1 / 52

Valvular Heart Disease

Valvular Heart Disease. Dr.Isazadehfar. Types. Mitral Stenosis Mitral Regurgitation Mitral Valve Prolapse Aortic Stenosis Aortic regurgitation Tricuspid valve is affected infrequently Tricuspid stenosis – causes Rt HF Tricuspid regurgitation –causes venous overload.

samber
Télécharger la présentation

Valvular Heart Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Valvular Heart Disease Dr.Isazadehfar

  2. Types • Mitral Stenosis • Mitral Regurgitation • Mitral Valve Prolapse • Aortic Stenosis • Aortic regurgitation • Tricuspid valve is affected infrequently • Tricuspid stenosis – causes Rt HF • Tricuspid regurgitation –causes venous overload

  3. Rheumatic Heart Disease • Inflammatory process that may affect the myocardium, pericardium and or endocardium • Usually results in distortion and scarring of the valves

  4. Subjective symptoms Prior history of rheumatic fever General malaise Pain – may or may not be present Objective symptoms Temperature Murmurs Dyspnea polyarthritis Rheumatic Heart Disease, cont.

  5. Rheumatic Heart Disease • Diagnosis • H/P • WBC and ESR • C-reactive protein • Cardiac enzymes • EKG • Chest x-ray • Echo • Cardiac cath • Cardiac output

  6. Rheumatic Heart Disease • Nursing Care • Vital signs • Rest and quiet environment • Give antibiotics, digitalis, and diuretics • Provide adequate nutrition • Monitor I/O • Explain treatment and home care

  7. Cardiac Physiology Systole AV/PV – opens S1-S2 MV/TV – closes Diastole AV/PV – closes S2-S1 MV/TV – opens

  8. Cardiac Physiology

  9. Cardiac Physiology Regurg/ Insuff – leaking (backflow) of blood across a closed valve Stenosis – Obstruction of (forward) flow across an openedvalve SystoleAV/PV – opens-------Aortic Stenosis S1-S2 MV/TV – closes------Mitral Regurg DiastoleAV/PV – closes------Aortic Regurg S2-S1MV/TV – opens-------Mitral Stenosis These concepts are set in stone, it can’t occur any other way, It would be anatomically impossible

  10. Cardiac Anatomy

  11. 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

  12. 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

  13. Etiology of Mitral Stenosis • Rheumatic heart disease: 77-99% of all cases • Infective endocarditis: 3.3% • Mitral annular calcification: 2.7%

  14. Mitral Stenosis

  15. MS Pathophysiology • Progressive Dyspnea (70%):LA dilation  pulmonary congestion (reduced emptying) • worse with exercise, fever, tachycardia, and pregnancy • Increased Transmitral Pressures: Leads to left atrial enlargement and atrial fibrillation. • Right heart failure symptoms: due to Pulmonary venous HTN • Hemoptysis: due to rupture of bronchial vessels due to elevated pulmonary pressure

  16. Mitral Stenosis

  17. Heart Sounds in MS • Diastolic murmur: • Low-pitched diastolic rumble most prominent at the apex. • Heard best with the patient lying on the left side in held expiration • Intensity of the diastolic murmur does not correlate with the severity of the stenosis

  18. Heart Sounds in MS • Loud Opening S1 snap: heard at the apex when leaflets are still mobile  • Due to the abrupt halt in leaflet motion in early diastole, after rapid initial rapid opening, due to fusion at the leaflet tips. • A shorter S2 to opening snap interval indicates more severe disease.

  19. Management of MS Serial echocardiography: • Mild: 3-5 years • Moderate:1-2 years • Severe: yearly

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

  21. Mitral Regurgitation Physical Exam • Holosystolic Apical Blowing Murmur • Laterally displaced apical impulse • Split S2 (but is obscured by the murmur) • S3 Gallop (increased volume during diastole) • Radiation depends on the etiology

  22. 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

  23. Mitral Regurgitation -MVP

  24. Mitral Regurgitation -MVP

  25. Mitral Regurgitation -MVP Diagnosis and Treatment • Echo 2D/Color • B-Blockers (hyperadrenergic symptoms, Palpitations) • Aspirin (TIAs without etiology) • SBE Prophylaxis (only if associated with MR) • Severe Symptomatic MR – same as chronic MR

  26. 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

  27. Aortic Stenosis Physical Exam • Harsh Systolic Ejection Murmur – late peaking • S4 gallop (from LVH) • Sustained Bifid LV impulse (from LVH) • Pulsus Parvus et Tardus (Carotid Impulse) • Heart sounds- soft and split second heart sound

  28. Presentation of Aortic Stenosis • Syncope: (exertional) • Angina: (increased myocardial oxygen demand; demand/supply mismatch) • Dyspnea: on exertion due to heart failure (systolic and diastolic) • Sudden death

  29. Aortic Stenosis

  30. Echo Surveillance • Mild: Every 5 years • Moderate: Every 2 years • Severe: Every 6 months to 1 year

  31. Summary • Disease of aging • Look for the signs on physical exam • Echocardiogram to assess severity • Asymptomatic: Medical management and surveillance • Symptomatic: AoV replacement (even in elderly and CHF)

  32. 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

  33. Etiology of Acute AR • Endocarditis • Aortic Dissection • Physical Findings: • Wide pulse pressure • Diastolic murmur • Florid pulmonary edema

  34. Aortic Regurg – pathophysiology

  35. Aortic Regurgitation

  36. Progressive Symptoms include: - Dyspnea: exertional, orthopnea, and paroxsymal nocturnal dyspnea • Nocturnal angina: due to slowing of heart rate and reduction of diastolic blood pressure • Palpitations: due to increased force of contraction

  37. Aortic Regurgitation Physical Exam • Diastolic Decrescendo Blowing Murmur at the left sternal border • Hyperdynamic LV apical impulse • Bounding Pulses • S4, S3 Gallop-advanced AI • Apical Rumble – “Austin Flint Murmur” (apex): Regurgitant jet impinges on anterior MVL causing it to vibrate • Systolic ejection murmur: due to increased flow across the aortic valve

  38. 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

  39. Assessment, cont. • Objective symptoms • Orthopnea • Dyspnea, rales • Pink-tinged sputum • Murmurs • Palpitations • Cyanosis, capillary refill • Edema • Dysrhythmias • Restlessness

  40. Diagnosis • History and physical findings • EKG • Chest x-ray • Cardiac cath • Echocardiogram

  41. Medical 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

  42. Interventions • Assess vitals, heart sounds, adventitious 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

  43. Surgical Management of Valve Disease • Mitral Valve • Commissurotomy • Mitral Valve Replacement • Balloon Valvuloplasty • Aortic Valve Replacement

  44. Mechanical Valve

  45. Mechanical Valve

  46. Porcine Valve

  47. Tissue Valve

More Related