficiency– Tricuspid stenosis, Tricuspid insufficiency– Pulmonary stenosis, pulmonary insufficiency

Mitral Stenosis

• Obstructs blood flow from LA to LV

• Leads to:– Pulmonary HTN – RV hypertrophy – Right sided heart failure– Low cardiac output from inadequate filling of LV

• May be caused by congenital abnormality or Rheumatic Fever

Mitral Regurgitation(Mitral Insufficiency)

• Abnormality of leaflets, annulus, chordae tendinae, papillary muscles, or LV (hypertrophic CM)

• Blood from LV flows back into the LA during systole– LA dilation and LV hypertrophy– Left sided heart failure

Mitral Regurgitation(Mitral Insufficiency)

• May be caused by:– Rheumatic fever– Mitral Valve prolapse– MI with ruptured chordae tendinae– LV failure – Marfan Syndrome

Mitral Valve Prolapse

• Congenital• Cusps of Mitral Valve are enlarged, thickened

and • Cusps of valve prolapse into LA during

systole causing a “click” sound• Benign unless MV regurgitation develops

Aortic Stenosis• Narrowed valve opening obstructs blood flow from

LV to Aorta

• LV pressure increases to overcome resistance – Increases workload– Left sided heart failure– Poor coronary artery perfusion

Aortic Stenosis

• May be caused by:– Congenital (Bicuspid AV)– Rheumatic Fever– Atherosclerosis

Aortic Regurgitation(Aortic Insufficiency)

• Blood flows back into the LV during diastole– Fluid overload in the LV– LV dilation and hypertrophy

• Will eventually lead to Left sided heart failure

Aortic Regurgitation(Aortic Insufficiency)

• May be caused by:– Rheumatic Fever – Syphilis – HTN – Endocarditis – Marfan Syndrome

Pulmonic Stenosis

• Obstructs RV outflow causing RV hypertrophy and Right sided heart failure

• May be a congenital abnormality or rarely caused by Rheumatic fever

Diagnostic Tests

• Cardiac Catheterization• EKG• Echocardiogram – Transthoracic and Transesophogeal

Medical Treatment of Valvular Disorder

• Treat heart failure– Sodium restriction, diuretics, digoxin

• Reduce risk factors• Repair or replace valve

Surgical Treatment of Valvular Disorders

• Open Heart Surgery– Valve Replacement- mechanical or tissue– Commissurotomy- repair (splitting of the fused

mitral valve leaflet for treating stenosis• Valvuloplasty – surgical reconstruction of

deformed cardiac valve– Percutaneous– Balloon reshapes and opens valve

Nursing Interventions

• Goals:– Assist with ADLs– Symptomatic relief– Promote Comfort– VS, I&O, Auscultation lungs/heart; capillary

perfusion checks, diet compliance, O2 tx