STENOSIS (VALVULAR DISORDERS)

Question 1

 There will be less blood and less cardiac output
 Tightening of the lumen/narrowing

Answer 1

STENOSIS

Question 2

 Blood goes back from atrioventricle

▪ When the ventricles are contracting, AV
valves should be close. But because there is
a defect, during contraction the blood
goes back

Answer 2

REGURGITATION

Question 3

 Close completely if no tehere is a small opening

Answer 3

INSUFFICIENCY

Question 4

 Most common is ___ side of heart

Answer 4

left

Question 5

Common affected:

left valves due to

Answer 5

contraction against a high pressure.

▪ Aortic Valve and Mitral Valve

Question 6

explain why have

 Angina (Chest pain)

Answer 6

 Since less blood is received by the heart; therefore, there will be anaerobic metabolism, which causes the production of lactic acid. And that lactic acid will irritate the nerve endings causing chest pain

Question 7

If there is _____: there will be accumulation of blood in the atrium; the atrium will become enlarged (increasing the pre-load)
 There will be a back flow of blood in the lungs leading to pulmonary congestion —> pressure in the lungs are high
 The right ventricle is pushing against the high pressure in the lungs (increasing the workload; which increases the demand for blood because it becomes enlarged; however, the coronary artery will just give the same amount of blood)
 Less blood —> less cardiac output
o Fatigue
o Dyspnea
 Increasing pre-load in the left atrium

Answer 7

mitral stenosis

Question 8

explain why have

dsypnea

Answer 8

 Only small amount of blood is being sent to the aorta, the blood is accumulating in the left ventricles.

 If there is aortic stenosis, the blood will flow back to the left atrium, then going back to the lungs the blood in the lungs can no longer enter the left atrium causing pulmonary congestion

Question 9

 The fluids or the blood entered already the alveoli
 The blood in the upper and lower extremities goes inside the lungs; causing pulmonary congestion —> which causes difficulty of breathing, and it is relieved by standing up.
 Sudden awakening for 1-2 hours of sleep with dyspnea; and when the patient stands up to get more air, and when they stand the fluids goes down because of gravity and now the patient can breathe normally.

Answer 9

PAROXYSMAL NOCTURAL DYSPNEA

Question 10

 The patient cannot do supine position (because there can be dyspnea)
 Place 2-3 pillows in the head and the shoulders to elevate the head part
 2 pillow orthopnea
 4 pillow orthopnea (if 4 pillow are used)
 Because the patient cannot breath in a supine position

Answer 10

ORTHOPNEA

Question 11

 Coughing out of blood
 High pressure in the pulmonary veins can rupture and can cause hemoptysis

Answer 11

HEMOPTYSIS

Question 12

 Because the heart is contracting forcefully to give an enough cardiac output

Answer 12

PALPITATIONS

Question 13

 The doctors will insert their fingers or a small instrument to expand the mitral valve.

Answer 13

COMMISSUROTOMY

Question 14

 It will widen the mitral valve because of the balloon inserted in the right atrium.

Answer 14

VALVULOPLASTY

Question 15

 No contact sports
 Easy to bleed
 Soft bristles toothbrush
 Remove clutters
 Patient may be prone to risk for fall
 Apply pressure to stop bleeding

Answer 15

WARFARIN

Question 16

 The aortic valves becomes narrowed
 Most common cardiac valve dysfunction
 Usually asymptomatic
 Heart murmur is the most common early sign
 Most common in males
 Left ventricle will enlarged first if there is aortic stenosis.
 Sudden cardiac death —> if not treated
 Angina, Syncope, Exertional Dyspnea —> 3 cardinal symptoms

Answer 16

AORTIC STENOSIS

Question 17

 There is a backflow
 Once, the atrium filled the ventricles with blood, the mitral valves do not close completely (insufficiency) —>some blood pushes at the ascending aorta, but some blood went back to the left atrium because of insufficiency.
 Left atrium will become enlarged
 If it is enlarged, there can be a backflow in the pulmonary veins causing pulmonary congestion
 Less blood ejected from the left ventricle
 Less cardiac output

Answer 17

MITRAL REGURGITATION

Question 18

There is backflow of blood;
* Mitral and tricuspid should close, however in mitral valve it cannot close completely called Mitral Insufficiency
When right ventricle is contracting push blood towards aorta; since not closed pushing some blood went back to left atrium; so the chamber enlarged in left atrium
- Amount of blood from left ventricle which is less because some got back to left atrium
- Enlarging again left atrium, can result to thrombi there come a time it can have backflow of blood going to lungs

Answer 18

MITRAL REGURGITATION

Question 19

EXPLAIN

Rheumatic fever

Answer 19

▪ Rheumatic fever is common in children, the cause is streptococci.

