1. Valvular Heart DiseaseCardiomyopathy and Aneursyms by Laurie Dickson

2. Valvular Heart Disease • Heart contains • Two atrioventricular valves • Mitral • Tricuspid • Two semilunar valves • Aortic • Pulmonic • Valvular Disease

3. Valvular Heart Disease • Types of valvular heart disease depend on • Valve or valves affected • Two types of functional alterations • Stenosis • Regurgitation • HeartPoint: HeartPoint Gallery • Flashcards about Ch 19 NETI KQ- on your own

4. Pathophysiology • Stenosis- narrowed valve, increases afterload • Regurgitation or insufficiency- increases preload. The heart has to pump same blood • **Blood volume and pressures are reduced in front of the affected valve and increased behind the affected valve. • This results in heart failure • All valvular diseases have a characteristic murmur murmurs

5. Valvular Heart Disease • Valvular disorders occur • in children and adolescents primarily from congenital conditions • in adults from degenerative heart disease • Risk Factors • Rheumatic Heart Disease MI • Congenital Heart Defects • Aging • CHF

6. Mitral Valve Stenosis Pathophysiology • Decreased blood flow into LV • LA hypertrophy • Pulmonary pressures increase • Pulmonary hypertension • Decreased CO

7. Fig. 37-9 Fish mouth

8. Mitral Valve Stenosis Manifestations • Primary symptom is DOE • Later get symptoms of R heart failure • A fib is common • MVS murmur • Usually secondary to rheumatic fever

9. Mitral Valve Regurgitation Pathophysiology Manifestations • Regurgitation of blood into LA during systole • LA dilation and hypertrophy • Pulmonary congestion • RV failure • LV dilation and hypertrophy-to accommodate increased preload and decreased CO • Thready pulses • Cool extremities • Symptoms of LV failure • Third heart sound (S3) • MVR murmur

11. Mitral Valve Prolapse Pathophysiology Manifestations • Abnormality of the mitral valve leaflets, papillary muscles or chordae • Etiology unknown • Most common valvular heart disease in US • Female 2x > Male • Usually asymptomatic • Click murmur • Atypical chest pain does not respond to NTG • Tachydysrhythmias may develop- SVT • Risk for endocarditis may be increased • heart association guidelines

12. Mitral Valve Prolapse • May or may not be present with chest pain • If pain occurs, episodes tend to occur in clusters, especially during stress • Pain may be accompanied by dyspnea, palpitations, and syncope • Does not respond to antianginal treatment • MVP murmur (mid-systolic click) • TEE MVP

14. Aortic Valve Stenosis Pathophysiology Aortic Valve Problems • Increase in afterload • Incomplete emptying of LA • LV hypertrophy • Reduced CO • RV strain • Pulmonary congestion • Poor prognosis when experiencing symptoms and not treated- 10-20%sudden cardiac death

15. Aortic Valve Stenosis Manifestations • May be asymptomatic for many years due to compensation • AVS murmur Nitroglycerin is contraindicated because it reduces preload • Syncope • Angina • Dyspnea • Exertional Syncope, Angina, DOE are classic symptoms • This triad reflects LVF • Later get signs of RHF

16. Bicuspid Aortic Valve Congenital Heart Defect Most Common Congenital Heart Disease Familial Male>Female

17. Aortic Valve Regurgitation Pathophysiology • Increased preoad- 60% of SV can be regurgitated • Characteristic water hammer pulse • Regurgitation of blood into the LV • LV dilation and hypertrophy • Decreased CO YouTube - Corrigan's sign

18. Aortic Valve Regurgitation Manifestations • Sudden manifestations of cardiovascular collapse • Left ventricle exposed to aortic pressure during diastole • Weakness • Severe dyspnea • Chest pain • Hypotension • Constitutes a medical emergency • AVR murmur

19. Tricuspid and Pulmonic Valve Disease Pathophysiology Manifestations • Uncommon • Both conditions cause an increase in blood volume in R atrium and R ventricle • Result in Right sided heart failure • Tricuspid- Rheumatic • Pulmonic- Congenital • RHF

