valvular disease 2023

1. CONGENITAL AND
ACQUIRED
VALVULAR DISEASES

2. OUTLINES
• Introduction.
• Definition.
• Incidence.
• Congenital Valvular Diseases.
• Acquired Valvular Diseases.
• Combined Congenital & Acquired Valvular
Diseases.
• Nursing Responsibilities.

3. INTRODUCTION
The movement of blood through the heart is
crucial for human life. But in addition to
perfusion , blood must flow through the heart
in an efficient and orderly manner.
So here we will focus on the cardiac disorders
that affect the structure of heart and impair
the efficiency of the heart as a pump.

5. DEFINITION
Valvular heart disease can be defined as the
damage to or a defect in one of the four heart
valves : tricuspid, bicuspid (mitral), pulmonary,
and aortic.

6. Some important terms :-
Regurgitation- The valve’s tissues flaps
(leaflets ) do not fully close or the edges do
not fully meet, which causes blood to leak
back into the heart.
Stenosis- The leaflets can not have an opening
for blood to flow through.
Atresia- The heart valves do not have an
opening for blood to flow through.

7. INCIDENCE
Valvular heart diseases remain fairly common
in United States even through the incidence is
steadily decreasing as the incidence of
rheumatic fever decreases
Mitral valve prolapse syndrome is one of the
most common cardiac abnormalities; as much
as 5% of the population is affected , and
females are affected more often than males.

8. CONGENITAL VALVULAR DISEASES
These occur when a valve does not form correctly
in the developing fetus, although it can be
diagnosed at any age.
Mostly affected valves are pulmonary and aortic.
It is of four types:
1 Pulmonary atresia
2 Pulmonary stenosis
3 Tricuspid atresia
4 Bicuspid aortic valve disease

9. 1) PULMONARY ATRESIA
Pulmonary atresia is a congenital birth defect,
in which pulmonary valve does not form
properly.
In this, a solid sheet of tissues form at place of
valve opening , so valve stays closed. So due to
this blood can not go to lungs from right
ventricle to pick up oxygen.

12.  Its Causes:-
• Idiopathic.
• It can be linked with another type of
congenital heart defect (Patent Ductus
Arteriosus).
• It can occur with or without
‘Ventricular septal defect’

13. Symptoms:-
• Usually occur in the first few hours of life ,
although it may take up to few days .
• Bluish colourd skin (cyanosis).
• Fast breathing.
• Fatigue.
• Poor feeding habits.
• Shortness of breath.

14. Investigations:-
• Chest X ray.
• Echocardiogram.
• Electrocardiogram.
• Heart catheterization.
• Pulse oximetry.

15.  Treatment:
• Prostaglandin E1
this medicine keeps blood vessel (PDA) open b/w
pulmonary artery and aorta.
• Heart Catheterization.
• Open heart surgery:
- to repair or replace valve
- to place a tube b/w right ventricle and
pulmonary artery.
• Reconstriction of heart as a single ventricle
(for temporary period).
• Heart transplant.

16.  Complications:-
• Delayed growth and development.
• Seizures.
• Stroke.
• Infectious endocarditis.
• Heart Failure.
• Death.

17. 2) PULMONARY STENOSIS
Pulmonary stenosis or narrowing occurs when
the valve can not open wide enough leading
to obstructed blood flow from right ventricle
to pulmonary artery.

19.  Its Causes:-
• Idiopathic.
• Congenital.
• Due to problems during Intra uterine life.
• Defect occur alone or with other heart
defects.

20.  Symptoms:-
• Most cases are mild with no symptoms.
• Presence of heart murmur sound in infants during routine
examination.
• When the valve stenosis is moderate to severe , the
symptoms are:
- Abdominal distension.
- Cyanosis in some clients.
- Poor appetite.
- Chest pain.
- Fainting.
- Poor weight gain or Failure to thrive in infants
with a severe blockage.
- Sudden Death.

21.  Investigations:-
• Physical Examination ( presenting heart
murmur sound) .
• Other tests are:
- Cardiac catheterization,
- Chest X-ray,
- ECG,
- Echocardiogram,
- MRI of Heart.

22.  Treatment:-
• No need of treatment for mild cases.
• In Case of other associated heart defects, the
drugs may be used :
- prostaglandin.
- blood thinners.
- diuretics.
- antiarrythmic drugs.
• Vulvoplasty (percutaneous balloon pulmonary
dilation) may be performed in absence of other
heart disease.
• Valve repair or replacement.

23.  Complications :-
• Abnormal heart beats (arrythmias).
• Heart failure & right sided heart enlargement.
• After repair the chances of pulmonary
regurgitation.
• Death.

24. 3) TRICUSPID ATRESIA
In this condition the tricuspid valve is missing
or abnormally developed .
This defect blocks the blood flow from right
atrium to right ventricle.

