The document discusses various types of heart valve disorders including stenosis, regurgitation, and prolapse of the mitral, aortic, tricuspid, and pulmonary valves. It describes the causes, effects, symptoms, treatments including medications, valvuloplasty, and valve replacement surgery for each type of valve disorder. Nursing diagnoses and interventions are also provided focusing on monitoring cardiac function and output, managing fluid volume and electrolytes, conserving energy, and educating the patient.

1. DR. PALLAVI

2. Heart
Valves

4.  the valve opening narrows
 the valve leaflets may become fused or thickened that the
valve cannot open freely  obstructs the normal flow of blood
EFFECTS: the chamber behind the stenotic valve is subject to
greater stress  must generate more pressure or work
hard to force blood through the narrowed opening
 initially, the compensates for the additional workload by
gradual hypertrophy and dilation of the myocardium  heart failure

5.  scarring and retraction of valve leaflets or weakening of
supporting structures  incomplete closure of the valve
 result to leakage or backflow of blood from the previous
chamber
EFFECTS: causes the to pump the same blood twice (as the
blood comes back into the chamber)
 the dilates to accommodate more blood (the usual blood
it needs to pump + regurgitated blood)
 ventricular dilation and hypertrophy  eventually leads to
heart failure

6.  Congenital heart disease
 Rheumatic heart disease
 Heart attack – damage to the heart muscle, papillary muscles
 Weakening of supporting structures of the heart
 Weakening of the heart muscle
 Infections – bacterial endocarditis

7.  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. 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

10.  exertional dyspnea and fatigue (most common)
 orthopnea, paroxysmal nocturnal dyspnea, cough,
hemoptysis
 cyanosis
 Right-sided heart failure – distended neck veins,
peripheral edema, hepatomegaly, abdominal discomfort
 Auscultation: S1 followed by an opening snap--created by
forceful opening of mitral valve
- rumbling diastolic murmur (apex)
 CXR- left atrial enlargement
 ECG – atrial fibrillation may develop (50-80% of pts.)
- pulses becomes irregular & faint,  BP
 Echocardiogram (2D Echo) – most sensitive in diagnosis

11.  Na+ restriction, diuretics – to relieve pulmonary congestion
 bed rest, sitting position
 Digitalis – improve cardiac contraction,  HR, treat atrial
fibrillation
 Anticoagulants (blood thinners) – coumadin, aspirin,
ticlopidine (Ticlid), Plavix, dipyridamole
 Surgical interventions:
 Mitral commissurotomy – separation or incision of the stenosed
valve leaflets at their borders or commissures
 Balloon mitral valvuloplasty
 Mitral valve replacement – when stenosis is severe

12. Balloon mitral
valvuloplasty

13.  incomplete closure of the mitral valve
 rheumatic disease is the predominant cause
 may also be due to congenital anomaly, infective endocarditis,
rupture of papillary muscle following MI

14.  a leaking mitral valve -  Stroke volume,  CO
- Left atrial hypertrophy
- Pulmonary congestion

16. Incomplete closure of mitral
valve
 vol. of blood ejected by
left ventricle
 Left atrial pressure
Right-sided heart failure
Left atrial hypertrophy CO
 Pulmonary pressure
Backflow of blood to the left
atrium
 Right ventricular pressure

17.  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

18.  restrict physical activity – to prevent fatigue & dyspnea
  Na+ intake, diuretics – relieve congestion
 Digitalis, vasodilators – promote adequate ventricular
emptying and prevent or decrease regurgitation
 ACE inhibitors – arterial dilation,  afterload
 Surgery:
- Valvuloplasty (repair or reconstruction)
- Valve replacement

19. Mitral Valve Prolapse

20.  when 1 or both of the valve leaflets bulge into the left
atrium during ventricular contraction
 more common in women
 Cause: due to an inherited connective tissue disorder 
enlargement of one or both valve leaflets
 Elongates/stretches the chordae tendinae & papillary
muscles  regurgitation may occur
 usually asymptomatic
 Extra heart sound (Mitral click) – an early sign that a valve
leaflet is ballooning into the left atrium
 fatigue, shortness of breath
 arrhythmias may develop – dizziness, chest pain, dyspnea,
palpitations, syncope
 high-pitched late systolic murmur

21. Interventions:
 antibiotic prophylaxis to prevent endocarditis
 If w/ dysrhythmia – avoid caffeine, alcohol, stop
smoking
 anti-arrhythmic drugs
 for chest pain – nitrates, calcium channel blockers,
beta blockers
 surgery not indicated

22.  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

23. Aortic Stenosis

24. Aortic
Stenosis

25. 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

26.  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

27.  restrict activity
 digitalis
 Na+ restriction, diuretics
 Nitroglycerin – for chest pain
 Surgical:
 Balloon aortic valvuloplasty
 Aortic valve replacement – if not done –- poor prognosis

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

30. 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

31.  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
 Auscultation: soft, blowing diastolic murmur

32.  antibiotic prophylaxis before any invasive or dental
procedures
 avoid physical exertion, competitive sports
 vasodilators, calcium channel blockers, ACE inhibitors
Aortic valvuloplasty or valve replacement

33.  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

34.  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

35.  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

36.  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

37.  a rare condition caused by infective endocarditis,
tumors or RF
 blood flows back into Right ventricle  Right ventricle
and atrium hypertrphy  symptoms of Right-sided
heart failure

