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By
Mr.Surendran.S.R
M.Sc(N) I Year
Dept of Medical Surgical Nursing
KGNC
INTRODUCTION
• Valvular heart disease remains common in industrialized countries.
• Aortic stenosis and mitral regurgitation are the two most common
types of valvular disease in Europe.
REVIEW OF ANATOMY
AND PHYSIOLOGY
• A hollow muscular organ that pumps the blood through the
circulatory system
• Heart has 4 chambers
REVIEW OF ANATOMY
AND PHYSIOLOGY
• Heart 4 Valves
DEFINITION
• Valvular heart disease is characterized by damage to or a defect
in one of the four heart valves: the mitral, aortic, tricuspid or
pulmonary.
TYPES OF VALVULAR
HEART DISEASES
MITRAL VALVE
STENOSIS
• Mitral stenosis is a valvular heart disease characterized by the
narrowing of the orifice of the mitral valve of the heart.
ETIOLOGY
• Rheumatic Fever
• Bacterial infection
• Thrombus formation
• Calcification
• Infective Endocarditis
• Systemic Lupus Erythematosus
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
Heart failure
Fatigue
PATHOPHYSIOLOGY
CLINICAL
MANIFESTATIONS
• Dyspnea on exertion
• Hemoptysis
• Fatigue
• Palpitations
• Stroke
• Loud accentuated S1
• Low-pitched diastolic murmur
• Hepatomegaly
• Peripheral Edema
• Distended Neck Veins
• Abdominal Discomfort
MITRAL VALVE
REGURGITATION
• Mitral regurgitation is
defined as an abnormal
reversal of blood flow from
the left ventricle to the left
atrium. It is caused by
disruption in any part of the
mitral valve apparatus.
ETIOLOGY
• Rheumatic Heart Disease
• Rheumatic Fever
• Congenital Anomaly
• Infective Endocarditis
• Trauma
• Rupture of Papillary Muscle following MI
• Mitral Valve Prolapse
• Rupture of the Chordae Tendinae
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
PATHOPHYSIOLOGY
CLINICAL
MANIFESTATIONS
• Fatigue
• Weakness
• Dyspnea on Exertion
• Palpitations
• Ascites
• Hepatomegaly
• Distended Neck Veins
• S3 Gallop
• Systolic Murmur
MITRAL VALVE
PROLAPSE
• Mitral valve prolapse (MVP) is an abnormality of the mitral valve
leaflets and the papillary muscles or chordae that allows the
leaflets to prolapse, or buckle, back into the left atrium during
systole
• Mitral valve prolapse is also known as click-murmur syndrome,
Barlow’s syndrome or floppy valve syndrome.
ETIOLOGY
• Inherited Connective Tissue Disorder
• Rheumatic Heart Disease
• Rheumatic Fever
PATHOPHYSIOLOGY
CLINICAL
MANIFESTATIONS
• Extra heart sound (Mitral click) – an early sign that a valve leaflet is
ballooning into the left atrium
• Fatigue
• Shortness Of Breath
• Arrhythmias
• Dizziness
• Chest Pain
• Dyspnea
• Palpitations
• Syncope
• High-Pitched Late Systolic Murmur
AOTIC VALVE STENOSIS
• Aortic stenosis is a narrowing of the aortic valve opening. Aortic
stenosis restricts the blood flow from the left ventricle to the aorta
and may also affect the pressure in the left atrium.
ETIOLOGY
• Rheumatic Heart Disease
• Atherosclerosis
• Congenital Malformations
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
CLINICAL
MANIFESTATIONS
• Fatigue
• Exertional Dyspnea
• Pulmonary Congestion
• Chest Pain (Angina)
• Syncope
• Vertigo
• Weakness
• Orthopnea
• PND
• Pulmonary Edema (Severe Cases)
AORTIC VALVE
REGURGITATION
• Aortic regurgitation is
leakage of the aortic valve
each time the left ventricle
relaxes.
