Transcript Valvular Heart Disease/Myopathy/Aneurysm

Intro to Valvular Disease
Morris, an 82 year-old man, went to the doctor to get a
physical.
A few days later, the doctor saw Morris walking down the
street with a gorgeous young woman on his arm.
A couple of days later, the doctor spoke to Morris and said,
'You're really doing great, aren't you?'
Morris replied, 'Just doing what you said, Doc: 'Get a hot
mamma and be cheerful.''
The doctor said, 'I didn't say that.. I said, 'You've got a heart
murmur; be careful.'
Valvular Heart Disease
Heart contains
Two atrioventricular valves
Mitral
Tricuspid
Two semilunar valves
Aortic
Pulmonic
**review areas to listen**
Tricuspid
Valvular Heart Disease
Types of valvular heart disease
depend on
Valve or valves affected
Two types of functional alterations
Stenosis
Regurgitation
Valvular disorders occur in children and
adolescents primarily from congenital
conditions and in adults from degenerative
heart disease
Stenosis and Insufficiency
Risk Factors
Rheumatic Heart Disease, MI
Congenital Heart Defects-bicuspid valve
Aging
CHF
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
Mitral Valve Stenosis
Pathophysiology
Decreased blood flow
into LV
LA hypertrophy
Pulmonary pressures
increase
Pulmonary
hypertension
Decreased CO
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
Treatment
Mitral Valve Regurgitation
Pathophysiology
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
Manifestations
Thready pulses
Cool extremities
Symptoms of LV failure
Third heart sound (S3)
MVR murmur
Mitral Valve Prolapse
Pathophysiology
Abnormality of the mitral
valve leaflets, papillary
muscles or chordae
Type of mitral
insufficiency
Etiology unknown
Most common valvular
heart disease in US
Female 2x > Male
Manifestations
• Usually asymptomatic
• Click murmur
• Atypical chest pain does
not respond to NTG
• Tachydysrhythmias may
develop- SVT, VT
• Risk for endocarditis may
be increased
–
heart association guidelines
Mitral Valve Prolapse
Usually benign, but serious
complications can occur
Mitral valve regurgitation
Infective endocarditis
Sudden death
Cerebral ischemia
Mitral Valve Prolapse
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
Aortic Valve Stenosis
Pathophysiology
•
•
•
•
•
•
•
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
Aortic Valve Problems
Aortic Valve Stenosis
Manifestations
• Syncope
• Angina
• Dyspnea
Exertional Syncope, Angina,
DOE are classic symptoms
• This triad reflects LVF
• Later get signs of RHF
•
May be asymptomatic for
many years due to
compensation
AVS murmur
Nitroglycerin is
contraindicated because
it reduces preload
Aortic Valve Regurgitation
Pathophysiology
Bicuspid valve, genetic
Increased preoad- 60%
of SV can be regurgitated
Characteristic water
hammer pulse
Regurgitation of blood
into the LV
LV dilation and
hypertrophy
Decreased CO
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
Water Hammer pulse
Pulse, water hammer: A jerky
pulse that is full and then collapses
because of aortic insufficiency
(when blood ejected into the aorta
regurgitates back through the aortic
valve into the left ventricle ).
Also called a Corrigan pulse or a
cannonball, collapsing, pistol-shot, or
trip-hammer pulse. YouTube - Corrigan's sign
Austin Flint
Tricuspid and Pulmonic Valve
Disease
Pathophysiology
Uncommon
Both conditions cause an
increase in blood volume
in R atrium and R
ventricle
Result in Right sided
heart failure
Tricuspid- Rheumatic, IV
drug abuse
Pulmonic- Congenital
Manifestations
RHF
Diagnostic Tests
Echo- assess valve motion and chamber
size
CXR
EKG
Cardiac cath- get pressures
Medications
Like Heart Failure
ACE inhibitors
Digoxin
Diuretics
Vasodilators
Beta blockers
Anticoagulants
*Prophylactic antibiotics
Antiarrhythmics
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- on own
Ross Procedure
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 because of wear and calcification.
