VALVULAR HEART-2.pptxbbbbbbbbbbbbbbbbbbbb

Very effective data used for study related purposes

1. Valvular Heart Disease Ms.Fouzia 11/14/2023 1

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3. Definition Defined according to the valve or valves affected and the type of functional alteration Includes stenosis regurgitation 11/14/2023 3

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5. ST E NOSIS Valve orifice is smaller, impending the forward flow of blood and creating a pressure gradient difference across an open valve 11/14/2023 5

6. R E GURGI T A TION Incomplete closure of the valve leaflets results in the backward flow of blood 11/14/2023 6

7. MITRAL STENOSIS is the narrowing of heart mitral valve. 11/14/2023 7

8. Etiology M ost common valvular disorder in rheumatic fever M ay also be caused by bacterial infection, thrombus formation, calcification O bstruct blood flow from left atrium to the left ventricle . 11/14/2023 8

9. P ATHOPHYSIOLOGY Narrowing of mitral valve  CO  O2/CO2 exchange (fatigue, dyspnea, orthopnea) Left ventricular atrophy pulmonary co n g e stion  pulmonary pressure  left atrial pressure Hypertrophy left atrium  blood flow to left ventricle R i g h t- si d ed failure Fatigue 11/14/2023 9

10. C LINICAL MANIFESTATIONS Exertional dyspnea Fatigue and palpitations Loud first heart sound Low pitched diastolic murmur Hoarseness of voice Hemoptysis Chest pain Seizures or a stroke 11/14/2023 10

11. M ITRAL R EGURGITATION incomplete closure of the mitral valve 11/14/2023 11

12. E TIOLOGY Myocardial infarction Chronic rheumatic heart disease Mitral valve prolapse Ischemic papilary muscle dysfunction Infective endocarditis 11/14/2023 12

13. C LIN ICAL M ANIFESTATIONS 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 11/14/2023 13

14. 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. 11/14/2023 14

15. Mitral Valve Prolapse 11/14/2023 15

16. C AUSE : due to an inherited connective tissue disorder enlargement of one or both valve m leaflets 11/14/2023 16

17. 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 11/14/2023 17

18. A ORTIC S TENOSIS 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. 11/14/2023 18

19. Aortic Stenosis 11/14/2023 19

20. E TIOLOGY Congenital aortic valve stenosis Rheumatic fever 11/14/2023 20

21. P ATHOPHYSIOLOGY 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 11/14/2023 21

22. C LIN ICAL M ANIFESTATIONS fatigue & exertional dyspnea – 1 st 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) sig ns of right-sided heart failure –- end-stage symptoms if untreated, survival rate: 1.5-3 years Auscultation: harsh, rough, mid-systolic murmur 11/14/2023 22

23. A ORTIC R EGURGITATION the aortic valve doesn't close properly, causing blood to leak backward from the aorta into the left ventricle. 11/14/2023 23

24. Etiology may be due to rheumatic fever – most common cause other causes: connective tissue disease (Marfan’s syndrome), severe hypertension, congenital anomaly 11/14/2023 24

25. P ATHOPHYSIOLOGY 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 11/14/2023 25

26. C LIN ICAL M ANIFESTATIONS 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 11/14/2023 26

27. T RICUSPID S TENOSIS 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 11/14/2023 27

28. T RICUSPID R EGURGITATION I s a condition in which the valve between the two right heart chambers (right ventricle and right atrium) doesn't close properly . 11/14/2023 28

29. 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 11/14/2023 29

30. C LINICAL M ANIFESTATIONS 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 11/14/2023 30

31. P ULMONIC V ALVE S TENOSIS 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 11/14/2023 31

32. D IAGNOSTIC STUDIES History and physical examination Echocardiogram Cardiac catheterization Electrocardiogram Chest X ray 11/14/2023 32

33. Epidemiology About 2.5% of the U.S. population has valvular heart disease About 13% of people born before 1943 have valvular heart disease. 11/14/2023 33

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35. 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. 11/14/2023 35

36. 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 11/14/2023 36

37. 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 11/14/2023 37

38. 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 11/14/2023 38

39. A NNULOPLASTY 11/14/2023 39

40. A NNULOPLASTY ( CONT .) 11/14/2023 40

41. 5. P ROSTHETIC VALVES Mechanical valves Biologic valves 11/14/2023 41

42. D IFFERENCE 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 11/14/2023 42

43. T YPES OF MECHANICAL VALVES Caged ball valve Tilting disk valve Bi- laeflet valve 11/14/2023 43

44. T YPES OF BIOLOGIC VALVE Porcine heterograft Pericardial heterograft homograft 11/14/2023 44

45. NURSING MANAGEMENT Assess the high risk patients Monitor ECG of the patient Assess the family history of heart disease Assess the history of smoking and alcoholism Monitor lab values frequently especially serum cholesterol levels. Assess for CAD Monitor vital signs Instruct to avoid high fat and oil rich diet 11/14/2023 45

46. N URSING 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 11/14/2023 46

47. N URSING 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 11/14/2023 47