T4: Valvular Heart Disease Flashcards by Spencer Aldrich-Stone

atrioventricular valves include

-Mitral
-Tricuspid

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semilunar valves include

-Aortic
-Pulmonic

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stenosis

constriction or narrowing

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in a stenosed valve..

-Valve orifice is smaller
-Forward blood flow is impeded
-Pressure differences reflect degree of stenosis, BLOOD CANT PUMP OUT

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regurgitation

incompetence/ insufficiency

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in a valve with regurgitation..

-Incomplete closure of valve leaflets
-Results in backward flow of blood

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mitral valve stenosis

narrowing of the mitral valve from scarring, usually caused by episodes of rheumatic fever

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what do the majority of mitral valve stenosis cases result in

rheumatic heart disease

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Rheumatic endocarditis causes scarring of

the valve leaflets and the chordae tendineae.

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mitral valve stenosis results in

decreased blood flow from left atrium to left ventricle
-↑ Left atrial pressure and volume
-↑ Pressure in pulmonary vasculature

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because mitral valve stenosis causes an overloaded left atrium, it places the patient at risk for

atrial fibrillation

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atrial fibrillation increases the risk for

blood clots

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The stenotic mitral valve takes on what kind of shape

a “fish mouth” shape because of the thickening and shortening of the mitral valve structures.

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clinical manifestations of mitral valve stenosis

-EXERTIONAL DYSPNEA
-Loud S1
-Murmur
-Fatigue
-Palpitations
-Hoarseness, hemoptysis
-Chest pain, seizures/stroke

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Mitral valve regurgitation

*allows blood to flow backward from the left ventricle to the left atrium due to incomplete valve closure during systole.

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In chronic Mitral valve Regurgitation, the additional volume results in

left atrial enlargement, left ventricular dilation and hypertrophy, and finally a decrease in CO.

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Mitral Valve Regurgitation damage is caused by

-MI
-Chronic rheumatic heart disease
-Mitral valve prolapse
-Ischemic papillary muscle

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acute clinical manifestations of mitral valve regurgitation

Thready peripheral pulses and cool, clammy extremities

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chronic clinical manifestations of mitral valve regurgitation

-Asymptomatic for years until development of some degree of left ventricular failure
-Weakness, fatigue, palpitations, progressive dyspnea
-Peripheral edema, S3, murmur

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mitral valve prolapse

Abnormality of mitral valve leaflets and the papillary muscle or chordae
-Leaflets prolapse back into left atrium during systole

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clinical manifestations of mitral valve prolapse

-Most patients asymptomatic for life
-Dysrhythmias can cause palpitations, light-headedness, and dizziness
-Infective endocarditis
-Chest pain unresponsive to nitrates
-Murmur d/t regurgitation
-Severe MR uncommon

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how do we treat the symptoms of mitral valve prolapse

with B-blockers

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patient teaching for mitral valve prolapse

-Antibiotic prophylaxis if MR present
-Take drugs as prescribed
-Healthy diet; avoid caffeine, hydrate
-Avoid OTC stimulants
-Exercise
-When to call HCP or EMS

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which population mostly gets mitral valve prolapse and why

women because of hormones

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what is the most discriminating test or having an MI

troponins

HINT HINT what medications can we give for mitral valve prolapse

metoprolol; b blocker s

aortic valve stenosis

narrowing of the aortic valve resulting in Obstruction of flow from left ventricle to aorta -Left ventricular hypertrophy and ↑ myocardial oxygen consumption

aortic valve stenosis leads to

↓ CO, pulmonary hypertension, and HF

aortic valve stenosis can be caused by

-Congenital stenosis usually discovered in childhood, adolescence, or young adulthood

clinical manifestations of aortic valve stenosis

-Angina -Syncope -Exertional dyspnea (reflecting left ventricular failure)

auscultatory findings in aortic stenosis

§Normal to soft S1 §Diminished or absent S2 §Systolic murmur §Prominent S4

why do we use nitro cautiously in aortic valve stenosis

-Reduces preload and BP -Can worsen chest pain

aortic valve regurgitation is...

