Professional Documents
Culture Documents
Disorders
Pattie Schrader, MSN, RN
Cardiac Valves
Open & close passively
Respond to pressure &
volume changes
Supported by chordae
tendineae
2 Types of Valves
Atrioventricular (AV)
Semilunar
Semilunar Valves
Consist of 3 cuplike cusps
Prevent backflow of blood during ventricular
diastole
Permit blood blow during ventricular systole.
Pulmonic valve separates ___ ventricle from the
_______
Aortic valve separates ___ ventricle from the
_______
Valvular Disorders
Regurgitation: the valve does not close
properly and blood flows backwards through
the valve
Stenosis: the valve does not open
completely and blood flow through the valve
is reduced
Valve prolapse: the stretching of an
atrioventricular valve leaflet into the atrium
during diastole
Mitral Stenosis
Thickening of the mitral valve by fibrosis
and calcification
Valve leaflets fuse together, becoming stiff
Chordae tendineae contract and shorten
Valvular orifice narrows
Thromboemboli may form on calcified
leaflets
Chronic and progressive
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Mitral
Regurgitation/Insufficiency
Fibrotic changes and calcification in the
mitral valve preventing complete
closure
Incomplete closure allows backflow of
blood from the left ventricle into the left
atrium during ventricular systole
Mitral Regurgitation/Insufficiency
Causes
Rheumatic heart disease more in women
Degenerative calcification of the mitral opening
in older women
Processes that dilate the mitral open or affect
the support structures, papillary muscles, or the
chordae tendineae (left ventricular hypertrophy
and MI)
Infective endocarditis
Congenital anomaly
Mitral Regurgitation
Mitral
Regurgitation/Insufficiency
Assessment Findings
Fatigue & weakness
DOE
Orthopnea
Anxiety
Atypical CP
Palpitations
Atrial fibrillation
Neck vein distention
Pitting edema
High-pitched, holosystolic murmur
Mitral Stenosis
Causes
Rheumatic fever
Bacterial endocarditis
Atrial myxoma, calcium accumulation, &
thrombus formation
Congenital defects
Females > Males
Mitral Stenosis
Prevents normal blood
flow from the ____ to
the _____ which
increases the
pressure in the
______ causing the
_____ ______ to
dilate increasing the
pressure in the _____
so the ____ _____
hypertrophies.
Valvular Dysfunction
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Mitral Stenosis
Signs/symptoms - asymptomatic to severe
Fatigue
DOE - earliest manifestation
Cough
Hemoptysis
Frequent pulmonary infections
Paroxysmal nocturnal dyspnea
Orthopnea
Weakness
Palpitations
Mitral Stenosis
Assessment findings will worsen and ___
heart failure appears
JVD
Hepatomegaly
Ascites
Pitting peripheral edema
Crackles in lung bases
Mitral Stenosis
Assessment findings if severe
Cyanosis of face & extremities
CP is rare but may occur
Rumbling, _____ diastolic murmur
Atrial dysrhythmias
Thrombi
Aortic
Regurgitation/Insufficiency
Aortic valve leaflets do not close properly
during diastole (incompetent)
Leaflets are dilated, loose, or deformed
Allows regurgitation of blood from the
aorta back into the ____ ventricle
Left ventricle dilates to accommodate
larger blood volume
Left ventricle hypertrophies
Aortic
Regurgitation/Insufficiency
Causes
Nonrheumatic conditions
Infective endocarditis
Congenital anatomic abnormalities
Hypertension
Marfans syndrome
75% Men
Aortic
Regurgitation/Insufficiency
Aortic
Regurgitation/Insufficiency
Assessment Findings asymptomatic for many years
until left ventricular failure develops
DOE
Orthopnea
Paroxysmal noctural dyspnea
Palpitation especially when lying on left
Nocturnal angina with diaphoresis
Bounding arterial pulse
Wide pulse pressure elevated SBP& diminished DBP