▪ If a child has sore throat or tonsilitis, the body will compensate by producing antibodies. The doctor will also prescribe an antibiotic. However, if tonsilitis keeps on returning, it will result to antigen-antibody complexes. Antigen-Antibody Complexes damages the heart. As for adult, it will now be called Rheumatic Heart Disease which causes valvular disorders.

▪ TREND: If the child always develops tonsilitis, remove it through tonsillectomy because antigen-antibody complexes may develop which can cause valvular disorders in the future

Question 20

backflow of blood into left ventricle from the aorta during diastole

may caused by congenital valve abnormality, inflammatory lesions that deform aortic valve leaflets or dilation of aorta, preventing complete closure of the aortic valve

pathophy: blood flows back into left ventricles which will dilate to accomodate increased blood volume

Answer 20

aortic regurgitation

Question 21

are thin, fibrous cords in the heart. They are attached to the papillary muscles, which are extensions of the heart muscle in the ventricles.

▪ Responsible for keeping the valves in their proper position, ensuring one-way blood flow through the heart

Answer 21

Chordae tendineae

Question 22

Most common problem that may result to
valvular disorders is

Answer 22

Rheumatic Fever.

Question 23

→ It is usually caused by Rheumatic Endocarditis, which progressively thickens the mitral valve leaflets and chordae tendineae, causing the leaflets to fuse together.

Answer 23

❖ MITRAL STENOSIS

Question 24

Pathophysiology Explain

MITRAL STENOSIS

Answer 24

▪ When the mitral valve is open, it should be as wide as three fingers. However, if there is stenosis, it becomes as narrow as a pencil, allowing less blood to flow into the left ventricle. This causes an accumulation of blood in the left atrium, leading to enlargement and increased preload. The accumulated blood may then backflow into the lungs, causing pulmonary congestion. This increased pressure in the lungs causes the right ventricle to contract under a higher pressure, increasing the afterload and leading to its enlargement. Due to this enlargement and the accumulation of blood in the right ventricle, blood may backflow into the atria, resulting in right-sided heart failure.

▪ It causes enlargement of Left Atrium.

Question 25

Clinical Manifestations of Mitral Stenosis:

1. The first symptom is Dyspnea on Exertion (DOE) because of ______
2. Fatigue – due to ______
3. Palpitation – the heart is ______
4. Dry Cough
5. Orthopnea – the patient is having a hard time to _____
6. Paroxysmal Nocturnal Dyspnea –
   ➢ At a supine position,
   ➢ During sleep, typically after 1 or 2 hours, the px suddenly
7. Hemoptysis – due to high pressure in the pulmonary veins caused by the ____

Answer 25

1. pulmonary venous hypertension.
2. less cardiac output delivered to different systems of the body.
3. contracting forcefully to increase the cardiac output.
4. breath at supine position, so elevate the bed.
   ➢ Two-pillow Orthopnea – if 2 pillows are
   used.
   ➢ Positive of 4-pillow-orthopnea – if 4 pillows are used.
5. the fluid from the extremities goes to the lungs and enters the alveoli causing pulmonary edema.

wakes up experiencing shortness of breath. It is alleviated with upright position or standing up because by gravity the fluid goes down.

7. accumulation of blood in the left atrium, this increased pressure can rupture the pulmonary veins

Question 26

MITRAL STENOSIS
→ Medical Treatment

Answer 26

▪ Diuretic

▪ Digoxin – for HF

▪ Beta-Blockers or Calcium Channel Blockers
➢ Metoprolol & Verapamil

▪ Anticoagulants for AF

▪ If atrial fibrillation develops, cardioversion may be attempted to restore normal sinus rhythm.
➢ AF causes 400 to 600 HR making the blood viscous causing clot formation.

▪ Avoid strenuous activities because it can increase heart rate.

▪ Surgical interventions include valvuloplasty and commissurotomy to open the fused commissure of the valve.

