Valvular Heart Disease (Stenosis, Prolapse, Regurgitation)

Question 1

Where to listen to the different valves/heart sounds

Answer 1

aortic area - right 2nd ICS
pulmonic - left 2nd ICS
Erb’s point - left 3rd ICS (S1/S2 simultaneously)
tricuspid - left 4th ICS
mitral - left 5th ICS midclavicular line

All (aorta)
People (pulmonic)
Everywhere (Erb’s point)
Take (tricuspid)
Meds (mitral)

Question 2

valvular problems

Answer 2

stenosis
regurgitation
prolapse

Question 3

stenosis

Answer 3

constriction/narrowing

• secondary to rheumatic heart disease (RHD)
• the door won’t open all the way
• the valve is stiff, non-compliant

Question 4

regurgitation

Answer 4

incompetence/insufficiency

• secondary to aging & ineffective endocarditis
• the door won’t close all the way

Question 5

prolapse

Answer 5

the leaflets buckle

• etiology unknown
• most common valve problem in U.S.

Question 6

clinical manifestations of valvular problems

Answer 6

• exertional dyspnea, weakness, fatigue
• chest pain
• murmur
• pulmonary or peripheral edema/HF

Question 7

collaborative care with valvular heart disease

Answer 7

• prevention of rheumatic fever, RHD, IE (abx prophylaxis)
• sodium restriction
• meds to treat/control HF
• anticoags & anti-dysrhythmia drugs
• percutaneous comissurotomy / transluminal balloon valvuloplasty
• percutaneous valve replacement

Question 8

surgical care for valvular heart disease (repair)

Answer 8

valve repair

• commissurotomy (valvulotomy / valvotomy; incisions)
• valvuloplasty (opens stiff valves; uses balloons)
• annuloplasty (surgery to repair/reshape valves)

Question 9

options for valve replacement

Answer 9

mechanical
biologic

Question 10

mechanical valves

Answer 10

lasts > 20 years; more durable
require lifelong anticoagulation
will hear click

Question 11

biologic (porcine) valves

Answer 11

lasts 8-10 years; less durable
no anticoagulation needed
no click

Question 12

annuloplasty

Answer 12

a procedure to tighten or reinforce the ring (annulus) around a valve in the heart, with or without the aid of prosthetic rings. It may be done during other procedures to repair a heart valve

Question 13

post-op patient considerations after valve replacement

Answer 13

post-op recovery similar to CABG

prosthetic valve - lifetime of prophylactic anticoag
if warfarin, therapeutic range of 2.5-3.5
limit Vit. K, or don’t binge on (antidote to warfarin)
use electric razor prn
report bleeding or excessive bleeding
avoid magnetic resonance (mechanical valve)
medic alert bracelet/card