Valvular Heart Disease

Normal heart valves function to maintain the direction of blood flow through the atria and ventricles to the rest of the body Heart valves operate by passively opening and closing in response to pressure changes in the heart Valvular disease occurs when the valves are compromised and don’t open and close properly

Valvular Disease Two valvular problems: – Stenosis: thickening of the valve tissue  narrowing – Insufficiency: valve unable to close completely Valvular heart disorders include: – Mitral stenosis, Mitral insufficiency – Aortic stenosis, Aortic insufficiency – Tricuspid stenosis, Tricuspid insufficiency – Pulmonary stenosis, pulmonary insufficiency

Mitral Stenosis Obstructs blood flow from LA to LV Leads to: – Pulmonary HTN – RV hypertrophy – Right sided heart failure – Low cardiac output from inadequate filling of LV May be caused by congenital abnormality or Rheumatic Fever

Mitral Regurgitation (Mitral Insufficiency) Abnormality of leaflets, annulus, chordae tendinae, papillary muscles, or LV (hypertrophic CM) Blood from LV flows back into the LA during systole – LA dilation and LV hypertrophy – Left sided heart failure

Mitral Regurgitation (Mitral Insufficiency) May be caused by: – Rheumatic fever – Mitral Valve prolapse – MI with ruptured chordae tendinae – LV failure – Marfan Syndrome

Mitral Valve Prolapse Congenital Cusps of Mitral Valve are enlarged, thickened and Cusps of valve  prolapse into LA during systole causing a “click” sound Benign unless MV regurgitation develops

Aortic Stenosis Narrowed valve opening obstructs blood flow from LV to Aorta LV pressure increases to overcome resistance – Increases workload – Left sided heart failure – Poor coronary artery perfusion

Aortic Stenosis May be caused by: – Congenital (Bicuspid AV) – Rheumatic Fever – Atherosclerosis

Aortic Regurgitation (Aortic Insufficiency) Blood flows back into the LV during diastole – Fluid overload in the LV – LV dilation and hypertrophy Will eventually lead to Left sided heart failure

Aortic Regurgitation (Aortic Insufficiency) May be caused by: – Rheumatic Fever – Syphilis – HTN – Endocarditis – Marfan Syndrome

Pulmonic Stenosis Obstructs RV outflow causing RV hypertrophy and Right sided heart failure May be a congenital abnormality or rarely caused by Rheumatic fever

Diagnostic Tests Cardiac Catheterization EKG Echocardiogram – Transthoracic and Transesophogeal

Medical Treatment of Valvular Disorder Treat heart failure – Sodium restriction, diuretics, digoxin Reduce risk factors Repair or replace valve

Surgical Treatment of Valvular Disorders Open Heart Surgery – Valve Replacement- mechanical or tissue – Commissurotomy- repair (splitting of the fused mitral valve leaflet for treating stenosis Valvuloplasty – surgical reconstruction of deformed cardiac valve – Percutaneous – Balloon reshapes and opens valve

Nursing Interventions Goals: – Assist with ADLs – Symptomatic relief – Promote Comfort – VS, I&O, Auscultation lungs/heart; capillary perfusion checks, diet compliance, O2 tx