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Disorder of Cardiac Structure: Valvular Heart - Coggle Diagram
Disorder of Cardiac Structure: Valvular Heart
Valvular Heart Disease
Types of Disorders
Stenosis
Caused by scarring of valves from endocarditis, infarction and calcium deposit
Effect: impede forward flow, ↓ CO, backflow of blood
Valve leaflets fuse together and cannot fully open or close. Valve opening narrows and becomes rigid
Examples
Mitral Stenosis
Narrowing of the mitral valve opening, restricting blood flow from the left atrium to the left ventricle
Aortic Stenosis
Narrowing of the aortic valve, impeding blood flow from the left ventricle into the aorta
Regurgitation/Insufficiency/Incompetent
Caused by deformity/erosion of valve cusps due to vegetative lesions of bacterial endocarditis, scarring/ tearing from MI or cardiac dilation
Effect: Allows backflow of blood through the valve into the area it just left
Valves do not close completely → regurgitation, backflow of blood
Examples
Mitral Regurgitation
Inability of the mitral valve to close properly, causing backward blood flow from the left ventricle into the left atrium
Mitral Valve Prolapse
Abnormal bulging of the mitral valve leaflets into the left atrium during systole, often leading to regurgitation
Aortic Regurgitation
Incomplete closure of the aortic valve, causing blood to leak back from the aorta into the left ventricle
Includes Stenosis & Regurgitation
Tricuspid Valve Disorders
Includes stenosis and regurgitation, affecting blood flow between the right atrium and right ventricle
Pulmonic Valve Disorders
Involves stenosis or regurgitation, impacting blood flow from the right ventricle to the pulmonary artery
Location of Heart Valves
Types of Valvular Heart Diseases
Mitral Stenosis
Incidences
Caused by rheumatic fever or bacterial endocarditis
Affect females (66%) more than males
Chronic and progressive
Asymptomatic or cause severe impairment
Pathophysiology
Left atrium to left ventricle
Clinical Manifestation
Mitral Regurgitation/Insufficiency
Degenerative calcification - older women
Left ventricular hypertrophy and MI
Rheumatic heart disease common cause; Men > female
Congenital defects
Pathophysiology
Clinical Manifestation
Mitral Valve Prolapse
Cause: acute and chronic rheumatic damage, ischaemic heart disease, inherited connective tissue disorders i.e. Marfan
Pathophysiology
More common in young women between ages 14 and 30
Clinical Manifestation
Valve insufficiency that occurs when one or both valve cusps billows into the atrium when ventricular systole
Aortic Stenosis
May be idiopathic, due to congenital defect
i.e. Paget’s disease, rheumatic damage or degenerative changes i.e. end stage renal failure; ↑BP lipid & DM
Pathophysiology
More common in males 80% than females; risk increases with age
Clinical Manifestation
Obstructs blood flow from left ventricle into aorta during systole
Aortic Regurgitation
More common in males (75%)
Commonly associated with coexisting mitral valve disease
Ventricle from aorta during diastole
Causes: rheumatic heart disease (67%), congenital disorders, infective endocarditis, blunt chest trauma, aortic aneurysm, syphilis, Marfan syndrome and chronic hypertension
Pathophysiology
Clinical Manifestation
Tricuspid Stenosis
Occurs concurrently with mitral stenosis
Results from rheumatic fever
Obstructs blood flow from right atrium to right ventricle
S/s systemic congestion & right heart failure i.e. ↑ CVP, jugular venous distension, ascites hepatomegaly & peripheral oedema
S/s ↓ CO i.e. fatigue & weakness
Low pitch rumbling diastolic murmur 4th ICS left sternal or over xiphoid process
Tricuspid Regurgitation
Stretching distort valve and supporting structures → valve can't close completely
Allows blood flow back into right atrium during systole →
↑RAP (Right Atrial Pressure)→RHF(Right Heart Failure) → ↓CO & systemic venous congestion - ↑RAP (Increased Right Atrial Pressure)
Occurs secondary to right ventricular dilatation
LVF(Left Ventricular Failure,) & pulmonary hypertension (PH) → Right ventricular overload
Atrial distension → AF
Retrograde blood flow over deformed valve →High pitched, blowing systolic murmur over tricuspid or xiphoid
Pulmonic Stenosis
Usually is congenital disorder other than rheumatic heart disease
Right ventricle hypertrophies to generate pressure to pump blood into pulmonary system
Obstructs blood flow from the right ventricle into pulmonary system
Right atrium hypertrophies to overcome high pressure generated in right ventricle
Right heart failure occurs when ventricle can no longer generate enough pressure to force blood past valve opening
S/s : dyspnoea on exertion & fatigue → Right heart failure
Pulmonic Regurgitation
More common than pulmonary stenosis
Causes: complication of pulmonary
hypertension, infective endocarditis, pulmonary artery (PA) aneurysm & syphilis
Incomplete valve closure allow blood to flow back into right ventricle during diastole, ↓ blood flow to pulmonary circuit; extra blood ↑right ventricular end diastolic volume → right heart failure
Diagnostic Investigation
ECG
Can show atrial and ventricular hypertrophy, conduction defects &
dysrhythmias
Cardiac catheterisation
To assess contractility and pressure gradient heart valves heart chambers & pulmonary system
CXR
Can identify cardiac hypertrophy, chamber & great vessel enlargement, dilation of pulmonary vasculature; calcification of valve leaflets and annular opening
Exercise testing
Only for asymptomatic patients to assess exercise induced symptoms and abnormal BP response
Echocardiography
Routine for diagnosis; Determine thickness of valve leaflets, vegetation or growth on valve, myocardial function chamber size & pressure gradients across valves & PA pressure can be determined
Medication
Surgical Intervention
Percutaneous Balloon Valvotomy
Valvulopasty
Types of Valve
Advantages & Disadvantages of Prosthetic Heart Valves
Nursing Care
Decreased Cardiac Output
Decreased Activity Tolerance
Risk for Bleeding