Valvular Heart Disease

Valves

• Mitral valve• Aortic valve• Tricuspid valve• Pulmonary valve

Valve Defects

Mitral valve

STENOSIS REGURGITATION

Aortic valve

Tricuspid valve

Pulmonary valve

Rheumatic Heart Disease

• Inflammatory process that may affect the myocardium, pericardium and or endocardium 2ry to infection with group A streptococci.

• Occurs in 5-15yr age group• Usually results in distortion and

scarring of the valves.• Most commonly affected valve is

mitral valve followed by aortic valve.

Pathology

• Abs produced against streptococci cross react with cardiac myosin, sarcolemmal membrane protein.

• Inflammation occurs in joints and skin in addition to heart.

Rheumatic Heart DiseaseClinical features

• Major manifestations

CarditisPolyarthritisChoreaErythema

marginatumSubcutaneous

nodules

• Minor manifestations

FeverArthralgiaPast Hx of RFRaised ESR/ CRP Leucocytosis1st degree AV block

Rheumatic Heart Disease

• Diagnosis is done according to Jones criteria.

2 or more major manifestations1 major + 2 or more minor manifestations

Rheumatic Heart DiseaseTreatment

• Penicillin• Bed rest• Aspirin• Corticosteroid• Secondary prevention with monthly

benzathine penicillin injections.

Mitral Stenosis• Usually results from rheumatic carditis• Is a thickening by fibrosis or calcification• Can be caused by tumors, calcium and thrombus • Valve leaflets fuse and become stiff and the

cordae tendineae contract• These narrows the opening and prevents normal

blood flow from the LA to the LV• LA pressure increases, left atrium dilates, PAP

increases, and the RV hypertrophies• Pulmonary congestion and right sided heart

failure occurs• Followed by decreased preload and CO decreases

Mitral Stenosis, cont.

• Mild – asymptomatic• With progression – dyspnea, orthopneas,

dry cough, hemoptysis, and pulmonary edema may appear as hypertension and congestion progresses

• Right sided heart failure symptoms occur later

• S/S– Pulse may be normal to A-Fib– Apical diastolic murmur is heard

Mitral Regurgitation• Primarily caused by rheumatic heart disease, but

may be caused by papillary muscle rupture form congenital, infective endocarditis or ischemic heart disease

• Abnormality prevents the valve from closing• Blood flows back into the right atrium during

systole• During diastole the regurg output flows into the

LV with the normal blood flow and increases the volume into the LV

• Progression is slowly – fatigue, chronic weakness, dyspnea, anxiety, palpitations

• May have A-fib and changes of LV failure• May develop right sided failure as well

Mitral Valve Prolapse

• Cause is variable and may be associated with congenital defects

• More common in women• Valvular leaflets enlarge and prolapse into

the LA during systole• Most are asymptomatic• Some may report chest pain, palpitations

or exercise intolerance• May have dizziness, syncope and

palpitations associated with dysrhythmias• May have audible click and murmur

Aortic Stenosis• Valve becomes stiff and fibrotic, impeding blood flow with

LV contraction• Results in LV hypertrophy, increased O2 demands, and

pulmonary congestion• Causes – rheumatic fever, congenital, arthrosclerosis• Atherosclerosis and calcification is primary cause in the

elderly• Complications – right sided heart failure, pulmonary edema,

and A-fib• S/S – Early: dyspnea, angina, syncope Late: marked fatigue, debilitation, and

peripheral cyanosis, crescendo- decrescendo murmur is heard

Aortic Regurgitation• Aortic valve leaflets do not close properly during diastole• The valve ring that attaches to the leaflets may be dilated,

loose, or deformed• The ventricle dilates to accommodate the ^ blood volume

and hypertrophies• Causes: infective endocarditis, congenital, hypertension,

Marfan’s • May remain asymptomatic for years• Develop dyspnea, orthopnea, palpitations, ,and angina• May have ^ systolic pressure with bounding pulse• Have a high pitch, blowing, decrescendo diastolic murmur

Assessment for Valve Dysfunction

• Subjective symptoms– Fatigue– Weakness– General malaise– Dyspnea on exertion– Dizziness– Chest pain or discomfort– Weight gain – Prior history of rheumatic heart disease

Assessment, cont.

• Objective symptoms– Orthopnea– Dyspnea, rales– Pink-tinged sputum– Murmurs– Palpitations– Cyanosis, delayed capillary refill– Edema– Dysrhythmias– Restlessness

Diagnosis

• History and physical findings• ECG• Chest x-ray• Cardiac catheterization • Echocardiogram

Medial Treatment

• Nonsurgical management focuses on drug therapy and rest

• Diuretic, beta blockers, digoxin, O2, vasodilators, prophylactic antibiotic therapy

• Manage A-fib, if develops, with conversion if possible, and use of anticoagulation

Interventions

• Assess vitals, heart sounds, breath sounds• O2 as prescribed• Emotional support• Give medications• I/O• Weight• Check for edema• Explain disease process, provide for home

care with O2, medications

Surgical Management of Valve Disease

• Mitral Valve– Commissurotomy – Mitral Valve Replacement– Balloon Valvuloplasty

• Aortic Valve Replacement

Mechanical Valve

Mechanical Valve

Porcine Valve

Tissue Valve

Tissue Valve