This document discusses aortic regurgitation and aortic stenosis. Aortic regurgitation occurs when blood flows back into the left ventricle from the aorta during diastole. Causes include inflammatory lesions, endocarditis, congenital abnormalities, and aneurysms. Aortic stenosis is a narrowing of the aortic valve. Causes are congenital abnormalities, rheumatic fever, and calcification. Both conditions cause the left ventricle to hypertrophy to compensate for the increased workload. Symptoms include dyspnea, dizziness, and angina. Diagnosis involves echocardiograms, EKGs, and cardiac catheterization. Treatment consists of antibiotics before procedures to prevent endocard

1. AORTIC REGURGITATION AND
AORTIC STENOSIS

2.  Aortic regurgitation is the flow of blood back into the left
ventricle from the aorta during diastole.
 Causes include:
 Inflammatory lesions that deform the leaflets of the aortic
valve
 Endocarditis
 Congenital abnormalities, diseases such as syphilis
 A dissecting aneurysm that causes dilation or tearing of the
ascending aorta
 Deterioration of an aortic valve replacement
Aortic Regurgitation

4.  Blood from the aorta returns to the left ventricle during
diastole
 Left ventricle dilates, trying to accommodate the increased
volume of blood
 Left ventricle hypertrophies, trying to increase muscle
strength to expel more blood
 Arteries attempt to compensate for the higher pressures
by reflex vasodilation
 Peripheral arterioles relax, reducing peripheral resistance
and diastolic blood pressure
Pathophysiology

5.  Forceful heart beat in head or neck
 Marked arterial pulsations that are visible or palpable
at the carotid or temporal arteries
 Exertional dyspnea and fatigue
 Left ventricular failure include breathing difficulties
(eg, orthopnea, paroxysmal nocturnal dyspnea)
Clinical Manifestations

6.  Diastolic murmur is heard as a high-pitched, blowing
sound at the third or fourth intercostal space at the
left sternal border
 Pulse pressure (ie, difference between systolic and
diastolic pressures) is considerably widened
 Water-hammer pulse, in which the pulse strikes the
palpating finger with a quick, sharp stroke and then
suddenly collapses
Diagnostic Investigations

7.  Diagnosis may be confirmed by
 Echocardiogram
 Radionuclide imaging
 ECG
 Magnetic resonance imaging,
 Cardiac catheterization
Diagnostic Investigations

8.  Antibiotic prophylaxis is needed to prevent
endocarditis before the patient undergoes invasive or
dental procedures
 Aortic valvuloplasty or valve replacement
 Surgery is recommended for any patient with left
ventricular hypertrophy, regardless of the presence
or absence of symptoms
Medical Management

9.  Aortic valve stenosis is narrowing of the orifice
between the left ventricle and the aorta.
 Causes include:
 Congenital leaflet malformations
 Rheumatic endocarditis
 Cusp calcification of unknown cause
 Fused leaflets of aortic valve
Aortic Stenosis

11.  Progressively narrowing of valve orifice
 Left ventricle contract slowly but with greater energy
 Obstruction to left ventricular outflow increases
pressure on the left ventricle
 Heart muscle hypertrophies
 When these compensatory mechanisms of the heart
begin to fail, clinical signs and symptoms develop
Pathophysiology

12. Pathophysiology of Aortic Stenosis

14.  Exertional dyspnea, caused by left ventricular failure.
 Dizziness and syncope because of reduced blood flow
to the brain.
 Angina pectoris that results from the decreased blood
flow into the coronary arteries.
 May be a low pulse pressure (30 mm hg or less)
because of diminished blood flow.
Clinical Manifestations

15.  Systolic crescendo-decrescendo murmur which is low-
pitched, rough, rasping, and vibrating may be heard
over the aortic area
 If the examiner rests a hand over the base of the
heart, a vibration may be felt.
 Evidence of left ventricular hypertrophy may be seen
on a 12-lead ECG and echocardiogram.
 Left-sided heart catheterization is necessary to
measure the severity of the valvular abnormality
Diagnostic Investigations

16.  Antibiotic prophylaxis to prevent endocarditis
 After left ventricular failure or dysrhythmias occur,
medications are prescribed
 Definitive treatment is surgical replacement of the
aortic valve
 Patients who are not surgical candidates may benefit
from one- or two-balloon percutaneous valvuloplasty
procedures
Medical Management

18.  Health education on valvular heart disease
 Emphasizes the need for prophylactic antibiotic
therapy before any invasive procedure
 Patient’s heart rate, blood pressure, and respiratory
rate are measured
 Heart and lung sounds are auscultated and peripheral
pulses palpated
 Assess for signs and symptoms of heart failure
Nursing Management

19.  Assesses for dysrhythmias by palpating the patient’s pulse
for strength and rhythm
 Assesses for dizziness, syncope, increased weakness, or
angina pectoris
 Collaborates with the patient to develop a medication
schedule and teaches about the name, dosage, actions,
side effects
 Assist the patient with planning activity and rest periods to
achieve a lifestyle acceptable to the patient
Nursing Management

21. Any
Questions?