Cardiac Valves Disorders For Nursing

Heart valves

•    When any of the heart valves do not close or open properly, blood flow is affected.
•    Three types of mechanical disruption can occur:
•    Regurgitation (insufficiency): when valves do not close completely, blood flows backward through the valve.
•    Stenosis: when valves do not open completely, the flow blood through the valve is reduce.
•    Prolapse: stretching of the valve leaflet into the atrium during systole.

Aortic valve stenosis

•    Aortic valve stenosis is the narrowing of the orifice between the left ventricle and the aorta.
Clinical manifestation:
•    1] dyspnea : because of left ventricle decompensation which lead also to pulmonary congestion.
•    2] dizziness + fainting : because of reduce volume of   blood going to the brain .
•    3] angina pectoris is frequent symptoms.

Causes:
•    1- Endocarditis
•    2- Congenital abnormalities.
Clinical manifestation:
•    Earliest manifestation is the pt’s awarness of the increased force of the heart beat.
•    1- Artierial pulsation in the neck is visible [most common]
•    2- Orthopnea.
Management:
•    Aortic valve replacement is the treatment of choice. [most effective, common durables]
•    If the pt has symptoms of C.H.F [medical management is required until surgery can be performed].

Tricuspid insufficiency


•    In which blood flows back into the right atrium during systole, decreasing blood flow to the lungs and left side of the heart (fluid overload in the right side of the heart can eventually lead to right sided heart failure.
•    S & S: Dyspnea, Fatigue and peripheral edema.
•    Diagnostic test:ECG shows right atrial or right ventricular hypertrophy, X- ray shows right dilation and right ventricular enlargement, Echo shows prolapse.

Mitral stenosis:

–    In which narrowing of the valve by valvular abnormalities, fibrosis, or calcification obstructs blood flow from the left atrium to the left ventricle.
–    S & S: dyspnea on exertion, fatigue, orthopnea, palpitations, peripheral edema and weakness.
–    Diagnosis: ECG show lt atrial hypertrophy, Echo, x-ray shows lt atrial and ventricular enlargement.
–    Rx: bed rest, replacement of the mitral valve.
antibiotic if cause infection.
Mitral Insufficiency [Regurgitation]
•    Results when the mitral valve are unable to close during systole. That lead to mitral regurgitation or back flow of blood from the left ventricle into the left atrium during ventricular contraction causing atrium enlarge.

Clinical manifestation:
•    1] shortness of breath on exertion.
•    2] palpitation of the heart [irregular and fast beating of the heart], peripheral edema.

   Management:
•    1] mitral valve replacement.
•    2] treatment of complications.

Mitral Valve Prolapse MVP:

•    In which one or both valve leaflets protrude into the left atrium (MVP syndrome is the term used when the anatomic prolapse is accompanied by assessment findings unrelated to the valvular abnormality.

Clinical manifestation:
•    mitral click [extra heart sound] which consider an early signs of mitral valve prolapsed
•    regurgitation → CHF.

Management:
•    Treat C.H.F.
•    mitral valve replacement [advanced stages]

Replacement Valves
Replacement Valves

•    Valvuloplasty: the repair of cardiac valve and not replacement
•    * Most valvuloplasty procedure require general anesthesia.
•    * The patient is managed in critical care unit for the 1st 24 hours to 72 hours post operatively.

Types of valve prosthesis:
•    1- Mechanical valve: are the ball and cage its more durable , then the other types.  Complications (Thromboembolism)
   2- Tissue or biologic valves:
•    Homograft.
•    Heterografts: are obtained from cadaver tissue donations.

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Posted in Cardiovascular, Critical Care Nursing

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