ETIOLOGY
• Rheumatic Fever
• Severe Hypertension
• Connective Tissue Disease
• Congenital anomaly
• Trauma
• Aortic Dissection
• Infective Endocarditis
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
CLINICAL
MANIFESTATIONS
• May remain asymptomatic for years – heart compensates by
hypertrophy & dilation
• Palpitations especially when pt. Lies on left lateral position
• Tachycardia
• PVC associated with left ventricular dilation
• Bounding Pulse
• Fatigue
• Exertional Dyspnea
• Chest pain – Myocardial Ischemia
• Orthopnea
• PND
• Peripheral edema
TRICUSPID VALVE
STENOSIS
• Tricuspid valve stenosis is
a valvular heart disease
which results in the
narrowing of the orifice of
the tricuspid valve of the
heart.
ETIOLOGY
• Rheumatic Fever
• IV Drug Abusers
• Carcinoid Syndrome
• Endocarditis,
• Endomyocardial Fibrosis
• Lupus Erythematosus,
• Congenital Tricuspid Atresia.
PATHOPHYSIOLOGY
CLINICAL
MANIFESTATIONS
• Peripheral Edema
• Ascites
• Fatigue
• Hypotension
• Neck Vein Engorgement
• Hepatomegaly
• Diastolic low-pitched murmur with increased intensity during
inspiration
PULMONIC STENOSIS
Pulmonic stenosis is a dynamic or fixed obstruction of flow from the
right ventricle of the heart to the pulmonary artery. It is usually first
diagnosed in childhood.
ETIOLOGY
• Congenital
PATHOPHYSIOLOGY
CLINICAL
MANIFESTATIONS
• Harsh systolic murmur
• Fatigue
• Dyspnea on exertion
• Cyanosis
• Poor weight gain or failure to thrive in infants
• Hepatomegaly
• Ascites
• Edema
DIAGNOSTIC EVALUATION
MEDICAL MANAGEMENT
• Prophylactic Antibiotic Therapy
• Sodium Restriction
• Vasodilator
• AnticoagulationTherapy
• Diuretics
• Antiarrhythmic Drugs
• ß- Adrenergic Blockers
SURGICAL
MANAGEMENT
• Valvulotomy (Commisurotomy)
• Valvuloplasty
• Annuloplasty
• Valve Replacement
NURSING
MANAGEMENT
Valvular Heart Diseases
Valvular Heart Diseases
Valvular Heart Diseases
Valvular Heart Diseases
Valvular Heart Diseases
Valvular Heart Diseases
Valvular Heart Diseases
Valvular Heart Diseases

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Valvular Heart Diseases

  • 1. By Mr.Surendran.S.R M.Sc(N) I Year Dept of Medical Surgical Nursing KGNC
  • 2. INTRODUCTION • Valvular heart disease remains common in industrialized countries. • Aortic stenosis and mitral regurgitation are the two most common types of valvular disease in Europe.
  • 3. REVIEW OF ANATOMY AND PHYSIOLOGY • A hollow muscular organ that pumps the blood through the circulatory system • Heart has 4 chambers
  • 4. REVIEW OF ANATOMY AND PHYSIOLOGY • Heart 4 Valves
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  • 6. DEFINITION • Valvular heart disease is characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary.
  • 8. MITRAL VALVE STENOSIS • Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart.
  • 9. ETIOLOGY • Rheumatic Fever • Bacterial infection • Thrombus formation • Calcification • Infective Endocarditis • Systemic Lupus Erythematosus
  • 10. 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 Heart failure Fatigue PATHOPHYSIOLOGY
  • 11. CLINICAL MANIFESTATIONS • Dyspnea on exertion • Hemoptysis • Fatigue • Palpitations • Stroke • Loud accentuated S1 • Low-pitched diastolic murmur • Hepatomegaly • Peripheral Edema • Distended Neck Veins • Abdominal Discomfort
  • 12. MITRAL VALVE REGURGITATION • Mitral regurgitation is defined as an abnormal reversal of blood flow from the left ventricle to the left atrium. It is caused by disruption in any part of the mitral valve apparatus.