Question 27

PATHOPHYSIOLOGY

❖ AORTIC STENOSIS

▪ Forward Effect
▪ Backward Effect
— Left-Side Heart Failure —

Answer 27

▪ Forward Effect: Aortic stenosis occurs when the aortic valve narrows, reducing the amount of blood ejected from the left ventricle into the aorta during each heartbeat causing decreased CO. As a result, various body systems will receive lesssupply of oxygen and nutrients.

▪ Backward Effect: The restricted flow through the narrowed aortic valve leads to the accumulation of blood and an increase in pressure within the left ventricle. This increased pressure causes the left ventricle to work harder to pump blood effectively, resulting in the enlargement of the left ventricle. It demands more blood from the coronary artery, but the coronary artery can only deliver the same amount of blood, leading to decreased contractility of the left ventricle. Consequently, the blood from the left ventricle will backflow into the left atrium, and then the blood from the left atrium will backflow into the lungs, causing
pulmonary congestion. This condition is known as Left-Side Heart Failure.

Question 28

→ Characteristics of Aortic Stenosis

Answer 28

▪ It causes enlargement of Left Ventricle.

▪ Most common cardiac valve dysfunction.
➢ more common in men
➢ can be asymptomatic for years
➢ hear murmur (most common early sign)

▪ Without treatment, the patient is at risk for:
➢ Heart Failure
➢ Dilated Cardiomyopathy
➢ Sudden Cardiac Death

Question 29

Three Cardinal Symptoms of Aortic Stenosis

Answer 29

▪ Angina – due to less oxygenated blood going to the heart
▪ Syncope – due to less oxygenated blood going to different body systems
▪ Exertional Dyspnea – due to presence of blood in the lungs

Question 30

→ Medical Management of Aortic Stenosis

Answer 30

▪ Transcatheter Aortic Valve Replacement is often preferred for patients who are at higher surgical risk or are not suitable candidates for open-heart surgery.

▪ One or Two Balloon Percutaneous Valvuloplasty for patients who are symptomatic and are not candidates for valve replacement.

Question 31

→ It is a heart condition where the mitral valve does not close completely during contraction.

▪ As a result, some of the blood flows back into the left atrium

Answer 31

❖ MITRAL REGURGITATION

Question 32

→ Etiology of Mitral Regurgitation
RICCC

Answer 32

▪ Rheumatic Fever
▪ Coronary Artery Disease
▪ Cardiomyopathy
▪ Congenital
▪ Infective Endocarditis

Question 33

→ Clinical Manifestations of Mitral Regurgitation

Answer 33

▪ It is often asymptomatic.
▪ Severe and sudden congestive heart failure.
▪ Dyspnea, fatigue, weakness, palpitations, and cough.

Question 34

→ Medical Management of Mitral Regurgitation

Answer 34

▪ ACE Inhibitors (e.g., Captopril, Lisinopril) or ARBs (e.g., Losartan, Valsartan)

▪ Direct Arterial Dilators (e.g., Hydralazine)

▪ Beta-Blockers (e.g., Carvedilol, Metoprolol)

▪ Mitral Valvuloplasty or Valve Replacement

Question 35

→ It is a heart condition where the aortic valve does not close completely during contraction.
▪ As a result, some of the blood flows back into the left ventricle.
▪ Aortic Insufficiency

Answer 35

❖ AORTIC REGURGITATION

Question 36

→ Etiology of Aortic Regurgitation

Answer 36

▪ Rheumatic Fever – most common
▪ Congenital Defect
▪ Calcification among elderly
▪ Trauma
▪ Long standing systemic hypertension

Question 36

→ Clinical Manifestations of Aortic Regurgitation

Answer 36

▪ It develops without symptoms in most px.
▪ Visible or palpable arterial pulsations at the carotid or temporal arteries due to increased force and blood volume.
▪ As it worsens, DOE and fatigue follows; orthopnea, PND

Question 37

→ Medical Management of Aortic Regurgitation

Answer 37

▪ Avoid physical exertion, competitive sports, and isometric exercise until the valve has been replaced.

▪ ACE Inhibitors & Calcium Channel Blockers

▪ Restrict sodium intake to prevent volume overload.

▪ Aortic valve replacement or valvuloplasty performed before left ventricular failure occurs. – done if severely damaged