7. MITRAL STENOSIS
most common valvular
disorder
in rheumatic fever
may also be caused by
bacterial
infection, thrombus formation,
calcification
obstruct blood flow from left
atrium to the left ventricle
8. PATHOPHYSIOLOGY
Narrowing of mitral valve
CO
O2/CO2 exchange
(fatigue, dyspnea,
orthopnea)
Left ventricular
atrophy
pulmonary
congestion
pulmonary
pressure
left atrial
pressure
Hypertrophy left
atrium
blood flow to
left ventricle
Right-sided
failure
Fatigue
9. CLINICAL MANIFESTATIONS
Exertional dyspnea
Fatigue and palpitations
Loud first heart sound
Low pitched diastolic murmur
Hoarseness of voice
Hemoptysis
Chest pain
Seizures or a stroke
10. MITRAL REGURGITATION
incomplete closure of the mitral valve
rheumatic disease is the predominant cause
may also be due to congenital anomaly, infective
endocarditis, rupture of papillary muscle following
MI
14. CAUSE:
due to an inherited connective tissue
disorder
enlargement of one or both valve
leaflets
15. CLINICAL MANIFESTATIONS
Palpitations
May or may not have chest pain
Dyspnea, palpitations and syncope accompany the
chest pain and do not respond to antianginal
treatment
16. AORTIC STENOSIS
may be due to rheumatic heart disease, atherosclerosis,
congenital valvular disease or malformations
narrowing of the aortic valve
flow of blood from the left ventricle to the aorta
blood volume and pressure in the left ventricle
Left ventricle hypertrophy develops as a
compensatory mechanism to continue pumping
blood through the narrowed opening.
19. PATHOPHYSIOLOGY
Stiffening/Narrowing of Aortic
Valve
Incomplete emptying of left
atrium
Left ventricular hypertrophy
Pulmonary congestion
Compression of
coronary arteries
Right-sided heart failure
CO
Myocardial
O2 needs
Myocardial ischemia
(chest pain)
O2 supply
20. CLINICAL MANIFESTATIONS
fatigue & exertional dyspnea – 1st symptoms – due to CO
and pulmonary congestion
chest pain (angina) – most common symptom
- occurs during exercise – due to inability of the heart to
increase coronary blood flow to cardiac
muscle
exertional syncope, vertigo, periods of confusion -- CO
weakness, orthopnea, PND, pulmonary edema (severe cases)
signs of right-sided heart failure –- end-stage symptoms
- if untreated, survival rate: 1.5-3 years
Auscultation: harsh, rough, mid-systolic murmur
21. AORTIC REGURGITATION
may be due to
rheumatic fever –
most common
cause
other causes:
connective tissue
disease (Marfan’s
syndrome), severe
hypertension,
congenital
anomaly
22. PATHOPHYSIOLOGY
Incomplete closure of the
aortic valve
Backflow of blood to Left
ventricle
Left ventricular hypertrophy
& dilation
Left atrial pressure
Left-sided heart failure
(late stage)
Left atrium hypertrophy
CO
Pulmonary pressure
Right-sided heart failure
Right ventricular
pressure
23. CLINICAL MANIFESTATIONS
pt. may remain asymptomatic for years --- heart
compensates by hypertrophy & dilation
1st s/sx- heightened awareness of the heart beat &
palpitations esp. when pt. lies on left lateral position
tachycardia, PVC assoc. w/ left ventricular dilation
bounding pulse, marked carotid artery pulsation, apical
pulse force and volume of contraction of the
hypertrophied left ventricle
Decompensation occurs (cardiac muscle fatigue)
exertional dyspnea
chest pain – myocardial ischemia
left-heart failure – fatigue, orthopnea, PND
right-heart failure – peripheral edema
Auscultation: soft, blowing diastolic murmur
24. TRICUSPID STENOSIS
usually occurs together w/ aortic or mitral stenosis
may be due to rheumatic heart disease
blood flow from right atrium to right ventricle
right ventricular output
left ventricular filling CO
blood accumulates in systemic circulation
systemic pressure
S/Sx: symptoms of right-sided heart failure
- hepatomegaly
- peripheral edema
- neck vein engorgement
- CO – fatigue, hypotension
25. TRICUSPID REGURGITATION
uncommon, may be caused by RF, bacterial
endocarditis
may also be caused by enlargement of right ventricle
an insufficient tricuspid valve allows blood to flow
back
into the right atrium venous congestion & right
ventricular output blood flow towards the lungs
26. CLINICAL MANIFESTATIONS
may not produce any symptoms
moderate-to-severe tricuspid regurgitation exist, the ff.
