AB Med Surg > Valves > Flashcards

Valves Flashcards

(58 cards)

Study These Flashcards
1
Q

list

AV valves

(atrial-ventricular valves)

A
  • mitral
  • tricuspid
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2
Q

list

semilunar valves

A
  • aortic
  • pulmonic
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3
Q

What is the purpose of valves?

A

to maintain unidirectional blood flow through heart and pulmonic systemic circulation

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4
Q

3 causes of acquired valvular heart disease

these are the most common ones

A
  • rheumatic heart disease
  • infective endocarditis
  • degenerative or age-related
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5
Q

define

stenosis

A

restriction of the forward flow of blood because the valve is unable to fully open

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6
Q

what happens with stenosis?

to the valves and chamber

A
  • valve leaflets are calcified and stiff
  • the chamber behind the stenotic valve has to work harder to pump

hypertrophy of chamber/heart muscle

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7
Q

what does stenosis result in?

A
  • increases the workload of the heart’s LV (specifically the afterload)
  • hypertrophy of the chamber pumping against the stenotic valve

stenosis occurs over time!!

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8
Q

define

regurgitation

in relation to valves

A

when the valve does not close completely and permits backward flow of blood
* d/t leaflets don’t close all the way

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9
Q

which chamber experiences volume overload when there is mitral valve regurgitation?

A

left ventricle

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10
Q

what will you hear listening to the heart with valve regurgitation?

A

murmur

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11
Q

What are other diagnostic testing for valve regurgitation?

A
  • echocardiogram (TTE)
  • chest X-Ray
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12
Q

define

aortic stenosis (AS)

A

an obstruction of blood flow from the left ventricle into the aorta during systole, caused by a narrower valve opening

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13
Q

risk factors for aortic stenosis (AS)

A
  • congential bicuspid valve
  • degenerative stenosis: age, DM, elevated cholesterol, HTN, smoking
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14
Q

How does AS affect the left ventricle (LV)?

A

AS causes an increase left ventricle workload leading to LV hypertrophy

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15
Q

overtime, what can severe AS cause?

2 points

A
  • decrease in LV function (d/t hypertrophy)
  • heart failure (both R and L sided)
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16
Q

Clinical manifestions of Aortic stenosis (AS)

A
  • exertional dyspnea
  • exercise intolerance
  • fatigue
  • angina
  • syncope w/ fixed cardiac output
  • systolic ejection murmur (“LUB, murmur, DUB”)
  • heart failure
  • slower HR
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17
Q

How does a systolic ejection murmur sound?

happens with AS!

A

LUB > murmur > DUB

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18
Q

why might a person with AS have a slower HR?

A

it takes longer for LV to eject blood

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19
Q

define

aortic regurgitation

A

backflow of blood from the aorta into the LV during diastole
* d/t ineffective closure of the aortic cusps

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20
Q

list

risk factors for aortic regurgitation

4 points

A
  • infective or rheumatic endocarditis
  • congential malformations
  • dissection aortic aneurysm
  • chest trauma
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21
Q

explain

dissection aortic aneurysm

A

layers of aortic vessel are separating and blood is filling in those gaps

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22
Q

result of aortic regurgitation

A
  • LVED (left ventricular end diastolic) volume increases
  • over time, cause dilation of LV and subsequent HF
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23
Q

list

clincal manifestations of Aortic regurgitation

A
  • fatigue
  • dyspnea on exertion
  • palpitations
  • dizziness
  • sensation of a forceful heartbeat (decr. in diastolic pressure = incr. in pulse pressure)
  • angina
  • HF
  • diastolic murmur (“LUB DUB MURMUR”)
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24
Q

Why may someone experience angina during aortic regurgitation?

Study These Flashcards
A

a drop in diastolic pressure decreases coronary artery perfusion, thus ischemia, then pain