38.  Valvuloplasty is repair of cardiac valve
• pt. does not require continuous anti-coagulant medication
• usually require cardiopulmonary bypass machine
1.Commissurotomy – to separate the fused leaflets
 Balloon Valvuloplasty – performed in the cardiac cath. lab.
- balloon inflated for 10-30 secs., w/ multiple inflations
- common used for mitral and aortic stenosis
 Closed surgical valvuloplasty – done in the OR under GA
- midsternal incision, a small hole is cut into the heart,
the surgeons finger or a dilator is used to open the
commissure
 Open Commissurotomy – done w/ direct visualization of
the valve, thrombus and calcifications may be identified
and removed

39. 2. Annuloplasty is repair of valve annulus (junction of the valve leaflets
and the muscular heart wall)
- narrows the diameter of the valve’s orifice, useful for
valvular regurgitation
3. Chordoplasty is repair of chordae tendineae
- done for mitral valve regurgitation – caused by stretched,
torn or shortened chordae tendineae

42.  Mechanical valves – Ex. Caged ball valve, Tilting-disk valve
- more durable, used for younger pts.
- risk of thromboembolism – long-term use of anti-coagulants
 Tissue or biological valves:
- xenografts – porcine or bovine heterografts (7-10 yrs
viability)
- homografts – from cadaver tissue donations (10-15 yrs)
- autografts – excising the pts.’s own pulmonic valve and
portion of pulmonary artery for use as the artic valve
 Long-term anticoagulant therapy
 Antibiotic prophylaxis

49. NURSING DIAGNOSIS
 Decreased cardiac output related to valvular
incompetence as evidenced by murmurs, dyspnea,
dysrhythmias, peripheral edema
 NURSING INTERVENTION: Cardiac Care
 Monitor vital signs, cardiovascular status, and respiratory
status to assess for palpitations, angina, widened pulse
pressure).
 Monitor for cardiac dysrhythmias, including disturbances
of both rhythm and conduction, to identify and treat
significant dysrhythmias.

50. CONT...
 Hemodynamic Regulation
 Administer inotropic medication as ordered to increase
myocardial contractility.
 Elevate head of bed to reduce venous return, reduce O2
demand, and maximize chest excursion.
 Energy Management
 Promote bed rest/activity limitation to decrease cardiac
workload and O2 demand.manifestations of decreased
cardiac output (e.g., fatigue, malaise, shortness of breath,
dyspnea on exertion,

51. CONT...
Excess fluid volume related to fluid retention secondary
to valvular-induced heart failure as evidenced by
peripheral edema, weight gain, adventitious breath sounds,
neck vein distention.
NURSING INTERVENTION:
 Hypervolemia Management
 Monitor changes in peripheral edema to detect
hypervolemia.
 Monitor respiratory system for symptoms of difficulty
(e.g., dyspnea, tachypnea, adventitious breath sounds) to
assess for fluid congestion in the lungs.

52. CONT...
 Monitor vital signs and intake and output to assess
hemodynamic response to and effectiveness of
interventions.
 Weigh patient daily and monitor trends (noting gain of >2
lb [0.9 kg]/day or >5 1b [2.3 kg]/wk) to monitor
indicators of hypervolemia.
 Administer prescribed diuretics to assist with removal of
fluid.
 Monitor serum electrolyte values to assess effectiveness of
interventions.

53. CONT...
 Fluid/Electrolyte Management
 Provide restricted-sodium diet as ordered to prevent fluid
retention

54. CONT...
 Activity intolerance related to insufficient oxygenation
secondary to decreased cardiac output and pulmonary
congestion as evidenced by weakness, fatigue, shortness
of breath, increase or decrease in pulse rate, BP changes.
 NURSING DIAGNOSIS: Energy Management
 Monitor cardiorespiratory response to activity (e.g., pulse
rate, respirations, pulse oximetry, BP) to plan appropriate
interventions.
 Encourage alternate rest and activity periods to conserve
energy and decrease cardiac demands.

55. CONT...
 Encourage patient to choose activities that gradually build
endurance to increase cardiac tolerance.
 Assist the patient/caregiver to establish realistic activity
goals to promote feelings of accomplishment.

56. CONT...
 Deficient knowledge related to lack of experience and
exposure to information about disease and treatment
process as evidenced by verbalization of misconceptions
about measures to prevent complications and requests for
information.
 NURSING INTERVENTION:Teaching: Disease Process
 Explain pathophysiology of disease process to ensure
knowledge base.
 Describe disease process and possible chronic
complications (e.g., heart failure, infective endocarditis) to
ensure early reporting and treatment of complications.

57.  Instruct patient on measures to prevent complications
(e.g., importance of notifying dentist, urologist,
gynecologist, and other health care providers of valvular
disease) so prophylactic antibiotic treatments can be
initiated before invasive procedures and to wear Medic
Alert bracelet to notify providers of health condition in
emergencies.
 Discuss lifestyle changes to prevent complications and/or
control the disease (e.g., smoking cessation) to prevent an
increased cardiac workload and the oxygen-depleting
effect of carbon monoxide.
.

58. CONT...
 Instruct patient and/or caregiver on signs and symptoms to
report to health care provider to ensure appropriate
interventions

59. REFERENCES
 Suddarth’s and Brunner ; Textbook of Medical Surgical
Nursing ; Published by; Lippincott ; 10th Edition ; Page No.
788-790’
 Porter McKenzine ; Clinical companoin Medical Surgical ;
Published by; Elsevier ; 1st Edition ; Page No. 68-69,
 Black M Jaycee ; Textbook of Medical Surgical Nursing ;
Published by; Elsevier ; 7th Edition ; 2nd Volume ; Page No.
1385-1392
 http:meddean.luc.edu.in