may result:
Active pulsing in the neck veins
Swelling of the abdomen
Swelling of the feet and ankles
Fatigue, tiredness
Weakness
Decreased urine output
on palpation, there may be a lift (beating of enlarged right
ventricle)
murmur on auscultation
27. PULMONIC VALVE STENOSIS
rare, usually congenital in origin
flow of blood to the pulmonary artery due to narrowing
blood flows back to right ventricle and right atrium
right ventricle hypertrophy to compensate for
blood volume and force blood to the pulmonary
artery
S/Sx:
harsh systolic murmur
fatigue, dyspnea on exertion, cyanosis
poor weight gain or failure to thrive in infants
hepatomegaly, ascites, edema
28. DIAGNOSTIC STUDIES
History and physical examination
Echocardiogram
Cardiac catheterization
Electrocardiogram
Chest X ray
29.
30. Prophylactic antibiotic therapy( rheumatic fever,
infective endocarditis)
if the patient is having the signs of heart failure it
should be treated first vasodialators, beta blockers
and diuretics.
Low sodium diet should be prescribed to the patient
Anticoagulant therapy is used to treat pulmonary
embolization.
31. Percutaneous trans luminal balloon valvoloplasty:
- splits open the fused commissures
- 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
32. SURGICAL MANAGEMENT
1. Valvuloplasty
is repair of cardiac valve
• pt. does not require continuous anti-coagulant
medication
• usually require cardiopulmonary bypass
machine.
2. Annuloplasty
is repair of valve annulus (junction of
the valve leaflet and the muscular heart wall)
- narrows the diameter of the valve’s orifice,
useful for valvular regurgitation
33. 3. Chordoplasty
is repair of chordae tendineae
- done for mitral valve regurgitation – caused by
stretched or shortened chordae tendineae
4.valvulotomy( commissurotomy)
it is an old surgical method for pure
mitral stenosis
37. DIFFERENCE BETWEEN MECHANICAL AND
BIOLOGIC VALVE
Mechanical valve Biologic valve
Manufactured from man made materials
and consists of combinations of metal
alloys, pyrolite carbon and dacron
Constructed from porine and human
cardiac tissue and usually contain some
man made materials
More durable Less durable
Increased risk of thromboembolism Low thrombogenicity
Need long term anticoagulation therapy No need of anticoagulation therapy
38. TYPES OF MECHANICAL VALVES
Caged ball valve
Tilting disk valve
Bi- laeflet valve
40. NURSING MANAGEMENT
1. Assess the high risk patients
2. Monitor ECG of the patient
3. Assess the family history of heart disease
4. Assess the history of smoking and alcoholism
5. Monitor lab values frequently especially serum
cholesterol levels.
6. Assess for CAD
7. Monitor vital signs
8. Instruct to avoid high fat and oil rich diet
41. NURSING DIAGNOSIS
Activity intolerance related to insufficient
oxygenation as evidenced by weakness, fatigue,
shortness of breath, BP changes
Excess fluid volume related to heart failure as
evidenced by peripheral edema, weight gain,
adventitious breath sounds, neck vein distention
42. NURSING DIAGNOSIS
Decreased cardiac output related to valvular
incompetence as evidenced by murmurs, dyspnea,
peripheral edema
Deficient knowledge related to lack of experience
and exposure to information about disease and
treatment process as evidenced by verbalization of
misconception about measures to prevent
complications