26.  Its causes:-
• Idiopathic.
• Heredity.
• Risk factors are down’s syndrome.

27.  Symptoms:-
• Cyanosis.
• Tacypnea.
• Fatigue.
• Poor growth.
• Shortness of breath.

28.  Investigations:-
• By routine pre natal Ultrasound imaging or by
post natal examination (signs of cyanosis).
• Physical examination often showing the
presence of heart murmur sound at birth and
may increase in loudness over several
months..
• Tests are: ECG, Echocardiogram, Chest X-ray ,
Cardiac catheterization and MRI of heart.

29.  Treatment:-
• Prostaglandin E1 is administered to keep ductus
arteriosus open (so that blood can circulate to
lungs).
• This condition always require surgery
i. an artificial shunt is inserted to keep blood
flowing to lungs (in some cases it is not
needed).
ii. Glenn-shunt or hemi-fontan procedure (in this
half of veins carrying blue blood from upper half
of body directly to pulmonary artery),( at age of
4-6 months).

30. CONTINUED……
( during first & second stage child may still look
cyanotic )
iii. this is final step also called Fontan procedure (
in this the rest of veins carrying blue blood from
body are connected directly to pulmonary
artery leading to lungs. The left ventricle is now
only has to pump to body, not to lungs),(at the
age of 18 months to 3 years).
(after thisfinal step the baby is no longer
cyanotic)

31.  Complications:-
• Arrythmias.
• Heart failure.
• Ascites (fluid in abdomen) ,and
Pleural effusion (fluid in lungs).
• Blockage of artificial shunt.
• Stroke or other neural disease.
• Sudden death.

32. 4) BICUSPID AORTIC VALVE DISEASE
In this condition the aortic valve has only two
cusps or leaflets instead of three.
Bicuspid aortic valve works normally for years
without any signs of problem, but the valve
does not function well.

34.  Its causes:-
• Idiopathic.
• Latest studies suggest that BAV is caused by a
connective tissue disorder that also causes
other circulatory problems.
• Often associated with coarction of aorta
(narrowing of aorta).

35.  Symptoms:-
• Most of time symptoms are absent in infants
and children, however abnormal valve can
leak or narrow overtime the symptoms are:
- tiredness
- chest pain
- difficulty in breathing
- palpitations
- loss of consciousness
- pale skin.

36.  Investigations:-
• Physical examination presenting:
- enlarged heart
- heart murmur
- weak pulse in wrist and ankles.
• MRI of heart.
• Echocardiogram.
• If complications or additional heart defects
are suspected ,tests adviced are:
- chest X-ray, ECG, Cardiac catheterization.

37.  Treatment:-
• In severe conditions the surgery to repair or
replace a leaky or narrowed valve.
• Vulvoplasty (a catheter with a balloon attached at
its tip is inserted in groin and directed to heart ,
the balloon is inflated to make aortic valve
larger).
• Medicines may be needed to relieve symptoms :
- Beta blockers, ACE inhibitors (to lower
workload on heart)
- Water pills.

38.  Complications:-
• Heart failure.
• Leakage of blood through valve back in to
heart.
• Narrowing of valve’s opening.
• Aortic valve or cardiac muscle infection.

39. ACQUIRED VALVULAR DISEASE
The valves that are formed properly at birth can still
develop problems related to aging, infection ,heart attack
or heart damage and other events that cause wear and tear
to valves.
Valve function can also be affected by a build up of calcium
deposits on the valve leaflets , making them stiff and
inflexible.
( mostly affected valves are aortic and mitral)
AVD consists of 3 types:-
1 Aortic stenosis.
2Mitral regurgitation.
3- Mitral valve prolapse

40. 1) AORTIC STENOSIS
It consists of narrowing of aortic valve , which
leads to decreased blood flow from heart.

42.  Its causes:-
• Acquired (develops later in life).
• Due to build up of calcium deposits that narrow
the valve ,called calcific aortic stenosis. (Mostly
olders are affected).
- Calcium build up of valve happens sooner
in people who are born with abnormal
aortic or bicuspid valves
- Calcium build up can also develop more
quickly when a person has received chest
radiation. (in rare cases).
• Rheumatic fever ( leading to fibrosis of valve )
• Aging (> 65years of age), more in males .

43.  Symptoms:-
• Symptoms are not developed till the disease becomes
advanced.
• Chest discomfort (chest pain may get worse with
activity and reach into arm, neck, or jaw. Chest may
feel tight or squeezed).
• Cough (possibly haemoptysis)
• Breathing problems (during exercise).
• Becoming easily tired.
• Palpitation (feeling the heart beat).
• In infants:
- becoming easily tired
- failure to gain weight, poor feeding
- risk of bacterial endocarditis.

