o DEFINITION

o TYPE OF VALVULAR HEART DISEASE

o CLINICAL MANIFESTATIONS
o PHYSICAL SIGNS
o TREATMENT
o NURSING DIAGNOSIS & INTERVENTION

12/16/2014

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 Structural or/and functional abnormalities of

single or multiple cardiac valves.
It results alternation in blood flow across the
valve.
Classified as :

Stenosis
Regurgitation

1) Mitral valve stenosis

Pathophysiology
Valve cannot open enough
Left atrium generate >> pressure to propel blood
Blood and fluid collect in the lung tissue (pulmonary edema)

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Physical signs
1) CXR
- pulmonary congestion
2) ECG
- atrial fibrillation, atrial
dysrhythmias
3) Auscultation
- diastolic murmur
4) Catheterization
- increased pressure gradient
across valve, increased left
atrial pressure & pulmonary
artery pressure, low CO

Pharmacological tx
Diuretics
Nitrates, beta-blockers
Calcium channel
blockers
ACE inhibitors
Angiotensin receptor
blockers
Digoxin
Anticoagulants
Antibiotics

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2) Mitral valve regurgitation

Pathophysiology
Mitral valve doesn't close all the way
Blood flows backward into the left atrium
Decrease in blood flow to the rest of the body

Congestive heart failure

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Physical signs
1) CXR
-left atrial & ventricular
enlargement
2)ECG
-P-mitrale, left ventricular
hypertrophy, atrial fibrillation
3) Auscultation
-murmur
4)Catheterization
-opacification of left atrium
during injection, increased left
atrial & ventricular pressure

Pharmacological tx

Beta-blockers /ACE
inhibitors
Blood thinners
Drugs that help control
uneven or abnormal
heartbeats
Diuretics

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3) Aortic valve stenosis

Pathophysiology
Aortic valve narrows
Left ventricle works harder to pump blood out
Muscles in the ventricle walls become thicker

Chest pain

Physical signs
1) CXR
-poststenotic aortic dilation,
calcification
2) ECG
-left ventricular hypertrophy
3) Auscultation
-systolic ejection murmur
4) Catheterization
-increased left ventricular enddiastolic pressure

Pharmacological tx
Diuretics
Nitrates
Beta-blockers

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4) Aortic valve regurgitation

Pathophysiology

valve leaflets fail to close properly

during the hearts relaxation phase
blood from the aorta leak back into
the LV
The heart needs to
repump the regurgitated blood into
the aorta with the next heartbeat
Overtime, this extra workload on
the LV can cause the heart to enlarge
and may lead to heart failure.

Physical Signs
1) CXR
-Boot-shaped elongation of cardiac
apex
2) ECG
-Left ventricular(LV) hypertrophy
3) Auscultation
-Diastolic murmur
4) Catheterization
-Opacification of LV during aortic
injection
5) Peripheral signs
-Hyperdynamic myocardial action &
low peripheral resistance

Pharmacological tx
Diuretics
Angiotensinconverting enzyme
(ACE) inhibitors
Antibiotic

5 ) Tricuspid valve stenosis

Pathophysiology
The opening of a stenotic tricuspid valve is narrow
and stiff
restricting blood flow from the atrium to the
ventricle

difficult for blood to be passed from the right

atrium to the right ventricle
blood begins to pool in the atrium and enlarge it

ventricle does not receive enough blood and it

begins to shrink
shrunken ventricle reduces the cardiac output of
blood.

Physical sign
1) CXR
-right atrial enlargement
2) ECG
-right enlargement (Ppulmonale)
3 ) auscultation
-diastolic murmur
4) catherization
-elevated right atrial pressure
with large a waves, pressure
gradient across the triscupid
valve
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6)Tricuspid valve regurgitation

Pathophysiology
right ventricle contracts to pump
blood forward
to the lungs, some blood leaks
backward into
the right atrium
increasing the volume of blood in
the atrium
the right atrium can enlarge
change the pressure in the nearby
chambers
and blood vessels.
12/16/2014

Physical sign
1) CXR
-right atrial and ventricular
enlargement
2) ECG
-right ventricular hypertrophy
and right atrial enlargement,
atrial fibrillation
3) Auscultation
-murmur throughout systole
4 ) Catheterization elevated
-right atrial pressure and V
waves
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Pharmacological tx

Mild- no symptoms no
require treatment.
Antibiotics
Diuretics
Anticoagulants
Antiplatelets
Vasodilators
Cardiac glycosides

Annuloplasty

Valvuloplasty
Involves direct repair to torn leaflets by open surgery.

OPEN COMMISSUROTOMY

CLOSED COMMISSUROTOMY

MODIFIED NATURAL
VALVE

PIG TISSUE VALVE

PORCINE VALVE

COW VALVE

MECHANICAL
VALVE

1) Decrease Cardiac Output

2) Activity Intolerance

1) Decrease Cardiac Output

Intervention:
Assess heart rate and blood
Assess skin color and temperature.
Assess fluid balance and weight gain.
Assess heart sounds, noting gallops, S3, S4.S3 denotes
reduced left ventricular ejection and is a classic sign of left
ventricular failure. S4 occurs with reduced compliance of
the left ventricle, which impairs diastolic filling.
Assess lung sounds. Monitor ECG for rate, rhythm, ectopy,
and change in PR, QRS, and QT.
Assess response to increased activity.

Cont
Assess urine output. Determine how often the patient.
Assess for chest pain.
Indicates an imbalance between oxygen supply and demand.
Assess contributing factors so appropriate plan of care can be
initiated.
Administer medication as prescribed, noting response and watching
for side effects and toxicity.
Maintain optimal fluid balance. For patients with decreased preload,
administer fluid challenge as prescribed, closely monitoring. For
patients with increased preload, restrict fluids and sodium as
ordered.
To decrease extracellular fluid volume.
Maintain adequate ventilation and perfusion, as in the following:
Place patient in semi- to high-Fowler's position
To reduce preload and ventricular filling.

Cont..
Place in supine position
To increase venous return, promote diuresis.
Administer humidified O2 as ordered.
The failing heart may not be able to respond to increased
O2 demands.
Maintain physical and emotional rest, as in the following: Restrict
activity
To reduce O2 demands.
Provide quiet, relaxed environment.
Emotional stress increases cardiac demands.
Organize nursing and medical care
To allow rest periods.
Monitor progressive activity within limits of cardiac function.

2) Activity Intolerance
Intervention:

Determine patient's perception of causes of fatigue or

activity intolerance.

Assess patient's level of mobility.

Assess nutritional status.

Assess potential for physical injury with activity.

Assess need for ambulation aids: bracing, cane, walker,

equipment modification for activities of daily living
(ADLs).

Assess patient's cardiopulmonary status before activity

using the following measures: Heart rate, orthostatic BP
changes and need for oxygen with increased activity

Cont..
Monitor patient's sleep pattern and amount of sleep
achieved over past few days
Assess emotional response to change in physical
status.
Encourage active ROM exercises three times daily. If
further reconditioning is needed, confer with
rehabilitation personnel.
Provide emotional support while increasing activity.
Promote a positive attitude regarding abilities.
Encourage patient to choose activities that gradually
build endurance.

Cont..
Encourage adequate rest periods, especially
before meals, other activities of daily living,
exercise sessions, and ambulation.To reduce
cardiac workload.
Anticipate patient's needs (e.g., keep telephone
and tissues within reach).
Assist patient to plan activities for times when he
or she has the most energy.