The document provides an overview of valvular heart disease, detailing definitions, types such as stenosis and regurgitation, and their clinical manifestations. It emphasizes the etiologies, pathophysiology, and diagnostic assessments for various conditions like mitral regurgitation, aortic stenosis, and tricuspid regurgitation. Additionally, it covers treatment options including surgical interventions and nursing management strategies for patients with valvular heart issues.

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Valvular Heart
Disease
Ms.Fouzia

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Definition
 Defined according to the valve or valves affected
and the type of functional alteration
 Includes
- stenosis
- regurgitation

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STENOSIS
 Valve orifice is smaller, impending the forward flow
of blood and creating a pressure gradient difference
across an open valve

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REGURGITATIO
N
 Incomplete closure of the valve leaflets results in
the backward flow of blood

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MITRAL STENOSIS
 is the narrowing of heart mitral valve.

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Etiology
 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.

9. 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

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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

11. MITRAL REGURGITATION
 incomplete closure of the mitral valve

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ETIOLOGY
 Myocardial infarction
 Chronic rheumatic heart disease
 Mitral valve prolapse
 Ischemic papilary muscle dysfunction
 Infective endocarditis

13. CLIN ICAL MANIFESTATIONS
 Fatigue & weakness – due to  CO – predominant complaint
 exertional dyspnea & cough – pulmonary congestion
 palpitations – due to atrial fibrillation (occur in 75% of pts.)
 Right-sided heart failure – distended neck veins,
edema, ascites, hepatomegaly
 Auscultation: blowing, high-pitched systolic murmur
(apex)
- S1 is diminished
- S3 –severe regurgitation

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Mitral Valve Prolapse
 is the bulging of one or both of the mitral valve flaps
(leaflets) into the left atrium during the contraction of the
heart.

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Mitral Valve Prolapse

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CAUSE:
due to an inherited connective tissue
disorder enlargement of one or both
valvem leaflets

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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

18. 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.

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Aortic Stenosis

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ETIOLOGY
 Congenital aortic valve stenosis
 Rheumatic fever

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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

22. CLIN ICAL 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

23. AORTIC REGURGITATION
 the aortic valve doesn't close properly, causing blood
to leak backward from the aorta into the left ventricle.

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Etiology
 may be due to rheumatic fever – most common
cause
 other causes:
connective tissue disease (Marfan’s syndrome), severe
hypertension, congenital anomaly

25. 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

26. CLIN ICAL 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

27. 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

28. TRICUSPID REGURGITATION
Is a condition in which the valve
between the two right heart
chambers (right ventricle and right
atrium) doesn't close properly.

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Etiology
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

30. 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

31. 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

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DIAGNOSTIC STUDIES
History and physical examination
Echocardiogram
Cardiac catheterization
Electrocardiogram
Chest X ray

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Epidemiology
• About 2.5% of the U.S. population has valvular heart disease
• About 13% of people born before 1943 have valvular heart
disease.

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 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.

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 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

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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

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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

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ANNULOPLASTY

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ANNULOPLASTY (CONT.)

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5. PROSTHETIC VALVES
 Mechanical valves
 Biologic valves

42. 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

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TYPES OF MECHANICAL VALVES
 Caged ball valve
 Tilting disk valve
 Bi- laeflet valve

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TYPES OF BIOLOGIC VALVE
 Porcine heterograft
 Pericardial heterograft
 homograft

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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

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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

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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