  • 13. ETIOLOGY • Rheumatic Heart Disease • Rheumatic Fever • Congenital Anomaly • Infective Endocarditis • Trauma • Rupture of Papillary Muscle following MI • Mitral Valve Prolapse • Rupture of the Chordae Tendinae
  • 14. 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 PATHOPHYSIOLOGY
  • 15. CLINICAL MANIFESTATIONS • Fatigue • Weakness • Dyspnea on Exertion • Palpitations • Ascites • Hepatomegaly • Distended Neck Veins • S3 Gallop • Systolic Murmur
  • 16. MITRAL VALVE PROLAPSE • Mitral valve prolapse (MVP) is an abnormality of the mitral valve leaflets and the papillary muscles or chordae that allows the leaflets to prolapse, or buckle, back into the left atrium during systole • Mitral valve prolapse is also known as click-murmur syndrome, Barlow’s syndrome or floppy valve syndrome.
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  • 18. ETIOLOGY • Inherited Connective Tissue Disorder • Rheumatic Heart Disease • Rheumatic Fever
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  • 21. CLINICAL MANIFESTATIONS • Extra heart sound (Mitral click) – an early sign that a valve leaflet is ballooning into the left atrium • Fatigue • Shortness Of Breath • Arrhythmias • Dizziness • Chest Pain • Dyspnea • Palpitations • Syncope • High-Pitched Late Systolic Murmur
  • 22. AOTIC VALVE STENOSIS • Aortic stenosis is a narrowing of the aortic valve opening. Aortic stenosis restricts the blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium.
  • 23. ETIOLOGY • Rheumatic Heart Disease • Atherosclerosis • Congenital Malformations
  • 24. 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
  • 25. CLINICAL MANIFESTATIONS • Fatigue • Exertional Dyspnea • Pulmonary Congestion • Chest Pain (Angina) • Syncope • Vertigo • Weakness • Orthopnea • PND • Pulmonary Edema (Severe Cases)
  • 26. AORTIC VALVE REGURGITATION • Aortic regurgitation is leakage of the aortic valve each time the left ventricle relaxes.
  • 27. ETIOLOGY • Rheumatic Fever • Severe Hypertension • Connective Tissue Disease • Congenital anomaly • Trauma • Aortic Dissection • Infective Endocarditis
  • 28. 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
  • 29. CLINICAL MANIFESTATIONS • May remain asymptomatic for years – heart compensates by hypertrophy & dilation • Palpitations especially when pt. Lies on left lateral position • Tachycardia • PVC associated with left ventricular dilation • Bounding Pulse • Fatigue • Exertional Dyspnea • Chest pain – Myocardial Ischemia • Orthopnea • PND • Peripheral edema
  • 30. TRICUSPID VALVE STENOSIS • Tricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart.
  • 31. ETIOLOGY • Rheumatic Fever • IV Drug Abusers • Carcinoid Syndrome • Endocarditis, • Endomyocardial Fibrosis • Lupus Erythematosus, • Congenital Tricuspid Atresia.
  • 33. CLINICAL MANIFESTATIONS • Peripheral Edema • Ascites • Fatigue • Hypotension • Neck Vein Engorgement • Hepatomegaly • Diastolic low-pitched murmur with increased intensity during inspiration
  • 34. PULMONIC STENOSIS Pulmonic stenosis is a dynamic or fixed obstruction of flow from the right ventricle of the heart to the pulmonary artery. It is usually first diagnosed in childhood. ETIOLOGY • Congenital
  • 36. CLINICAL MANIFESTATIONS • Harsh systolic murmur • Fatigue • Dyspnea on exertion • Cyanosis • Poor weight gain or failure to thrive in infants • Hepatomegaly • Ascites • Edema
  • 38. MEDICAL MANAGEMENT • Prophylactic Antibiotic Therapy • Sodium Restriction • Vasodilator • AnticoagulationTherapy • Diuretics • Antiarrhythmic Drugs • ß- Adrenergic Blockers
  • 39. SURGICAL MANAGEMENT • Valvulotomy (Commisurotomy) • Valvuloplasty • Annuloplasty • Valve Replacement
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