Term
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Definition
Open and close secondary to changes in pressure gradients.
Dysfunction occurs when they are not able to fully open or close. |
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Term
|
Definition
of affects the aortic or pulmonic valve
Wrong size
malformed leaflets
leaflets that are not attached correctly |
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Term
|
Definition
Problems that develop with valves that were once normal
involve changes in the structure
due to a variety of diseases and infections |
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Term
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Definition
Is caused by an untreated bacterial infection
An acute inflammatory disease of the heart potentially
involving all layers
• Chronic condition resulting from rheumatic fever
• Characterized by scarring and deformity of the heart valves
Symptoms associated with the inflammation may not be seen until 20-40
years later
• (usually strep throat) |
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Term
|
Definition
Large numbers of organisms enter bloodstream and infect valves
(group A streptococcal pharyngitis)
swelling and erosion of valve leaflets
vegetation forms from deposits of fibrin and blood cells in
areas of erosion
fibrous thickening of leaflets
fusion of commissures and chordae tendineae
fibrosis of papillary muscle
valve leaflets may fuse and become thickened or calcified
resulting in stenosis
reduction in mobility of valve leaflets may occur with failure of
the valve leaflets to close properly
resulting in regurgitation
Mitral and Aortic valves most commonly affected |
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Term
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Definition
• Occurs when bacteria enter the bloodstream and attack the
heart valves
– Causing growths, holes and scarring in the valves
• Leaky valves
• Bacteria that enters the blood can occur during
– Dental procedures
– Surgery
– IV drug use
– Severe infections
People with valve disease can be at a higher risk for
developing ________. |
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Term
|
Definition
Valvular Heart disease is defined according to the
– valve or valves affected
– type of functional alteration |
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Term
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Definition
| Narrowing of orifice/impedes flow of blood |
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Term
|
Definition
| Incomplete closure of valve/backward flow of blood |
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Term
| Etiology and Pathophysiology in Mitral Stenosis |
|
Definition
Structural deformities cause
– Obstruction of blood flow
– Create a pressure difference between left atrium
and left ventricle during diastole
– Left atrial pressure and volume increases
– High pulmonary vascular pressures and
hypertrophy of the pulmonary vessels
• in chronic MS pressure overload occurs in the left
atrium, pulmonary bed and right ventricle |
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Term
| Clinical Manifestations Mitral Stenosis |
|
Definition
May remain asymptomatic for 10-15 years
• Any Physiological state that causes an
• increase in in CO
• decrease in diastolic filling time
• Excessive fatigue
• Malaise
• Decreased exercise tolerance
• Dyspnea on exertion
• Orthopnea
• Nocturnal dyspnea |
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Term
| Symptoms of right sided heart failure |
|
Definition
neck vein distention, pitting peripheral edema
Pulmonary edema, tachypnea, cyanosis, pink frothy sputum
loud apical 1st heart sound and diastolic murmur |
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Term
| Etiology and Pathophysiology in Mitral Regurgitation |
|
Definition
Any defect in intact leaflets, annulus, chordae tendineae,
papillary muscles, left atrium and left ventricle can result in
regurgitation
• Blood flows backward from the left ventricle to the left
atrium due to incomplete valve closure during systole
• Left ventricle and left atrium work harder to preserve an
adequate CO
– Acute
– Chronic |
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Term
Clinical Manifestations Mitral
Regurgitation |
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Definition
| Determined by the nature of onset |
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Term
Clinical Manifestations Mitral
Regurgitation (Acute) |
|
Definition
Low CO
– thready peripheral pulses, cool clammy extremities
• Rapid assessment and intervention
• (valve repair or replacement) |
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Term
Clinical Manifestations Mitral
Regurgitation (Chronic) |
|
Definition
Soft 1st heart sound and a systolic murmur
• increased ventricular filling can lead to an S3
• Pulmonary congestion (fine rales)
– May remain asymptomatic for many years
– weakness, fatigue, palpitations, dyspnea
– gradually progress to orthopnea, paroxysmal nocturnal dyspnea,
peripheral edema , JVD, enlarged live |
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Term
| Etiology and Pathophysiology in Mitral Valve Prolapse |
|
Definition
Most common form of valve disease in USA (2%-6%)
Abnormality of the mitral valve leaflets and the papillary
muscles or chordae that allows the leaflets to prolapse into
the left atrium during systole (2%-6%)
Usually benign
Serious complications can occur
MR, IE, HF,
Most patients have no other manifestations of cardiac disease
Follow up evaluations every 3-5 years recommended |
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Term
| Etiology and Pathophysiology in Aortic Stenosis |
|
Definition
Fusion of the commissures and secondary calcification cause
the valve leaflets to stiffen and retract resulting in stenosis
