Term
| risk for cardiac valve disease |
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Definition
nHx. HTN
nHx. Rheumatic Fever
nHx. Infective Endocarditis (IE)
nHx. Congenital Heart Deformities
nHx. Collagen Vascular Disease (SLE)
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Term
| diagnostic workup of valve disease |
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Definition
nChest xray: heart chamber enlargement, pulmonary congestion, valve calcification
n
n12 Lead EKG: shows heart chamber hypertrophy
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nECHOcardiogram: shows chamber size, hypertrophy, specific valve dysfunction, ejection fraction, amount of regurgitate flow
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nExercise Stress Test/Stress ECHO: asses for impact of exercise on valve function
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nAngiography: chamber pressure, ejection fraction, regurgitation and cardiac pressure gradients.
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Term
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Definition
nthe valve does not close properlyresulting inbackflow of blood through the valve
n
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Term
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Definition
nthe stretching of an atrio-ventricular valve leaflet into the atrium during diastole
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Term
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Definition
nthe valve does not open completely resulting in reduced blood flow through the valve
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Term
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Definition
mitral valve proplaspe
mitral valve stenosis
mitral regurgitation
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Term
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Definition
aortic regurg
aortic stenosis |
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Term
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Definition
nUsually asymptomatic
nMore frequently in women
nMay be a result of connective tissue disorders
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Term
| manifestions of mitral valve prolapse |
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Definition
¨Fatique
¨SOB
¨Lightheadedness
¨Dizziness
¨Syncope
¨Palpatations
¨Chest Pain
¨Anxiety
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Term
| physical findings of mitral valve prolapse |
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Definition
¨extra heart sound is heard: “Mitral click”
¨May progress to symptoms of heart failure
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Term
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Definition
¨Control symptoms
¨Treat dysrhythmias with anti-arrthymia agents
¨Treat chest pain with nitrates, calcium-channel blockers or B-blockers
¨Stop smoking
¨Avoid caffeine & alcohol
¨MV repair may be required
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Term
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Definition
¨Educate re: hereditary factor: 1st degree relatives need ECHO
¨Usually symptomatic due to arrhythmia
¨Need prophylactic abt. Tx. for invasive procedures (dental/gu /gi)
¨Avoid caffeine & alcohol & OTC that contain epinephrine or ephedrine
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Term
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Definition
nPatho: backflow of blood from LV to LA with each beatstretching of LA
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Term
| clinical manifestations of MR |
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Definition
¨often asymptomatic
¨Most common: Dyspnea, fatique, weakness
¨Palpitations, SOB/E, cough
¨Symptoms of CHF
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Term
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Definition
qRheumatic fever
qDegenerative changes of MV
qInfective endocarditis
qCollagen-vascular disease (SLE)
qCardiomyopathy
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Term
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Definition
¨Systolic murmur is heard @Apex
nHigh pitched/blowing sound
¨TEE provides best images of MV
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Term
| medical and nursing managment of MR |
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Definition
¨Tx. Symptoms of CHF
¨Reduce afterload: ACE/I, or Hydralazine
¨Abt. To prevent infectious endocarditis
¨Surgical Repair:
nMitral Valvuloplasty (valve repair)
nValve replacement
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Term
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Definition
¨Obstruction of blood flow from LA into LV
¨Caused by thickening of the mitral valve leafletsà fuse together
¨Mitral valve orifice narrowsà progressively obstructing blood flow to ventricle
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Term
| clinical manifestations of MS |
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Definition
¨1st sign: DOE (dyspnea on exertion) resulting from pulmonary hypertension
¨Fatigue resulting from decreased Cardiac Output
¨Hemoptysis, cough, wheeze
¨Palpitations
