Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street with a gorgeous young woman on his arm. A couple of days later, the doctor spoke to Morris and said, 'You're really doing great, aren't you?' Morris replied, 'Just doing what you said, Doc: 'Get a hot mamma and be cheerful.'' The doctor said, 'I didn't say that.. I said, 'You've got a heart murmur; be careful.'
Valvular Heart Disease • Heart contains • Two atrioventricular valves • Mitral • Tricuspid • Two semilunar valves • Aortic • Pulmonic • **review areas to listen**
Valvular Heart Disease • Types of valvular heart disease depend on • Valve or valves affected • Two types of functional alterations • Stenosis • Regurgitation • Valvular disorders occur in children and adolescents primarily from congenital conditions and in adults from degenerative heart disease Stenosis and Insufficiency
Valvular Heart Disease Flashcards about Ch 19 NETI KQ- on your own
Risk Factors • Rheumatic Heart Disease MI • Congenital Heart Defects • Aging • CHF
Pathophysiology • Stenosis- narrowed valve, increases afterload • Regurgitation or insufficiency- increases preload. The heart has to pump same blood • **Blood volume and pressures are reduced in front of the affected valve and increased behind the affected valve. • This results in heart failure • All valvular diseases have a characteristic murmur murmurs
Mitral Stenosis • Dec. flow into LV • LA hypertrophy • Pulmonary pressures increase • Pulmonary hypertension • Dec. CO • * early symptom is DOE • Later get symptoms of R heart failure • A fib is common- anticoagulants • Usually secondary to rheumatic fever
Mitral Regurgitation Mitral insufficiency
Mitral Regurgitation (Insufficiency) • Regurg of blood into LA during systole • LA dilation and hypertrophy • Pulmonary congestion • RV failure • LV dilation and hypertrophy-to accommodate inc. preload and dec CO
Mitral Valve Prolapse • A type of mitral insufficiency • Usually asymptomatic- click murmur • May get atypical chest pain related to fatigue • Tachydysrhythmias may develop • Risk for endocarditis may be increased
Mitral Valve Prolapse • Usually benign, but serious complications can occur • Mitral valve regurgitation • Infective endocarditis • Sudden death • Cerebral ischemia
Mitral Valve Prolapse • Dysrhythmias • Paroxysmal supraventricular tachycardia • Ventricular tachycardia • Palpitations • Lightheadedness • Dizziness
Mitral Valve Prolapse • May or may not be present with chest pain • If pain occurs, episodes tend to occur in clusters, especially during stress • Pain may be accompanied by dyspnea, palpitations, and syncope • Does not respond to antianginal treatment
Aortic Stenosis • Increase in afterload • Reduced CO • LV hypertrophy • Incomplete emptying of LA • Pulmonary congestion • RV strain
Symptoms • Syncope • Angina • Dyspnea • This triad reflects left ventricular failure
Aortic Stenosis • May be asymptomatic for many years due to compensation • DOE, angina, and exertional syncope are classic symptoms • Later get signs of R heart failure • Untreated-poor prognosis- 10-20%sudden cardiac death
Aortic Valve Stenosis • Poor prognosis when experiencing symptoms and valve obstruction is not relieved • Nitroglycerin is contraindicated because it reduces preload
Aortic Regurgitation • Get increased preoad- 60% of SV can be regurgitated • Characteristic water hammer pulse • Regurgitation of blood into the LV • LV dilation and hypertrophy • Dec. CO Echocardiography
Aortic Valve Regurgitation • Clinical manifestations • Sudden manifestations of cardiovascular collapse • Left ventricle exposed to aortic pressure during diastole • Weakness
Aortic Valve Regurgitation • Severe dyspnea • Chest pain • Hypotension • Constitutes a medical emergency
Water Hammer pulse Pulse, water hammer: A jerky pulse that is full and then collapses because of aortic insufficiency (when blood ejected into the aorta regurgitates back through the aortic valve into the left ventricle ). Also called a Corrigan pulse or a cannonball, collapsing, pistol-shot, or trip-hammer pulse. YouTube - Corrigan's sign Austin Flint
Tricuspid and Pulmonic Valve Disorders Result in R side heart failure
Diagnostic Tests • Echo- assess valve motion and chamber size • CXR • EKG • Cardiac cath- get pressures
Medications • Like Heart Failure • ACE inhibitors • Digoxin • Diuretics • Vasodilators • Beta blockers • Anticoagulants • *Prophylactic antibiotics • Antiarrhythmics
Medical/ Surgical Treatment • Percutaneous balloon valvuloplasty • Surgical therapy for valve repair or replacement: • **Valve repair is typically the surgical procedure of choice • Open commissurotomy- open stenotic valves • Annuloplasty- can be used for both • Valve replacement may be required for certain patients Heart valve surgery • Mechanical-need anticoagulant • Biologic-only last about 15 years • Ross Procedure • MedlinePlus: Interactive Health Tutorials- on own
This is an excised porcine bioprosthesis. The main advantage of a bioprosthesis is the lack of need for continuedanticoagulation. The drawback of this type of prosthetic heart valve is the limited lifespan, on average from 5 to 10 years (but sometimes shorter) because of wear and calcification.
This is a mechanical valve prosthesis of the more modern tilting disk variety (for the mitral valve). Such mechanical prostheses will last indefinitely from a structural standpoint, but the patient requires continuing anticoagulation because of the exposed non-biologic surfaces.
Nursing Diagnoses Activity intolerance Excess fluid volume Decreased cardiac output Ineffective therapeutic regimen management
What is new? Percutaneous Transcatheter Heart Valve Implantation- Metallic clip -for the treatment of mitral regurgitation Longer-lasting replacement valves Stem cell research and the use of endothelial cells
Cardiomyopathy • Condition is which a ventricle has become enlarged, thickened or stiffened. • As a result heart’s ability as a pump is reduced
Cardiomyopathy-Causes • Primary-idiopathic • Secondary • Ischemia- from CAD • infectious disease • exposure to toxins -alcohol, cocaine • Metabolic disorders • Nutritional deficiencies • Pregnancy
3 Types of Cardiomyopathy • Dilated • Hypertrophic • Restrictive
PathophysiologyDilated • Most common- heart failure in 25-40% • Cocaine and alcohol abuse • Chemotherapy, pregnancy • Hypertension • Genetic • * Heart chamber dilate and contraction is impaired and get dec. EF% • *Dysrhythmias are common- SVT Afib and VT • Prognosis poor-need transplant
This very large heart has a circular shape because all of the chambers are dilated. It felt very flabby, and the myocardium was poorly contractile. This is an example of a cardiomyopathy.
PathophysiologyHypertrophic-HCM • **Genetic • Also known as IHSS or HOCM • Get hypertrophy of the ventricular mass and impairs ventricular filling and CO • Symptoms develop during or after physical activity • Sudden cardiac death may be first symptom • Symptoms are dyspnea, angina and syncope
HOCM Patho 1. Massive ventricular hypertrophy 2. Rapid, forceful contraction of the LV 3. Impaired relaxation or diastole 4. Obstruction to aortic outflow Primary defect is diastolic filling **HCM most common cause of SCD in young adulthood
There is marked left ventricular hypertrophy, with asymmetric bulging of a very large interventricular septum into the left ventricular chamber. This is hypertrophic cardiomyopathy. About half of these cases are genetic. Both children and adults can be affected, and sudden death can occur.
HCM- Symptoms (SAD) • Dyspnea • Fatigue- dec. CO • Angina, Syncope • S4 and systolic murmur