High-pitched, blowing, decrescendo diastolic murmur
Aortic Stenosis
Aortic valve narrows & valvular tissue thickens
Obstructs left ventricular outflow during systole
Increased resistance to ejection or afterload
results in ventricular hypertrophy
CO becomes fixed and unable to meet demands
Left ventricle fails backs up in left atrium and
pulmonary system becomes congested right
heart failure
Aortic Stenosis
Causes
Congenital defects - predominantly
Bicuspid or unicuspid aortic valves
Rheumatic disease
Atherosclerosis
Degenerative calcification
Most common valvular disorder with aged populations
80% Men
Aortic Stenosis
Aortic Stenosis
Assessment Findings
Classic symptoms resulting from fixed CO
dyspnea, angina & syncope on exertion
As the CO falls marked fatigue,
debilitation and peripheral cyanosis
Narrow pulse pressure
A diamond-shaped, systolic crescendodecrescendo murmur is auscultated
Cardiac
Cycle
Diastole
Auscultation
Site
Configuration
of Sound
Continuity
Apical
Rumble,
continuous
Mitral
Systole
Regurgitation
Apex
Holosystolic,
continuous
Mitral Valve
Prolapse
Systole
Apex
Click
Aortic
Stenosis
Systole
Crescendodecrescendo,
continuous
Decrescendo,
continuous
Aortic
Diastole
Regurgitation
Question
Which statement is correct about regurgitation?
A.Valve does not close properly and blood
backflows through the valve
B.Valve does not open properly and blood flow
through the valve is reduced
C.Stretching of an atrioventricular valve leaflet into
the atrium diastole
D.Repair of a cardiac valves outer ring
Treatment Interventions
Nonsurgical management
Surgical management
Reparative Procedures
Replacement Procedures
Nonsurgical Management
Focuses on drug therapy and rest
Diuretics
Digoxin
Oxygen
Nitrates
Vasodilators (Adalat, Procardia)
EBP No longer need prophylactic antibiotics
before invasive procedures
Nonsurgical Management
Focuses on cardiac output
Monitor cardiac output & tissue perfusion
Monitor for any irregularly irregular rhythm
Prone to atrial fibrillation
Notify MD
Tx with drugs (IV diltiazem) or cardioversion
Nonsurgical Management
Other medications
Quinidine gluconate
Procainamide
Beta-blocking agents (propranolol
hydrochloride)
Calcium channel blocker (verapamil
Anticoagulants (Coumadine)
Valve replacement
Surgical Management
Reparative
Balloon Valvuloplasty
An invasive, nonsurgical procedure
Involves the passage of a balloon catheter
from the femoral vein through the atrial
septum to the mitral valve, or through the
femoral artery to the aortic valve
Balloon is inflated to enlarge the orifice
Balloon Valvuloplasty
Surgical Management
Reparative
Mitral annuloplasty tightening & suturing
the malfunctioning valve annulus to
eliminate or markedly reduce regurgitation
Surgical Management
Reparative
Commissurotomy/valvotomy
Accomplished with cardiopulmonary bypass
during open heart surgery
Valve is visualized, thrombi are removed from
the atria, fused leaflets are incised and
calcium is debrided from the leaflets thus
opening the orifice
Surgical Management
Replacement
Valve replacement procedures
Biological valves (xenograft)
Mechanical prosthetic valves
Pulmonary autographs
Valve Replacement
Mechanical Valves
Pulmonary Autographs
Relocation of the clients pulmonary valve
to the aortic position
Especially useful for younger clients
Postoperative pain
Incision care
Strategies to prevent respiratory complications
Oral anticoagulants .
Question
Is the following statement True or False?
The mitral valve is a semilunar valve located
between the right ventricle and the
pulmonary artery.
Question
Is the following statement True or False?
Xenograft is a heart valve replacement
made of tissue from an animal heart valve.