valvularheartdisease-1223958935203145-9
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HeartValves
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the valve opening narrowsthe valve leaflets may become fused or thickened that thevalve cannot open freely obstructs the normal flow of blood
EFFECTS: the chamber behind the stenotic valve is subject togreater stress must generate more pressure or workhard to force blood through the narrowed opening
initially, the compensates for the additional workload bygradual hypertrophy and dilation of the myocardium heart failure
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scarring and retraction of valve leaflets or weakening ofsupporting structures incomplete closure of the valve
result to leakage or backflow of blood from the previouschamber
EFFECTS: causes the to pump the same blood twice (as theblood comes back into the chamber)the dilates to accommodate more blood (the usual bloodit needs to pump + regurgitated blood)ventricular dilation and hypertrophy eventually leads to
heart failure
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Congenital heart diseaseRheumatic heart diseaseHeart attack damage to the heart muscle, papillary musclesWeakening of supporting structures of the heartWeakening of the heart muscleInfections bacterial endocarditis
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most common valvular disorderin rheumatic fevermay also be caused by bacterialinfection, thrombusformation, calcificationobstruct blood flow from leftatrium to the left ventricle
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Narrowing of mitral valve
CO
O2/CO2 exchange(fatigue, dyspnea,
orthopnea)
Left ventricularatrophypulmonarycongestion
pulmonarypressure
left atrialpressure
Hypertrophyleft atrium
blood flow toleft ventricle
Right-sidedfailure
Fatigue
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exertional dyspnea and fatigue (most common)orthopnea, paroxysmal nocturnal dyspnea, cough,hemoptysiscyanosis
Right-sided heart failure distended neck veins,peripheral edema, hepatomegaly, abdominal discomfortAuscultation: S1 followed by an opening snap--created by
forceful opening of mitral valve
- rumbling diastolic murmur (apex)CXR- left atrial enlargementECG atrial fibrillation may develop (50-80% of pts.)
- pulses becomes irregular & faint, BPEchocardiogram (2D Echo) most sensitive in diagnosis
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Na+ restriction, diuretics to relieve pulmonary congestionbed rest, sitting positionDigitalis improve cardiac contraction, HR, treat atrialfibrillationAnticoagulants (blood thinners) coumadin, aspirin,ticlopidine (Ticlid), Plavix, dipyridamoleSurgical interventions:
Mitral commissurotomy separation or incision of thestenosed valve leaflets at their borders or commissures
Balloon mitral valvuloplastyMitral valve replacement when stenosis is severe
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Balloonmitralvalvuloplas
ty
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incomplete closure of the mitral valverheumatic disease is the predominant causemay also be due to congenital anomaly, infective endocarditis,rupture of papillary muscle following MI
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a leaking mitral valve - Stroke volume, CO- Left atrial hypertrophy
- Pulmonary congestion
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Incomplete closure ofmitral valve
vol. of blood ejected byleft ventricle Left atrial pressure
Right-sided heart failure
Left atrial hypertrophyCO
Pulmonary pressure
Backflow of blood to theleft atrium
Right ventricular
pressure
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Fatigue & weakness due to CO predominant complaintexertional dyspnea & cough pulmonary congestionpalpitations due to atrial fibrillation (occur in 75% of pts.)Right-sided heart failure distended neck veins, edema,ascites, hepatomegalyAuscultation: blowing, high-pitched systolic murmur (apex)
- S1 is diminished- S3 severe regurgitation
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restrict physical activity to prevent fatigue & dyspnea Na+ intake, diuretics relieve congestion
Digitalis, vasodilators promote adequate ventricularemptying and prevent or decrease regurgitation
ACE inhibitors arterial dilation, afterloadSurgery:
- Valvuloplasty (repair or reconstruction)- Valve replacement
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Mitral Valve Prolapse
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when 1 or both of the valve leaflets bulge into the leftatrium during ventricular contraction
more common in women Cause: due to an inherited connective tissue disorder
enlargement of one or both valve leaflets
Elongates/stretches the chordae tendinae & papillarymuscles regurgitation may occurusually asymptomatic
Extra heart sound (Mitral click) an early sign that a valve
leaflet is ballooning into the left atriumfatigue, shortness of breatharrhythmias may develop dizziness, chest pain, dyspnea,palpitations, syncopehigh-pitched late systolic murmur
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Interventions:antibiotic prophylaxis to prevent endocarditis
If w/ dysrhythmia avoid caffeine, alcohol, stopsmokinganti-arrhythmic drugs
for chest pain nitrates, calcium channel blockers,
beta blockerssurgery not indicated
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may be due to rheumatic heart disease, atherosclerosis,congenital valvular disease or malformationsnarrowing of the aortic valve
flow of blood from the left ventricle to the aorta blood volume and pressure in the left ventricle
Left ventricle hypertrophy develops as a
compensatory mechanism to continue pumping bloodthrough the narrowed opening
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Aortic Stenosis
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Aortic