25
what does a diastolic murmur sound like?
LUB > DUB > MURMUR (high-pitched blowing sound)
26
orfices of coronary arteries | image
see image
27
treatment for aortic stenosis
* echo surveillance * medications * surgery (aortic valve replacement) * aortic balloon valvuloplasty * TAVR (trans catheter aortic valve replacement)
28
What does echo surveillance do? | aortic stenosis tx
follows the progression of the disease so we have the right timing to replace the valve
29
what type of medications are used in aortic stenosis tx | and what they do
* ACE inhibitors/ARBS to reduce afterload * Statins to slow disease progression
30
explain aortic valve replacement surgery | aortic stenosis tx
mechanical valve is sewn in place
31
what is aortic balloon valvuloplasty | aortic stenosis tx
helps the aortic valve stay open
32
when is a TAVR (trans catheter aortic valve replacement) done?
when open heart surgery is too risky * done in a cath lab!
33
# list aortic regurgitation txs
* echo surveillance * medications (to reduce afterload) * sodium restriction * aortic valve replacement surgery
34
# define mitral stenosis
obstruction of LV filling d/t a narrowing/incomplete opening of the orfice of the mitral valve ## Footnote MV is open during diastole to allow blood to flow from the LA to the LV
35
risk factors for mitral stenosis
* streptococcal infections (not as common d/t antibiotics) * congential valve abnormality
36
what does increasing the work of the left atrium cause on the heart muscle? | and what does it increase risk of?
hypertrophy of LA * risk of developing A Fib
37
clinical manifestations of mitral stenosis
* dyspnea on exertion * fatigue * palpitations and chest pain (especially w/ A Fib * left atrial enlargement * orthopnea/paroxysmal nocturnal dyspnea * pulmonary edema * HF * diastolic murmur (low frequency rumble)
38
why is orthopnea and paroxysmal nocturnal dyspnea dangerous? | mitral stenosis
blood can go back into the lungs
39
what does a diastolic murmur sound like with mitral stenosis?
LUB > DUB > murmur (**low frequency rumble**)
40
# define mitral regurgitation
backflow of blood from the LV to the LA during systole * d/t incomplete closure of MV | can be acute or chronic
41
Where does volume overload occur in mitral regurgitation? | and what it leads to
* Left atrium * left ventricle leads to ventricular dilation
42
what does mitral regurgitation cause?
* LA dilation * RV dysfunction * pulmonary HTN
43
# define mitral valve prolapse
a type of mitral valve insufficiency that occurs when one or both of the mitral valve cusps billow into the atrium during systole
44
tx for mitral valve prolapse
* beta blockers for palpitations * avoid stimulants * if symptomatic > valve repair or replacement
45
mitral stenosis tx
* echo surveillance * control HR with beta blockers * tx A fib * anticoagulate for A fib * mitral valvuloplasty * repair or replacement valve surgery
46
mitral regurgitation tx
* Echo surveillance * meds: vasodilators (hydralazine, ACE) * surgery valve repair or replacement
47
# define types of valves | 2
**tissue valves** * don't last as long as mechanical valves, don't require lifelong anticoagulation **mechanical valves** * requires lifelong anticoagulation, generally lasts longer than tissue valves
48
# fill in the blank a younger patient would most likely recieve **[tissue/mechanical]** valve replacement
a younger patient would most likely recieve **mechanical** valve replacement
49
# define infective endocarditis
an infection of the endocardial surface of the heart that causes vegetation on endocardium * may include one or more heart valves, the endocardium, or a septal defect
50
what are the 2 things that infective endocarditis requires to diagnose?
1. endocardial injury 2. bacteremia
51
risk factors of infective endocarditis
* recent dental procedures/poor dental health * hx of congenital heart disease or valvular disease * long term indwelling IV line, hemodialysis * IVDA, indwelling urinary catheters prosthetic valves, implanted hardware * IV drug use
52
manifestations of endocarditis
* fever/elevated WBC * heart murmur (vegetation on valve) * roth spots (hemorrhageson fundi of eye) * HF symptoms (d/t valve malfunction) * stroke symptoms * janeway lesions, osler nodes, splinter hemorrhages
53
what does osler node and janeway lesion look like | infective endocarditis
**Osler Nodes** * Tender (painful), violaceous (purple-pink) subcutaneous nodules, usually on finger/toe pads **Janeway Lesions** * Non-tender (painless), erythematous (red) or hemorrhagic spots, usually on palms/soles
54
what does a splinter hemorrhage look like | infective endocarditis
see image
55
what is valve vegetation?
bacteria adheres to injured surface and produces valve vegetation, the vegetation enlages as the pathogens, more Plts and fibrin attracted to site, vegetation can breakoff and travel via bloodstream to other organs ## Footnote may cause stroke, sepsis, pericarditis, infarction of lung, spleen, liver kidney and myocardium
56
who is recommended for antibiotic prophylaxis?
* prosthetic heart valve or had heart valve repaired w/ prosthetic material * hx of endocarditis * heart transplant w/ abnormal heart valve function * certain congential heart defects
57
nursing management for valve disease | 2
* maintain adequate cardiac output * optimize fluid balance * frequent assessments * lab tests (electrolytes, BUN, Cr, liver functions, blood cultures) * meds (beta blockers, ACE inhibitors, vasodilators, nitrates, antibiotics)
58
what is key to teach patient/family with valve disease management | medication recs.
* NEED for antibiotic prophylaxis before undergoing dental procedures!! * need long term anticoagulation meds
AB Med Surg
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