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 nonbiologic surfaces.
Nursing Diagnoses
Activity intolerance
Excess fluid volume
Decreased cardiac output
Ineffective therapeutic regimen
management
What is new?
Percutaneous Transcatheter Heart Valve
ImplantationMetallic clip -for the treatment of mitral
regurgitation
Longer-lasting replacement valves
Stem cell research and the use of endothelial cells
Review of Valvular diseases
using Prezis
Case
Case
Case
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Case
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Cardiomyopathy
Condition is which a ventricle has become
enlarged, thickened or stiffened.
As a result heart’s ability as a pump is reduced
Cardiomyopathy-Causes
Primary-idiopathic
Secondary
Ischemia- from CAD
infectious disease
exposure to toxins-alcohol, cocaine
Metabolic disorders
Nutritional deficiencies
Pregnancy
3 Types of Cardiomyopathy
Dilated
Hypertrophic
Restrictive
Pathophysiology
Dilated
Most common- heart failure in 25-40%
Cocaine and alcohol abuse
Chemotherapy, pregnancy
Hypertension
Genetic
* Heart chamber dilate and contraction is
impaired and get dec. EF%
*Dysrhythmias are common- SVT Afib and VT
Prognosis poor-need transplant
Dialated Cardiomyopathy
• Diagnostics
– Echocardiogram, CXR, ECG, labs
• Treatment-Control HF
– Diuretics
– Nitrates
– Ace inhibitors
– Beta blockers
– Digoxin
– Amiodarone
– Anticoagulants
Normal weight 350 gms now 700 gms
Pathophysiology
Hypertrophic-HCM
**Genetic
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 (fatigue from dec CO)
Sudden cardiac death may be first symptom
**HCM most common cause of SCD in young
adulthood
Hypertrophic Cardiomyopathy
Manifestations
Dyspnea
Fatigue-dec CO
Angina, syncope
S4 and systolic murmur
Diagnostics
Echo- TEE
Heart cath
Hypertrophic Cardiomyopathy
Treatment Goal- improve ventricular filling and
relieve LV outflow obstruction
Beta blockers
Calcium channel blockers
Digoxin- only for A-fib if present
Antidysrhythmics
ICD
AV pacing
Hypertrophic Cardiomyopathy
Ventriculomyotomy and myomectomyincising the septum muscle and removing
some of the hypertrophied muscle
PTSMA- alcohol induced percutaneous trans
luminal septal myocardial ablation
- inject alcohol into small branch of LAD
which causes ischemia and MI of septal wall.
Live Search Videos: cardiomyopathy
Nursing
Relieve symptoms
Prevent complications
Provide pysch and emotional support
TeachingAvoid strenuous exercise and dehydration
Avoid anything increasing the SVR
(afterload) makes obstruction worse
If chest pain- rest and elevation of feet for
venous return
Avoid vasodilators like nitroglycerinedecrease venous return to the heart
Pathophysiology
Restrictive
Least common
Rigid ventricular walls that impair filling
Contraction and EF normal
Signs of CHF
Prognosis-poor
Diagnostics for CMP
Echowall motion and EF
EKG
CXR
Hemodynamics
Perfusion scan
Cardiac cath
Myocardial biopsy
Treatment
Medications
Same as for heart failure except for hypertrophic
Surgery
Vad-bridge to transplant or destination therapy
Heart Transplant
Myoplasty
ICD- antiarrhythmics are negative inotropes
Dual chamber pacemaker
Hypertrophic- excision of ventricular septum-myotomy,
inject denatured alcohol in coronary artery that feeds
the top portion of septum.
Nursing Diagnoses
Decreased Cardiac Output
Fatigue
Ineffective Breathing Pattern
Fear
Ineffective Role Performance
Anticipatory grieving