Stenosis
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Stiffening/Narrowing ofAortic Valve
Incomplete emptying of
left atrium
Left ventricular hypertrophy
Pulmonary congestionCompression of
coronary arteries
Right-sided heart failure
CO
MyocardialO2 needs
Myocardial ischemia(chest pain)
O2 supply
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fatigue & exertional dyspnea 1st symptoms due to CO
and pulmonary congestion chest pain (angina) most common symptom
- occurs during exercise due to inability of the heart toincrease coronary blood flow to cardiac muscle
exertional syncope , vertigo, periods of confusion -- COweakness, orthopnea, PND, pulmonary edema (severe cases)signs of right-sided heart failure - end-stage symptoms
- if untreated, survival rate: 1.5-3 years
Auscultation: harsh, rough, mid-systolic murmur
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restrict activitydigitalisNa+ restriction, diuretics
Nitroglycerin for chest painSurgical:
Balloon aortic valvuloplastyAortic valve replacement if not done - poor prognosis
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may be due torheumatic fever most common causeother causes:connective tissuedisease (Marfanssyndrome), severehypertension,congenital anomaly
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Incomplete closure of theaortic valve
Backflow of blood to Leftventricle
Left ventricularhypertrophy & dilation
Left atrial pressure
Left-sided heart failure
(late stage)
Left atrium hypertrophy
COPulmonary pressure
Right-sided heart failure Right ventricular
pressure
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pt. may remain asymptomatic for years --- heartcompensates by hypertrophy & dilation 1st s/sx- heightened awareness of the heart beat &
palpitations esp. when pt. lies on left lateral positiontachycardia, PVC assoc. w/ left ventricular dilation
bounding pulse, marked carotid artery pulsation, apicalpulse force and volume of contraction of thehypertrophied left ventricleDecompensation occurs (cardiac muscle fatigue)
exertional dyspneachest pain myocardial ischemialeft-heart failure fatigue, orthopnea,
right-heart failure peripheral edema
Auscultation: soft, blowing diastolic murmur
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antibiotic prophylaxis before any invasive or dentalproceduresavoid physical exertion, competitive sportsvasodilators, calcium channel blockers, ACE inhibitors
Aortic valvuloplasty or valve replacement
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usually occurs together w/ aortic or mitral stenosismay be due to rheumatic heart disease
blood flow from right atrium to right ventricle right ventricular output
left ventricular filling CO
blood accumulates in systemic circulation systemic pressure
S/Sx: symptoms of right-sided heart failure- hepatomegaly- peripheral edema- neck vein engorgement- CO fatigue, hypotension
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uncommon, may be caused by RF, bacterial endocarditismay also be caused by enlargement of right ventriclean insufficient tricuspid valve allows blood to flow backinto the right atrium venous congestion & rightventricular output blood flow towards the lungs
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may not produce any symptomsmoderate-to-severe tricuspid regurgitation exist, the ff.may result:
Active pulsing in the neck veins
Swelling of the abdomenSwelling of the feet and anklesFatigue, tirednessWeakness
Decreased urine outputon palpation, there may be a lift (beating of enlarged rightventricle)murmur on auscultation
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rare, usually congenital in origin flow of blood to the pulmonary artery due to narrowing
blood flows back to right ventricle and right atrium
right ventricle hypertrophy to compensate for
blood volume and force blood to the pulmonary arteryS/Sx:
harsh systolic murmurfatigue, dyspnea on exertion, cyanosispoor weight gain or failure to thrive in infantshepatomegaly, ascites, edema
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a rare condition caused by infective endocarditis,tumors or RF
blood flows back into Right ventricle Right ventricleand atrium hypertrphy symptoms of Right-sidedheart failure
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Valvuloplasty is repair of cardiac valve pt. does not require continuous anti-coagulant medication usually require cardiopulmonary bypass machine
Commissurotomy to separate the fused leafletsBalloon Valvuloplasty performed in the cardiac cath. lab.
- balloon inflated for 10-30 secs., w/ multipleinflations- common used for mitral and aortic stenosis
Closed surgical valvuloplasty done in the OR under GA- midsternal incision, a small hole is cut into the
heart, the surgeons finger or a dilator is used to open thecommissure
Open Commissurotomy done w/ direct visualization ofthe valve, thrombus and calcifications may be identified
and removed
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2. Annuloplasty is repair of valve annulus (junction of the valve leafletsand the muscular heart wall)
- narrows the diameter of the valves orifice, useful forvalvular regurgitation
3. Chordoplasty is repair of chordae tendineae- done for mitral valve regurgitation caused by stretched,
torn or shortened chordae tendineae
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Mechanical valves Ex. Caged ball valve, Tilting-disk valve- more durable, used for younger pts.- risk of thromboembolism long-term use of anti-coagulants
Tissue or biological valves:
- xenografts porcine or bovine heterografts (7-10 yrsviability)- homografts from cadaver tissue donations (10-15 yrs)- autografts excising the pts.s own pulmonic valve and
portion of pulmonary artery for use as the artic valveLong-term anticoagulant therapyAntibiotic prophylaxis
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