VALVULAR HEART

DISEASES

Mr.Mihir M Patel,
Nursing Tutor,
Valvular Heart Diseases
Valvular heart diseases is defined according to the

valve involved /affected and the type of the

functional alteration (Stenosis /Regurgitation).
Stenosis
The pressure on either side of an open valve is normally

equal. In a stenotic valve, the valve orifice is smaller

impending the foreword flow of blood creating a pressure

gradient difference across an open valve. The degree of

stenosis is seen in the pressure gradient difference.

Regurgitation
Incomplete closure of the valve leaflets results in the

backward flow of blood

 Mitral Valve Stenosis
Etiology:
Rheumatic Heart Disease

Rheumatoid arthritis

Systemic Lupus Erythmatous

Congenital Condition (tricuspid atresia, pulmonary stenosis

and aortic stenosis.
 Pathophysiology
Due to etiological Factors
Scarring of valve leaflets and chordae tendane
Contractures and adhesion develop
Stenotic mitral valve
Obstruction of blood flow
Pressure difference between left atrium, left ventricle during
diastole
Left atrial pressure and volume increase
Increased pulmonary vascular pressure
Hypertrophies of pulmonary vessel
Clinical Manifestation
Dyspnea

Hemoptysis (due to pulmonary hypertension)

Fatigue and palpitation

Heart Sound : loud first heart sound and low pitched

diastolic murmur

Hoarseness from atrial enlargement.

Chest Pain

Seizure and stroke

Management
Heart disease: Oral diuretics and sodium restricted diet

Atrial Fibrillation(irregular heart beat )- Digitalis

Anti coagulant to reduce the risk of embolus

 Mitral Valve Regurgitation
Mitral valve function depends in intact mitral leaflets,
Charade tendanae, papillary muscles, left atrium and left
ventricle any defect in any of these structure can result in
regurgitation.
Causes/Etiology
Structural defects of the valve, charade tendinae,papillary
muscle.

Myocardial Infraction

Chronic rheumatic Heart Disease

Mitral Valve Prolapsed

Ischemic papillary muscle dysfunction.

Clinical Manifestation
Weak pulse, cool and clammy extremities,systemicMurmur,
Weakness, fatigue, palpitation, dyspnea, orthopnea,
peripheral edema, S3 heart sound
Management
Restrict Physical activity

Sodium restricted diet

Diuretics

Nitrates, digitalis- hemodynamic improvement and

symptomatic relief
 Mitral Valve Prolapse
Mitral valve prolapse is an abnormality of the mitral valve
leaflets and the papillary muscles or chorade that allows
the leaflets to prolapse back into the left atrium during
systole.
Causes/Etiology
Idiopathic
Related to diverse, pathogenic mechanisms of
mitral valve.
Marfani syndrome(It is a genetic disorder of the connective
tissue. People with Marfan tend to be unusually tall, with long limbs
and long, thin fingers)
Clinical Manifestation
Many are asymptomatic

Murmur

Midsystole clicks

Late murmur

PVC(pre-ventricular ventricular contraction)

Palpitation, dizziness, Dyspnea and syncope.

Management
B-adrenergic blockers-relief syncope, palpitation, chest
pain.

Aspirin-To prevent ischemic attack

Prophylactic antibiotics-to prevent endocarditis.

 Aortic Stenosis
Causes:
Idiopathic

Genetical factors

Congenital

calcification of fiber.
Pathophysiology
Rheumatic valvular disease
Fusion of commisures and secondary calcification
Valve leaflets stiffen and retract
Stenosis of aortic valve
Obstruction of flow of blood from Lt. ventricle to Aorta
Lt. ventricular hypertrophy
Increased oxygen consumption
Decreased cardiac output
Pulmonary Hypertension
Heart Failure
Clinical Manifestation
Syncope
Dyspnea
Diminished/absent S2
Crackle/abnormal S4
Management
Prophylactic antibiotics to prevent infective endocarditis

Digitalis and Diuretics

To treat ventricular failure but should be used with caution

 Aortic Valve Regurgitation
Aortic valve regurgitation may be the result of primary
disease of the aortic valve leaflet, the aortic root or both.

Etiology:
Trauma or aortic dissection

RHD

Congenital

Reiters syndrome

(A non specific Urethritis )

Pathophysiology
Due to etiological factor

Aortic regurgitation

Ascending aorta(Blood will go in lt. ventricle)

Volume Overload

Dilatation and hypertrophy

Decreased Myocardial contractility

Increased blood volume in left atrium and pulmonary bed

Pulmonary hypertension and left ventricle failure

Clinical Manifestatation
Dyspnea, Chest pain, Hypotension

Left ventricular failure

Severe AR develops water hammer pulse

Abnormal heart sound

Pulmonary Valve Disease
Etiology:
Congenital
Pulmonary Hypertension
Chronic Lung Disease
Pathophysiology:
Due to etiological factors

Decreased blood to the left side of the heart

Decreased cardiac output

Right ventricular hypertension and hypertrophy

Clinical Manifestation
Dyspnea and fatigue
Murmur
Common Investigation
History collection
Infection, RHD, MI, SLE, Family History
Physical Examination
Heart Sound, murmur, tachycardia, hemoptysis, seizures,
peripheral edema.
Chest X-ray
Heart size and calcification of valve
ECG
HR, rhythm, ischemic change and chamber enlargement
Echocardiogram
Valve structure, function and chamber size.
Cont
Transesophageal Echocardiography
Progression of valvular heart disease
3D Echocardiography
Assessment of mitral valve and congenital disease
Cardiac catheterization
To detect pressure changes in chamber
Surgical Management
Percutaneous Transluminal Balloon Valvuloplasty
It involve threading a balloon tipped catheter from the
femoral artery or vein to the stenotic valve so that the
balloon may be inflated in an attempt to separate the valve
leaflets.

Valvuloplasty
Involves repair of the valve by suturing the leaflets, chorade
tendinae or papillary muscles.
Cont
Annuloplasty
Reconstruction of the annulus, with or without the aid of
prosthetic rings. It helps in repair or reconstruction of the
valve.

Prosthetic Valve (valvular Replacement)

It may be required for aortic ,tricuspid and occasionally
pulmonic valvular disease.
Nursing Management
1. Decreased cardiac output related to valvular incompetence

2. Excess fluid volume related to heart failure secondary to

incompetence valve

3. Activity intolerance related to insufficient oxygenation secondary ti

decreased cardiac output

4. Deficient knowledge related to lack of exposure to information

about disease.