44.  Investigations:-
• Physical examination presenting:
- Heart murmur
- Feeling vibration or movements during
palpation over heart
• Transthoracic echocardiogram(TTE), which
gives a moving images of basic structure of
heaart. (it detects most oftenly)
• Other tests are: ECG, exercise stress testing,
left cardiac catheterization, MRI.

45.  Treatment:-
• Proper check-ups regularly for early detection.
• Clients with confirmed aortic stenosis are adviced
not to play sports even if they have no symptoms.
• Drugs are used to treat symptoms of heart failure
or arrythmias:
- Diuretics
- Nitrates
- Beta blockers
- Anti-hypertensives
• Surgery to repair the valve (balloon vulvoplasty)
and valve replacement.

46.  Complications:-
If left uncheked:
• Chest pain (angina)
• Fainting (syncope)
• Heart failure
• Arrythmias
• Cardiac arrest

47. 2) MITRAL REGURGITATION
It is the leakage of blood backward through
mitral valve each time the left ventricle
contracts

49.  Its causes:-
• It may begin suddenly, often occurs after heart
attack.
• Due to weakening or damaging of valve or
heart tissue arround the valve.
• Risk factors are:
– CAD and hypertension
– Valvular infections
– Mitral valve prolapse
– Untreated syphilis (rarely)
– Rheumatic heart diseases (rarely)

50.  Symptoms:-
• Symptoms may begin suddenly if
– Heart attack damages the muscles arround mitral
valve.
– The cord that attach the muscle to valve is broken.
– Infection of valve destroys parts of valve.
• The symptoms may or may not include:-
– Cough
– Fatigue
– Tachypnea
– Palpitation
– shortness of breath.

51.  Investigations:-
• Physical examination may reveal:
– a thrill (vibration) sound over the heart.
– a heart murmur sound
– Crackles in lungs (if fluid backs up into lungs)
– hepatomegaly
• Some tests may be done
– CT scan of chest
– Echocardiogram (transthoracic or transesophageal)
– MRI.

52.  Treatment:-
• Symptomatic treatment.
• When the symptoms get worse , the following
antihypertensive drugs may be prescribed by
physician :
– Beta blockers (labetalol), ACE inhibitors (captopril),
calcium channel blockers (amlodipine).
– Blood thinners(anticoagulants)
– Antiarrythmic drugs
– Water pills (diuretics) (to remove excess fluid in lungs)
• Client may need surgery if conditions are not
treated by drugs (repair or replacement of valve).

53.  Complications :-
• Arrythmias
• Valvular infection
• Heart failure.

54. 3) MITRAL VALVE PROLAPSE
It is also called:
- Barlow syndrome.
- Myxomatous valve syndrome.
- Click murmurs syndrome.
MVP is a condition in which the two valve
flaps of mitral valve do not close smoothly, but
insteatd bulge (prolapse) upward in left atrium
that may cause heart murmur.

56.  Its causes:-
• Abnormally stretched valve leaflets (myxomatous
degeneration)
• Genetic risk of developing MVP
• Can be due to other connective tissue disease.
• Other causes include:
– Ethlers- danlos syndrome (a group of connective
tissue disorders).
– Marfan syndrome (a genetic disorder of connective
tissue).
– Rheumatic heart disease
– Ischemic papillary muscle dysfunction.

57.  Symptoms:-
• Initially no symptoms seen.
• But in later stages symptoms may be:
– Palpitation
– Shortness of breath
– Cough
– Fatigue (tiredness)
– Anxiety
– Chest discomfort.

58.  Investigations:-
• Physical examination may reveal:
– Heart murmur
• Client may need other tests to diagnose MVP:
– Echocardiography
– Doppler USG
– Chest X-ray
– ECG.

59.  Treatment:-
• Goals of treatment may include:-
– Correcting underlying mitral valve problem.
– Preventing infective endocarditis, arrythmias, etc.
– Relieving symptoms.
• Drugs including :
– Beta blockers (labetalol) to treat palpitation and chest
discomfort.
– Blood thinners (to treat atrial fibrillation).
– Diuretics.
– Antiarrhythmics (flecainide and procainamide).
– Vasodilators (isosorbide dinitrate and hydralazine).
• Surgery including valve repair and replacement.

60. CONGENITAL OR ACQUIRED
VALVULAR DISEASE
The valve disease which can be acquired or
congenital or both.
These are of two types :-
1- Mitral valve stenosis.
2- Aortic regurgitation.

61. 1) MITRAL VALVE STENOSIS
In this condition the the valve does not open
fully due to its narrowing, that restricts the
flow of blood.

63.  Its causes:-
• Rheumatic fever (causes fibrosis or thickening of mitral
valve).
• Severe mitral leaflet calcification.
• Congenital absence of one of the papillary muscles.
• Endocardial vegetation (may cause ulceration and
perforation of heart valve cusps).
• Congenital mitral valve defect.
• Tumors.
• Rheumatoid arthritis.
• Systemic lupus erythematosus (a chronic autoimmune
disease)
• Rheumatic endocarditis .

