Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)

Valvular Heart Disease

Definition/Etiology:

• Definition
  • Valvular heart disease is an acquired or congenital disorder of a cardiac valve.
    Valve disorders include those of stenosis, causing obstruction of forward flow, or regurgitation, allowing backward flow of blood.
• Etiology
  • Rheumatic Fever
  • Endocarditis – Vegetation / Damage
  • Congenital
• PCCN Focus = Left Sided Heart
  • Mitral & Aortic Valve

Pathophysiology:

• Aortic/Mitral Stenosis – Calcified Valve
  • Valves don’t open fully
  • (less forward flow)
  • Murmur heard when valves OPEN
• Aortic/Mitral Regurgitation – Leaky Valve
  • valves that don’t close properly
  • (Backward flow)
  • Murmurs heard when valves CLOSE

Noticing: Assessment & Recognizing Cues:

• Subjective Cues (Heart Failure)
  • Shortness of breath
  • Orthopnea
  • Weakness/ fatigued
  • Palpitations
• Objective Cues
  • MURMURS
    • Systolic (s1) or Diastolic (S2)
    • Lub vs Dub
    • Auscultate appropriate area
      • Aortic – 2nd ICS RSB
      • Mitral – 5th ICS MCL
• Symptoms of both sided heart failure
  • Signs of pulmonary edema (frothy, pink sputum)
  • Jugular venous distention
  • Edema

Interpreting: Analyzing & Planning:

• Labs
  • Pre-Op labs if repair/replacement is needed
• Diagnostics
  • ECG – Afib is common
  • Echocardiogram
    • Look at Valves
    • non-invasive
  • Transesophageal Echocardiogram
    • Sees Mitral valve better than traditional
    • More invasive (requires at least moderate sedation)

Responding: Patient Interventions & Taking Action:

• ABCs
• Meds and/or Surgery for repair
• Pharmacological Interventions
  • Benzos -reduce anxiety
  • ACEs/ARBs
  • Beta Blockers
  • Nitrates
  • Digoxin
• Non-Pharmacological
  • Valve Repair or Replacement
    • Mechanical or Biological
    • Completed via Open Heart or Cath Lab (Follow those lessons for specific interventions)

Reflecting: Evaluating Patient Outcomes:

• Monitor for complications
  • Signs/symptoms of heart failure
  • AFIB
  • Emboli
• If surgery was performed
  • See Cath Lab, Open Heart and minimally invasive surgery lesson
  • If the valve is replaced, the importance of endocarditis prophylaxis and chronic
    anticoagulation is stressed
    • if the patient does not comply with the follow-up medication regimen, stroke and possibly death are highly likely

Linchpins (Key Points):

• Notice
  • Heart Failure Symptoms
• Interpret
  • ECHO & TEE
• Respond
  • Meds vs Surgery
• Reflect
  • Post-Surgical