1. Inflammatory and Structural Heart Disorders Valvular Heart Disease
Chapter 37
Inflammatory and Structural Heart Disorders
Valvular Heart Disease

2. Valvular Heart Disease

3. Stenosis Valve orifice is restricted Impending forward blood flow
Creates a pressure gradient across open valve
Degree of stenosis reflected in pressure gradient differences

4. Regurgitation Incomplete closure of valve leaflets
Results in backward flow of blood

5. Mitral Stenosis Most adult cases result from rhematic heart disease
Other causes
Mitral valve becomes scarred and narrowed
Left atrial overload eventually leads to right ventricular failure

6. Mitral Stenosis
Manifestations include fatigue, palpitations, dysrhythmias, low pitched diastolic murmur

7. Mitral Regurgitation Mitral valve fails to close properly
Usually chronic
Blood flows back into left ventricle, elading to LA and LV dilation
Manifestations include symptoms of LV failure, holosystolic murmur

8. Mitral Valve Prolapse
One or more of the mitral valve leaflets prolapses back into the left atrium during systole
Usually congenital
Usually benign, but can be problematic if it progresses to mitral regurgitation
Most people asymptomatic, but manifestations may include CP, dyspnea and palpitations

9. Aortic Stenosis
Narrowing of the aortic valve causes obstruction of blood flow form the LV to the aorta during systole
Common causes include congenital, rheumatic heart disease and senile or degenerative stenosis
Manifestations: classic triad; systolic ejection murmur

10. Aortic Regurgitation Aortic valve fails to close properly
Blood flow back from the aorta into the LV during diastole-->volume overload of LV
Cause may be acute or chronic (rheumatic disease, bicuspid AV, autommune conditions)
Manifestations include signs and symptoms of LV failure (late), waterhammer pulse, high pitched diastolic murmur

11. Tricuspid and Pulmonic disease
Uncommon
Will manifest as RV failure

12. Diagnosis of valvular heart disease
History and physical
CXR
ECG
Echocardiogram
Cardiac catheterization

13. Collaborative Care Prophylactic antibiotic therapy
Rheumatic fever, infective endocarditis
Management of associated heart failure
Vasodilators (except aortic stenosis)
Inotropes (digoxin)
Diuretics
Beta blockers
Anticoagulant therapy as indicated

14. Surgical Treatment Percutaneous transluminal balloon valvuloplasty
For stenotic disease
Valve repair
Eg, valvuloplasty, annuloplasty
Valve replacement (prosthetic valves)
Mechanical valves
Biological valves
Choice of valve depends on variety of factors

15. Surgical Treatment Valve replacement Teaching Prophylaxis
Anticoagulation

17. Nursing Diagnoses and Interventions
Activity intolerance
Excess fluid volume
Decreased cardiac output
Deficient knowledge

18. Chapter 37
Cardiomyopathies

19. Cardiomyopathy
Constitutes a group of diseases that directly affect the structural or functional ability of the myocardium
Three major types

20. Dilated Cardiomyopathy
Characterized by diffuse inflammation and rapid degeneration of the myocardium that results in ventricular and atrial dilation and impaired systolic function
May develop acutely or insidiously
Manifest as heart failure, often biventricular
Causes (table 37-18)

21. Dilated Cardiomyopathy
Interventions focused on improving heart failure
Enhance contractility, decrease afterload
Drugs
Nitrates, diuretics, ACE inhibitors, beta blockers, aldosterone antagonists, anticoagulation
Treat underlying disease process (as able)
Cardiac resychronization therapy
May require VAD or transplant

22. Hypertrophic Cardiomyopathy
Asymmetical left ventricular hypertrophy without ventricular dilation
Primary defect is diastolic dysfunction
May be idiopathic, often genetic
Usually seen in young adults
High risk of SCD
Manifestations include dyspnea, fatigue, angina, syncope

23. Hypertrophic Cardiomyopathy
Collaborative management
Reduce contractility and relieve outflow obstruction
Drugs
Beta blockers, calcium channel blockers
Nitrates, digoxin contraindicated
Avoid diuretics
ICD placement
Surgical treatment
Teaching
Avoid strenous activity
Avoid dehydration
Symptoms - elevate feet

24. Restrictive Cardiomyopathy
Impaired ventricular filling
Manifestations include signs and symptoms of heart failure
Treat to maintain cardiac output and manage symptoms

25. Patient and Family Teaching for Cardiomyopathy
Meds as prescribed
Low sodium diet
Hydration
Avoid ETOH, tobacco and stimulants
Balace activity and rest
Avoid heavy lifting, discuss exercise with health care provider
Stress reduction
Report signs/symptoms of heart failure promptly
May require IE prophylaxis