Valvular Heart Disease

What is the primary pathophysiology of valvular stenosis?

Valve leaflets thicken and stiffen, narrowing the opening and causing pressure overload in the chamber proximal to the valve.

What is the primary pathophysiology of valvular regurgitation?

The valve fails to close completely, causing blood to leak backward into the previous chamber, leading to volume overload.

What is the classic murmur pattern for valvular stenosis?

A murmur heard during the phase when blood is trying to cross the narrowed valve.

What is the classic murmur pattern for valvular regurgitation?

A murmur heard during the phase when the valve should be closed but is failing to seal.

What is the most common cause of mitral valve stenosis?

Rheumatic heart disease.

Why is mitral valve stenosis associated with a high risk of stroke?

Left atrial enlargement and dilation increase the risk of atrial fibrillation, which can lead to thrombus formation.

What is the classic triad of symptoms for aortic valve stenosis?

Syncope, angina, and dyspnea on exertion (SAD).

What physical assessment finding is classic for aortic valve regurgitation?

Widened pulse pressure and a bounding (water-hammer) pulse.

How do you distinguish a systolic murmur from a diastolic murmur using the carotid pulse?

A systolic murmur occurs simultaneously with the carotid upstroke; a diastolic murmur occurs in the pause between pulse beats.

Which type of murmur is considered always pathological and requires immediate reporting?

Diastolic murmurs.

What is the primary difference in management between mechanical and bioprosthetic heart valves?

Mechanical valves require lifelong anticoagulation, whereas bioprosthetic valves typically do not require long-term anticoagulation.

What is the target INR range for a patient with a mechanical valve?

2.0 to 3.0 (or 2.5 to 3.5 for mitral mechanical valves).

What nursing action is required for patients with prosthetic valves before dental procedures?

Administration of prophylactic antibiotics to prevent infective endocarditis.

What are the clinical signs of heart failure progression in valvular disease patients?

Dyspnea, orthopnea, crackles, S3 gallop, edema, weight gain, JVD, and activity intolerance.

What does a systolic click at the apex indicate?

Mitral valve prolapse (MVP).

What is the expected hemodynamic effect of aortic stenosis?

Left ventricular hypertrophy and decreased cardiac output over time.

What is the expected hemodynamic effect of aortic regurgitation?

Left ventricular dilation due to blood leaking back into the ventricle during diastole.

What is the murmur description for mitral valve stenosis?

Low-pitched rumbling diastolic murmur at the apex.

What is the murmur description for mitral regurgitation?

Blowing systolic (holosystolic) murmur at the apex.

What is the murmur description for aortic stenosis?

Harsh crescendo-decrescendo systolic murmur at the aortic area.

What is the murmur description for aortic regurgitation?

Blowing decrescendo diastolic murmur at the left sternal border.

Why should a patient with known aortic stenosis who faints during exertion be prioritized?

Syncope is a sign of the classic triad, indicating severe disease and a worsening prognosis that requires immediate intervention.

What is the risk of a mechanical valve patient having an INR below the therapeutic goal?

Increased risk of valve thrombosis.