VALVULAR HEART DISEASE

VALVULAR HEART DISEASE

When any of the heart valves do not close or open

properly, blood flow is affected

When valves do not close properly, blood flows

backward through the valve in a process called

REGURGITATION
When the valves do not open completely, a

condition called STENOSIS, the flow of blood

through the valve is reduced

Valvular Stenosis
the valve opening narrows
the valve leaflets may become fused or thickened that the
valve cannot open freely obstructs the normal flow of blood
EFFECTS: the chamber behind the stenotic valve is subject to

greater stress must generate more pressure or work

hard to force blood through the narrowed opening
initially, the heart compensates for the additional workload by

gradual hypertrophy and dilation of the myocardium heart

failure

Valvular Insufficiency or
Regurgitation
scarring and retraction of valve leaflets or weakening of
supporting structures incomplete closure of the valve
result to leakage or backflow of blood from the previous
chamber
EFFECTS: causes the heart to pump the same blood twice (as
the
blood comes back into the chamber)
the heart dilates to accommodate more blood (the
usual blood it needs to pump + regurgitated blood)
ventricular dilation and hypertrophy eventually leads to
heart failure

MITRAL VALVE STENOSIS

Heart Valves

Heart Valves
AV Valves

- Mitral Valve: between LA and

LV
- Tricuspid Valve: between RA
and RV
- OPEN during DIASTOLE
- CLOSE during SYSTOLE

Heart Valves
Semilunar Valve

- Aortic Valve: between LV and aorta

- Pulmonic Valve: between RV and
pulmonary artery
- OPEN during SYSTOLE
- CLOSE during DIASTOLE

MITRAL VALVE STENOSIS

MITRAL STENOSIS
is an obstruction of blood

flowing from the left atrium

into the left ventricle
Most

often caused by
rheumatic
endocarditis,
which
progressively
thickens the mitral valves
and chordae tendineae

MITRAL STENOSIS
Leaflets often fuse

together
Eventually, the mitral
valve orifice narrows
and progressively
obstructs blood flow
into the ventricle

Causes of Mitral Stenosis

Rheumatic Heart Disease inflammatory

disease caused by Streptococcus pyogenes,

resulting in inflammation of valves and fibrinous
repair. Overall effect is thickening of the mitral
valve
Calcification An increase in calcium deposits

around the valve. This can occur due to aging.

Congenital A person can be born with narrowed

mitral valve

Symptoms
Dyspnea feeling of impaired breathing
Orthopnea feeling breathless when lying down
Paroxysmal nocturnal dyspnea severe shortness of
breath and coughing at night
Palpitations irregular heart rate
Chest pains
Hemoptysis coughing up blood
Ascites accumulation of fluid in peritoneal cavity

PATHOPHYSIOLOGY
Left atrium has great difficulty moving blood into

the ventricle because of the increased resistance

of the narrowed oriface
Left atrium dilates (stretches) and hypertropies

(thickens) because of the increased blood volume

it holds

PATHOPHYSIOLOGY (cont.)
Because there is no valve to protect the pulmonary

veins from backward flow of the blood from the

atrium, the pulmonary circulation becomes
congested
Right ventricle must contract against an

abnormally high pulmonary atrial pressure and is

subjected to excessive strain

PATHOPHYSIOLOGY (cont.)
Eventually, the right ventricle fails. The enlarged

left atrium may create pressure on the left

bronchial tree, resulting in a dry cough or
wheezing

ASSESSMENT
Breathing difficulty (as

a result of pulmonary
venous hypertension
Progressive fatigue (as
a result of low cardiac
output)
May expectorate blood
(hemopytysis)

ASSESSMENT
Cough, wheeze, palpitations,

orthopnea, paroxysmal nocturnal

dyspnea (PND), repeated respiratory
infections
Pulse is weal and often irregular
(because of atrial fibrilation)
Low-pitched, rumbling, diastolic
murmur (heard at the apex of heart)

Assessment
History: MI, Rheumatic infection
Physical Assessment:
Heart failure symptoms
- Dyspnea on exertion
- Fatigue and weakness
- Hemoptysis
Auscultation of murmur
- Location: apex
- Characteristic: diastolic murmur
- Irregular heart beats

DIAGNOSTIC AND
LABORATORY PROCEDURES
Doppler echocardiography used to diagnose

mitral stenosis
Electrocardiography (ECG) and Cardiac
catheterization with angiography may be
used to help determine the severity of mitral
stenosis

Echocardiography
Mitral valve normal size is 4-5cm squared
Symptoms appear when the size is >2cm squared

Hemodynamic Profile
High CVP (reflects the amount of blood returning

to the heart and the ability of the heart to pump

the blood into the arterial system)
High PAOP (pulmonary artery pressure)
Low cardiac otput

Electrocardiogram
Atrial fibrillation

MEDICAL-SURICAL AND NURSING

MANAGEMENT
PROBLEMS
Prevention
Dyspnea and orthopnea
Pulmonary congestion
Atrial fibrillation
Impaired contractility
Ineffective valve

MANAGEMENT
Prevention of rheumatic fever
reoccurrence
Oxygen
Diuretics, Low sodium diet,
nitrates
CCB, Coumadin
Digoxin
Surgery (repair/replacement)
depends on severity

Angina = MONA

MEDICAL-SURICAL AND NURSING

MANAGEMENT
May benefit from anticoagulants (decrease

the risk for developing atrial thrombus and

may also require treatment for anemia)
Antibiotic prophylaxis is instituted to
prevent infectious endocarditis

MEDICAL-SURICAL AND NURSING

MANAGEMENT

Advised to avoid strenuous activities and

comprehensive sports, both of which

increase the heart rate
Surgical intervention consists of

valvuloplasty, usually a commissurotomy

to open or rupture the fixed commissures
of the mitral valve

MEDICAL-SURICAL AND NURSING

MANAGEMENT
Valvuloplasty
Mitral valve replacement

Valvuloplasty
Repair of cardiac valve
The type of valvuloplasty depends on the cause

and the type of valve dysfunction

Types:
Commissurotomy
Annuloplasty
Chordoplasty

1. COMMISSUROTOMY to separate the fused

leaflets
Balloon Valvuloplasty
performed in the cardiac cath. lab.
- balloon inflated for 10-30 secs., w/ multiple inflations
- common used for mitral and aortic stenosis

the

Closed surgical valvuloplasty

done in the OR under GA
- midsternal incision, a small hole is cut into the heart,
the surgeons finger or a dilator is used to open
commissure
Open Commissurotomy
done w/ direct visualization of the valve, thrombus
and calcifications may be identified and removed

2.

ANNULOPLASTY

- is repair of valve annulus (junction of the valve

leaflets
and the muscular heart wall)
- narrows the diameter of the valves orifice, useful for
valvular regurgitation
3.

CHORDOPLASTY

- is repair of chordae tendineae

- done for mitral valve regurgitation caused by
stretched,
torn or shortened chordae tendineae

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