20. Diagnostic Tests • Echo- assess valve motion and chamber size • CXR • EKG • Cardiac cath- get pressures

21. Medications • Like Heart Failure • ACE inhibitors • Beta Blockers • Digoxin • Diuretics • Vasodilators • Anticoagulants • Prophylactic antibiotics

26. Mitral Stenosis Therapy • Surgical • Mitral Commissurotomy • Mitral Valve Replacement • Mechanical • Bioprosthetic

27. YouTube - Robotic Mitral Valve Repair Surgery Animation

29. This is a mechanical valve prosthesis of the more modern tilting disk variety (for the mitral valve). Such mechanical prostheses will last indefinitely from a structural standpoint, but the patient requires continuing anticoagulation because of the exposed non-biologic surfaces.

30. This is an excised porcine bioprosthesis. The main advantage of a bioprosthesis is the lack of need for continued anticoagulation. The drawback of this type of prosthetic heart valve is the limited lifespan, on average from 10 to 15 years (but sometimes shorter) because of wear and calcification.

31. Ross Procedure

32. Mitral Regurgitation MitraClip 3D Animation

33. Medical Animation. Aortic valve replacement

34. Medical/ Surgical Treatment • Percutaneous balloon valvuloplasty • Surgical therapy for valve repair or replacement: • Valve repair is typically the surgical procedure of choice • Open commissurotomy- open stenotic valves • Annuloplasty- can be used for both • Valve replacement may be required for certain patients Heart valve surgery • Mechanical-need anticoagulant • Biologic-only last about 15 years • Ross Procedure • MedlinePlus: Interactive Health Tutorials

35. Nursing Diagnoses • Activity intolerance • Excess fluid volume • Decreased cardiac output • Ineffective therapeutic regimen management

36. Cardiomyopathy • Condition is which a ventricle has become enlarged, thickened or stiffened. • As a result heart’s ability as a pump is reduced

37. Cardiomyopathy • Primary-idiopathic • Secondary • Ischemia- from CAD • Infectious disease • Exposure to toxins • Metabolic disorders • Nutritional deficiencies • Pregnancy

38. 3 Types • Dilated • Hypertrophic • Restrictive

39. Dilated Cardiomyopathy • Most common- heart failure in 25-40% • Cocaine and alcohol abuse • Chemotherapy, pregnancy • Hypertension • Genetic • * Heart chamber dilate and contraction is impaired and get decreased EF% • *Dysrhythmias are common- SVT Afib and VT • Prognosis poor-need transplant

40. This very large heart has a circular shape because all of the chambers are dilated. It felt very flabby, and the myocardium was poorly contractile. This is an example of a cardiomyopathy.

41. Normal weight 350 gms now 700 gms

42. Dialated Cardiomyopathy • Diagnostics • Echocardiogram, CXR, ECG, labs • Treatment-Control HF • Diuretics • Nitrates • Ace inhibitors • Beta blockers • Digoxin • Amiodarone • Anticoagulants

44. Hypertrophic Cardiomyopathy • Genetic • HCM -also known as IHSS or HOCM • Get hypertrophy of the ventricular mass and impairs ventricular filling and CO • Symptoms develop during or after physical activity • Sudden cardiac death may be first symptom • Symptoms are dyspnea, angina and syncope

45. Hypertrophic Cardiomyopathy • Massive ventricular hypertrophy • Rapid, forceful contraction of the LV • Impaired relaxation or diastole • Obstruction to aortic outflow • Primary defect is diastolic filling • **HCM most common cause of SCD in young adulthood

49. There is marked left ventricular hypertrophy, with asymmetric bulging of a very large interventricular septum into the left ventricular chamber. This is hypertrophic cardiomyopathy. About half of these cases are genetic. Both children and adults can be affected, and sudden death can occur.

50. Hypertrophic Cardiomyopathy • Manifestations • Dyspnea • Fatigue-dec CO • Angina, syncope • S4 and systolic murmur • Diagnostics • Echo- TEE • Heart cath