64.  Symptoms:-
• Adults may have no symptoms.
• However symptoms get worse with exercise or
other activity. Mostly between 20-50 yrs of age.
• Symptoms are:
– Chest discomfort (extended to arm , neck, jaw, etc.)
– Cough, dyspnea, fatigue.
– Respiratory infections.
• In infants and children within 2 yrs of life:
– Cough.
– Poor feeding.
– Sweating while feeding.
– Poor growth, shortness of breath.

65.  Investigations:-
• Physical examination may reveal:
– Heart murmur sound or other abnormal sound.
– Arrythmias.
• Other test may include:
– Chest X-ray.
– CT scan of heart.
– Echocardiogram.
– ECG.
– MRI of heart.
– Transesophageal echocardiogram (TEE).

66.  Treatment:-
• Initially symptomatic management.
• Drugs to treat symptoms of heart failure , hypertension
and arrythmia include:
– Diuretics
– Nitrites
– Beta blockers
– Calcium channel blockers
– ACE inhibitors.
• Anticoagulants (blood thinners).
• Antibiotics (penicillin).
• Surgeries needed:
– Percutaneous mitral balloon valvotomy (vulvoplasty).
– Valve replacement.

67.  Complications:-
• Atrial fibrillation and atrial flutter.
• Stroke.
• Congestive heart failure.
• Pulmonary edema.
• Pulmonary hypertension.

68. 2) AORTIC REGURGITATION
• Also called aortic insufficiency.
• It is the failure of aortc valve leding to back
flow of blood into left vetricle from aorta
during diastole.

70.  Its causes:-
• In past , the rheumatic fever was the main cause
for this but the use of antibiotics to treat strep
infections made rheumatic fever less common.
• Other causes are:
– Ankylating spondylitis (arthritis of spine).
– Aortic dissection (its tearing) .
– Congenital valve problems.
– Syphilis.
– Systemic lupus erythematosus.
– Chest trauma.

71.  Symptoms:-
• Most common in men (between 30-60 yrs).
• Bounding pulse (strong pulse).
• Chest pain similar to angina.
• Fainting.
• Fatigue.
• Palpitations
• Shortness of breath.
• Swelling of feet , leg, or abdomen.
• Weakness with activity.

72.  Investigations:-
• Physical examination reveal:
– Heart murmur.
– Palpitation.
– Hard pulses in arms and legs.
– Low diastolic B.P.
– Signs of fluid in lungs.
• Aortic insufficiency may be seen on tests :
– Aortic angiography.
– Echocardiogram.
– Left cardiac catheterization.
– MRI of heart.
– Transthoracic echocardiogram (TTE), or Transesophageal
echocardiogram (TEE).
• Chest X-ray may show swelling of left ventricle.

73. Treatment:-
• No treatment needed in case of no or mild
symptoms (but proper checkup is needed).
• Anti-hypertensives.
• Diuretics.
• Limiting activity needed.
• Surgery to repair or replace the aortic valve is
to be done.

74.  Complications:-
• Arrythmia.
• Heart failure.
• Infection in heart.

75. NURSING RESPONSIBILITIES
• History taking .
• Physical examination (timely).
• Administer drugs as prescribed by physician.
• Monitor for adverse and side effects of drugs
administered.
• Teach the client about the complications and
treatment plan.
• As doctors prescription the antibiotic therapy is
provided before any invasive procedures.

76. • The nurse teaches the client and his family
members about the complication after infections.
• The nurse teaches the patients about to weigh
daily and report to doctor if there is a weight gain
of more than 2.3 kg in one week.
• Assist the patient to adopt life style
modifications.
• If the patient have vulvoplasty or valve
replacement, teach them about the procedures ,
anticipated recovery time and complications.

77. SUMMARY
• Introduction.
• Definition.
• Incidence.
• Congenital Valvular Diseases.
• Acquired Valvular Diseases.
• Combined Congenital & Acquired Valvular
Diseases.
• Nursing Responsibilities

78. CONCLUSION
• Heart valves are essential for proper
circulation because they regulate the direction
that your blood flows . Defects in the valves
can lead to severe problems. So we should all
have to be aware about cardiac problems.

79. REFFERENCES
• Hariprasath P.,A Textbook of Cardiovscular &
thoracic Nursing, 1st Edition, 1st Volume,2016,
Published by Jaaypee Brothers Medical
Publishers (P) Ltd.
• Joyce M. Black, A Textbook of Medical Surgical
Nursing, 8th Edition, 2nd Volume, Published by
Saunders Elsevier Publication.
• http://medlineplus.gov/ency/articles..

80. Thankyou