• Causes obstruction of flow from the left ventricle to the aorta
during systole
• Left ventricular hypertrophy
• pulmonary hypertension and HF
• Reduced CO
• decreased tissue perfusion |
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Term
Clinical Manifestations in Aortic
Stenosis |
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Definition
Symptoms begin when the valve becomes one third of its
normal size |
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Term
Clinical Manifestations in Aortic
Stenosis (Chronic) |
|
Definition
diminished or absent S2
– systolic murmur
– Pulmonary congestion (fine rales) |
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Term
Clinical Manifestations in Aortic
Stenosis (Classic symptoms) (reflecting left ventricular failure) |
|
Definition
Angina
• Syncope
• Exertional dyspnea
Prognosis is poor for a patient with symptoms whose
valve obstruction is not relieved
(Use nitro cautiously it can significantly reduce BP and increase chest pain) |
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Term
Clinical Manifestations of Aortic
Stenosis |
|
Definition
• Acute
• Cardiovascular collapse
– (left ventricle is exposed to aortic pressure during diastole)
– Severe dyspnea, chest pain, hypotension
• Left ventricular failure and cardiogenic shock |
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Term
| Etiology and Pathophysiology of Aortic Regurgitation |
|
Definition
May be a result of primary disease of the aortic valve leaflets, the aortic root
or both
– Congenital or Acquired
– Acute
– Chronic
• Retrograde blood flow from the ascending aorta into the left ventricle during
diastole
• Volume overload
• LV compensates by dilation and hypertrophy
• Myocardial contractility declines and blood volume increases in the left
atrium and pulmonary bed
• Pulmonary hypertension and right ventricular failure |
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Term
| Clinical Manifestations of Aortic Regurgitation (most common symptoms) |
|
Definition
Labored breathing on exertion
– Angina with exertion
– Orthopnea
– Nocturnal dyspnea
• Thrusting apical pulsation (bounding and displaced to the left)
• Diastolic murmur
• Pulmonary congestion (fine crackles)
• Low diastolic BP |
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Term
Etiology and Pathophysiology of Tricuspid and Pulmonic Valvular
Disease |
|
Definition
Uncommon
• Stenosis occurs more frequently than
regurgitation |
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Term
|
Definition
Right atrial enlargement and elevated systemic
venous pressures |
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Term
|
Definition
| Right ventricular hypertension and hypertrophy |
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Term
|
Definition
History and Physical exam
• Chest x-ray
• CBC
• Electrocardiogram
• Echocardiography (Doppler and Transesophageal)
• Cardiac Catheterization |
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Term
|
Definition
depends on the valve involved and disease
severity |
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Term
Medical Therapy
– Preventing exacerbations of Heart Failure |
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Definition
vasodilators, positive inotropes, B-adrenergic blockers,
diuretics, low sodium diet |
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Term
Medical Therapy
– Preventing exacerbations of Acute pulmonary edema |
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Definition
| diuretics, preload reducers |
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Term
Medical Therapy
– Preventing exacerbations of Thromboembolism |
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Definition
|
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Term
Medical Therapy
– Preventing exacerbations of Dysrhythmias |
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Definition
| (atrial) digoxin, B-adrenergic blockers, antidysrhythmia drugs |
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Term
Medical Therapy
– Preventing exacerbations of Recurrent endocarditis |
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Definition
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Term
| Percutaneous Transluminal Balloon Valvuloplasty |
|
Definition
– Splits open the fused commissures
• aortic stenosis
• mitral stenosis
• tricuspid stenosis
• pulmonic stenosis
– Typically used in older adults who are poor surgical
candidates
• Fewer complications |
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Term
| Mitral Commissurotomy (MS) |
|
Definition
Open method (CPB)
• Commissure incision… separates fused chordae by splitting the underlying papillary
muscle and debriding the ca |
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Term
|
Definition
Suturing the torn leaflets, chordae tendineae or papillary muscle
Open surgical
Minimally invasive
Ministernotomy
May include robotics |
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Term
|
Definition
Reconstruction of the annulus
– With or without a prosthetic ring |
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Term
|
Definition
• Decreased Cardiac Output
• Fluid Volume Excess
• Ineffective Breathing Pattern
• Activity Intolerance
• Sleep Pattern Disturbance
• Anxiety
• Knowledge Deficit/Home Care |
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Term
|
Definition
• Decreased Cardiac Output
• Fluid Volume Excess
• Ineffective Breathing Pattern
• Activity Intolerance
• Sleep Pattern Disturbance
• Anxiety
• Knowledge Deficit/Home Care |
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Term
| Post OP Care after Valve Surgery |
|
Definition
Anticoagulants with artificial valves
• Prophylactic antibiotics with dental procedures to prevent
endocarditis |
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