Valvular heart disease

In valvular heart disease, three types of mechanical disruption can occur: stenosis, or narrowing, of the valve opening; incomplete closure of the valve; or prolapse of the valve. They can result from such disorders as endocarditis (most common), congenital defects, and inflammation, and they can lead to heart failure.

Valvular heart disease occurs in varying forms, described below. Additional information is provided in Types of valvular heart disease.

❑ Mitral insufficiency: In this form, blood from the left ventricle flows back into the left atrium during systole, causing the atrium to enlarge to accommodate the backflow. As a result, the left ventricle also dilates to accommodate the increased volume of blood from the atrium and to compensate for diminishing cardiac output. Ventricular hypertrophy and increased end-diastolic pressure result in increased pulmonary artery pressure, eventually leading to left- and right-sided heart failure.

❑ Mitral stenosis: Narrowing of the valve by valvular abnormalities, fibrosis, or calcification obstructs blood flow from the left atrium to the left ventricle. Consequently, left atrial volume and pressure rise and the chamber dilates. Greater resistance to blood flow causes pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure. Also, inadequate filling of the left ventricle produces low cardiac output.

❑ Mitral valve prolapse (MVP): One or both valve leaflets protrude into the left atrium. MVP is the term used when the anatomic prolapse is accompanied by signs and symptoms unrelated to the valvular abnormality.

❑ Aortic insufficiency: Blood flows back into the left ventricle during diastole, causing fluid overload in the ventricle, which dilates and hypertrophies. The excess volume causes fluid overload in the left atrium and, finally, the pulmonary system. Left-sided heart failure and pulmonary edema eventually result.

❑ Aortic stenosis: Increased left ventricular pressure tries to overcome the resistance of the narrowed valvular opening. The added workload increases the demand for oxygen, whereas diminished cardiac output causes poor coronary artery perfusion, ischemia of the left ventricle, and left-sided heart failure.

❑ Pulmonic insufficiency: Blood ejected into the pulmonary artery during systole flows back into the right ventricle during diastole, causing fluid overload in the ventricle, ventricular hypertrophy and, finally, right-sided heart failure.

❑ Pulmonic stenosis: Obstructed right ventricular outflow causes right ventricular hypertrophy, eventually resulting in right-sided heart failure.

❑ Tricuspid insufficiency: Blood flows back into the right atrium during systole, decreasing blood flow to the lungs and the left side of the heart. Cardiac output also lessens. Fluid overload in the right side of the heart can eventually lead to right-sided heart failure.

❑ Tricuspid stenosis: Obstructed blood flow from the right atrium to the right ventricle causes the right atrium to dilate and hypertrophy. Eventually, this leads to right-sided heart failure and increases pressure in the vena cava.

Treatment

Treatment depends on the nature and severity of associated symptoms. For example, heart failure requires digoxin, diuretics, a sodium-restricted diet and, in acute cases, oxygen. Other measures may include anticoagulant therapy or antiplatelet medications to prevent thrombus formation around diseased or replaced valves, prophylactic antibiotics before and after surgery or dental care, and valvuloplasty. An intra-aortic balloon pump may be used temporarily to reduce backflow by enhancing forward blood flow into the aorta.

If the patient has severe signs and symptoms that can’t be managed medically, open heart surgery using cardiopulmonary bypass for valve replacement is indicated.

Special considerations

❑ Watch closely for signs of heart failure or pulmonary edema and for adverse effects of drug therapy.

❑ Teach the patient about diet restrictions, medications, and the importance of consistent follow-up care.

❑ If the patient has surgery, watch for hypotension, arrhythmias, and thrombus formation. Monitor vital signs, arterial blood gas values, intake, output, daily weight, blood chemistries, chest X-rays, and pulmonary artery catheter readings.

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Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

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Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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