¨ PND( paroxysmal nocturnal dyspnea)
¨
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Term
| assessment findings of Mitral stenosis |
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Definition
¨Weak pulse
¨Irregular rate: a-fib
¨Low pitched diastolic murmur heard @ apex
¨Atrium dilatesà hypertrophies & becomes electrically unstableà
¨Atrial dysrhythmias
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Term
| medical managment mitral stenosis |
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Definition
¨Treat CHF
¨Anticoagulation
¨Abt. prophylaxisis to prevent endocarditis
¨Avoid competitive sports &/or strenuous activities
nBoth increase heart rateà decreases cardiac outputàincreased pulmonary artery pressureàbackup of bld. From LA to pulmonary veins
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Term
| pathophysiology of aortic regurgitation |
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Definition
¨Backflow of blood from aorta into LV during diastole
¨Caused by deformity of leaflets of aortic valve
¨LV dilates in attempt to increase blood volumeà hypertrophy
¨
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Term
| clinical manifestations of aortic regurgitation |
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Definition
¨most patients are asymptomatic
¨May exhibit palpable carotid or temporal arteries
¨Progression of symptomsà orthopnea & PND
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Term
| assessment of aortic regurgitation |
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Definition
¨Diastolic murmur: high-pitched/blowing (3rd/4th ICS/LSB)
¨Wide Pulse Pressure( difference between systolic & diastolic pressures)
¨Dx Tests: EKG, ECHO, TEE, MRI, cardiac cath,
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Term
| aortic regurgitation medical treatment |
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Definition
¨Abt. to prevent endocarditis
¨Avoid exertion, competitive sports or isometric exercise
¨Treat cardiac dysrhythmias , heart failure
¨Medications: Vasodilators, calcium channel blockers, ace inhibitors
¨Surgical Intervention: Aortic Valvuloplasty or valve replcaement before LV failure occurs
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Term
| pathology of aortic stenosis |
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Definition
¨Narrowing of orifice between LV & aorta
¨Stiffening of the valve cusps
¨Occurs over several years/decades
¨LV outflow pressure increases àventricular wall thickening
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Term
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Definition
¨Usually asymptomatic
¨Develop exertional dyspnea, orthopnea, PND, pulmonary edema
¨Angina pectoris may develop due to increased O2 demand
¨Pulse pressure decreases (<30mmHg) due to diminished bld.flow
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Term
| assessment findings of aortic stenosis |
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Definition
¨Loud, rough systolic murmur heard over oarta
¨May radiate to carotid arteries
¨S4 heart sound may be heard
¨Dx: LVH noted on EKG & ECHO
¨NO stress tests for pts. with AS: may precipitate VT & VF
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Term
| medical and nursing managment of aortic stenosis |
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Definition
¨Abt. Prophylaxis
¨Medications to tx. dysrhythmias & LVF
¨Surgical Intervention: AV replacement
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Term
| priority nursing dx for valve diseases |
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Definition
nDecrease Cardiac Output
n
nImpaired Gas Exchange
n
nActivity Intolerance
n
nAcute Pain
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Term
| priority nursing inteventions valve diseasre |
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Definition
nOxygen to improve myocardial oxygenation (Increase oxygen supply)
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nMaintain Fluid and Sodium Restriction (Control volume)
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nAdminister Medications
¨Diureticsà to decrease Pre-load
¨Anticoagulation Therapyà prevent clot formation
¨Inotrpicsà Increase contractility (digoxin, dobutamine)
¨Antihypertensivesà to reduce Afterload
n B-blocker
n Calcium Channel Blockers
nACE-inhibitors
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Term
| patient teaching valve diseases |
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Definition
¨Appropriate use of prophylactic antibiotics
¨Adherence to medication and dietary plan
¨Prescribed Activity & Exercise: conserve energy
n
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Term
| valve disease in the elderly |
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Definition
Normal Changes Resulting from Aging
Fibrotic thickening occurs in mitral & aortic valves
qAorta stiffens àincreased sytolic BP àresulting stress on the mitral valve
qDegenerative calcification of valves occur
qMedical management is most appropriate for older adults
qSurgery may be indicated to improve quality life (surgery NOT likely to prolong life expectancy)
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