valvular disease

valvular disease affects this valve the most?

aortic valve

4 different types of valvular disease

stenosis

insufficeincy

regurgitation

prolapse

stenosis

stiffening and thickening of the valve narrowing the opening, obstructing flow

regurgitation or insufficiency

blood flows or leaks in the reverse direction, ventricle to atria, aorta to the left ventricle, pulmonic circulation to the right ventricle, because incomplete closing of the valve

prolapse

displacement of the valve leaflets during systole

risk factors for valvular disease

infectious disease such as IE (infective endocarditis)

congenital defects

degenerative changes (older age)

pregnancy (wear and tear on mothers heart + body)

smoking

hyperlipidemia

hypertension

clinical manifestations for valvular disease

shortness of breath

angina

syncope

dysrhythmia

palpitation

dizziness

fatigue

weight gain

biological valves

biological valves

From bovine (cow) or porcine (pig) sources. No long-term anticoagulation is needed, but they don't last as long.

mechanical valves

Durable but require lifelong anticoagulation (Coumadin), doesnt reject as often

diagnostic testing for valvular disease

ekg (looks for hypertrophy)

echo (identifys leaflet abnormalities)

chest x-ray

stress testing (checks functional capacity)

heart cath (definitive test)

what are meds for valve disease

beta blockers (reduced hr and blood pressure to reduce workload on heart)

calcium channel blockers (vasodialation)

diuretics (decrease preload and pulmonary congestion)

requires higher preload in order to generate adequate pressure for blood flow through the stenosed valve. decreasing preload can cause decreased cardiac output and hypotension

aortic stenosis

valve replacement

1. open heart valve replacement

2. percutaneous approach to valve replacement: through an artery

a valve replacment with mechanical prosthetic valve....

anticoagulated for life to prevent thrombotic events

what are examples of valve repairs?

balloon valvuloplasty

commissurotomy

mitral valve annuloplasty

transcatheter aortic valve implantation (TAVI)

what is better fixing or replacing a valve

fixing it

percutaneous procedure to repair stenosed aortic or mitral valves. it involves inserting a balloon catheter catheter throuh an appropriate vessel and advancing it to the heart. the balloon is inflated in the affected valve to enlarge the opening

balloon valvuloplasty

surgical procedure done to incise fised leaflets, widening the opening

commissurotomy

a repconstructive procedure to repair the ring (annulus) that attaches and supports the valve leaflets

mitral valve annuloplasty

nursing care for valve disease

decrease cardiac output: related to decreased stroke volume secondary to valve disease (valve issue)

activity tolerance: related to decreased cardiac output secondary to HF due to valve disease

assesment for valve disease

vitals

monitor for irregular heart rhythm

skin color, temp, peripheral pulses. cap refill time

breath sounds

auscultate heart sounds

monitor INR

interventions for valve disease

longterm; besides the antibiotics

- meds

- diuretics

- calcium channel blockers (slows everything down)

- beta blockers

- antibiotics

- anticoagulation

- fluid restriction

teaching for valve disease

prophylatic antimicrobial for dental procedures prevent reoccurrence of infectious valvular disease (take an antibiotic before the dentist), also making sure you are following regiman for anticoagulants with prosthethic valve to prevent thrombotic/embolic events such as a stroke

anticoagulation precautions

- Avoid activities/sports that are high risk for injury, report any injuries or falls to your provider, report anticoagulant use prior to any procedure, care with shaving—electric razor preferred, care with flossing to avoid bleeding, limit alcohol

- Avoid activities/actions that increase bleeding risk

- Watch intake of green leafy vegetables

Green leafy vegetables impair the effectiveness of the anticoagulant Coumadin.

infectious heart disease (endocarditis)

an infection of the endocardium, affecting mostly the mitral or aortic valve, but the disorder can affect any valves. Of all the heart valves, the pulmonic valve is the least affected

aortic: most affected

pulmonic: least affected

risk factors for endocarditis

- age greater than 60

- immunodeficiency

- presence of prosthetic heart valves

- prior history of endocarditis

- congenital heart disease

- IV drug use or presence of intravascular access device

patient on hemodialysis, diabetics, patients with frequent exposure to the health care system

- rheumatic heart disease

- dental procedures

clincal manifestations for endocarditis

- Osler's nodes-red, painful nodes in the pads of the fingers and toes

- aneway's lesions-red, painless spots on the palms and soles

- Weight loss

- night sweats

- New or changing murmur

-fever

- Petechiae

- Fatigue

- Confusion (in the elderly)

- Rigor (shivering and increased temp)

lab and diagnostics for endocarditis

blood cultures

ECG

TTE (noninvasive)

TEE (invasive through esophagus)

what do we do for treatment?

antibiotics

valve repair or replacment surger (metal valve replacment; anticoagulants for life)

nusing care for endocarditis

assessment

interventions: including addiction counseling

teaching: good oral hygeine, notify providers before any dental or other procedures

infection related to an invading organism secondary to endocarditis