life threatening

what can cause ACUTE aortic valve regurgitation

TRAUMA, IE, aortic dissection IFE THREATENING !!

what can cause CHRONIC aortic valve regurgitation

Rheumatic heart disease, congenital bicuspid aortic valve, syphilis, chronic rheumatic conditions

Aortic Valve Regurgitation

Backward blood flow from ascending aorta into left ventricle

Aortic Valve Regurgitation can cause

-left ventricular dilation and hypertrophy -↓ Myocardial contractility -Pulmonary hypertension and right ventricular failure

HINT HINT what is the difference between stenosis and regurgitation

regurg: valves dont close properly stenosis: narrow

clinical manifestation of ACUTE aortic valve regurgitation

-Severe dyspnea (bc pulmonary HTN) -Chest pain -Hypotension -Cardiogenic shock -Life-threatening emergency

Clinical manifestations of CHRONIC aortic valve regurgitation

-May be asymptomatic for years -Exertional dyspnea, orthopnea, paroxysmal dyspnea -Angina -"Water-hammer" pulse if severe -Soft or absent S1 -S3 or S4 -Murmur

Tricuspid stenosis occurs almost exclusively in patients with

*RF or who abuse IV drugs.

Tricuspid stenosis results in

*right atrial enlargement and elevated systemic venous pressures.

clinical manifestations of tricuspid stenosis

-Peripheral edema -Ascites -Hepatomegaly -Murmur (diastolic low-pitched murmur with increased intensity during inspiration)

pulmonic valve stenosis cause

almost always congenital

pulmonary stenosis results in

right ventricular hypertension and hypertrophy

clinical manifestation fro pulmonary stenosis

Fatigue and loud murmur

Valvular Heart DiseaseDiagnostic Studies

-CT scan of chest -Echocardiogram -Chest x-ray -ECG -Heart catheterization

management for valvular heart disease

-Prophylactic antibiotic therapy to prevent recurrent RF and IE -Dependent on valve involved and disease severity -Prevent exacerbations of HF, pulmonary edema, thromboembolism, and recurrent endocarditis

drugs to treat/control HF

-Vasodilators (e.g., nitrates, ACE inhibitors) -Positive inotropes (e.g., digoxin) -Diuretics -β-blockers -Sodium restriction -Anticoagulation therapy -Anti-dysrhythmic drugs

in people with valvular heart disease what must they do before the dentist

abx before the dentist to prevent endocarditis

Percutaneous transluminal balloon valvuloplasty

balloon tipped catheter inserted via femoral artery into the stenoic valve -then inflated to separate valve leaflets -split open fused commissures

if a patient has mechanical valves inserted what must they be on

lifelong anticoagulants

the type of valve repair/replacement depends on

(1) valves involved (2) pathology and severity of the disease (3) patient's clinical condition.

what is the procedure of choice for patients with pure mitral stenosis

Mitral commissurotomy (valvulotomy)

Open surgical valvuloplasty involves

*repair of the valve by suturing the torn leaflets, chordae tendineae, or papillary muscles. It is primarily used to treat mitral or tricuspid regurgitation.

biologic (tissue)valve replacemetn are constructed form

bovine, porcine, and human (cadaver) heart tissue and usually contain some man-made materials

HINT HINT mechanical vs biologic valves

mechanical: on anticoagulants forever but lasts longer bio: no anticoagultion needed but less durable

objective data for valvular disease

-Fever -Diaphoresis, flushing, cyanosis, clubbing, peripheral edema -Crackles, wheezes, hoarseness -S3 and S4 -Dysrhythmias -↑ or ↓ in pulse pressure; hypotension -Water-hammer or thready peripheral pulses -Hepatomegaly, ascites -Weight gain

health promotion for valve disease

-Diagnosing and treating streptococcal infection -Prophylactic antibiotics for patients with history -Encourage compliance -Teach patient when to seek medical treatment -Individualize rest and exercise -Avoid strenuous activity -Discourage tobacco use -Ongoing cardiac assessments to monitor drug effectiveness -Monitor INR 2.5-3.5

INR levels

2.5-3.5

T4: Valvular Heart Disease Flashcards

(60 cards)