Valvular Disorder

Valvular Heart Disease

When the heart valves are stenotic or totally closed, valvular heart disease results (insufficiency or regurgitation). Valvular heart disease hinders the heart's ability to pump blood effectively. Rheumatic fever with carditis patients who develop chronic valvular heart disease are at least 50% of the population. The majority of cases involve women. More often than not, the mitral valve is impacted, then the aortic, tricuspid, and finally the pulmonary valves in decreasing order of frequency. The anatomical name and functional insufficiency of valvular heart disease are used to categorize it.

Mitral Stenosis (MS)

4 to 6 cm2 is the typical mitral valve area (MVA). Valvular tissue that thickens and narrows the valves results in mitral stenosis. Due to structural abnormalities of the mitral valve apparatus, MS is characterized by obstruction of left ventricular inflow at the level of the mitral valve. Usually brought on by rheumatic fever, but it can also be congenital. The valve apparatus becomes scarred and fused due to rheumatic heart disease. Two-thirds of MS patients are female, and pure or predominant MS affects about 40% of patients with rheumatic heart disease.

Pathophysiology

• The mitral valve aperture gradually narrows in rheumatic mitral stenosis due to increasing fibrosis, calcification of the valve leaflets, and valvular apparatus fusion.
• Breathlessness and pulmonary venous congestion result from the restriction of blood flow from the right atrium to the ventricle and the subsequent increase in left atrial pressure.
• The left atrium has enlargement and hypertrophy.
• Minimal symptoms of mild mitral stenosis (MVA 1.5–2.5cm2)
• Symptoms of MVA 1.0–1.5 cm2 moderate mitral stenosis are typically absent when the patient is at rest.
• When the MVA is less than 1 cm and there are 2 symptoms, the condition is severe.

Signs and Symptoms

• Cough, fatigue, SOB, palpitation, hemoptysis
• Left sided failure:
  • Orthopnea
  • Paroxysmal nocturnal dyspnea (PND)
• Right sided failure:
  • Hepatic Congestion
  • Edema
• Systemic embolism
• Worsened by conditions that ↑ cardiac output such as exertion, fever, anemia, tachycardia, intercourse, pregnancy, thyrotoxicosis
• Atrial fibrillations
• Loud first heart sound and middiastolic murmur on auscultation
• Crepitation, pulmonary edema, pulmonary effusions, and infection

Diagnosis

• ECG: LAH, LVH
• Chest X-ray: LAH, pulmonary venous congestion.
• ECHO: Reduced valve area, thickened immobile cusps, and a slower rate of LV diastolic filling

Management of Mitral Stenosis

• Medical management in early and less severe case:
  • Diuretics for LHF/RHF
  • Digitalis/Beta blockers/CCB: Rate control in a fibrillation
  • Anticoagulation: In a fibrillation to reduce the possibility of embolism
  • Endocarditis prophylaxis
• Balloon valvuloplasty: It is a surgical but non-invasive procedure. Through the arterial septum and the mitral valve, a balloon catheter is inserted from the femoral vein. The orifice is made larger by inflating the balloon. For long-term improvement, it works.

Surgical Management

• Mitral commissurotomy
• Mitral Valve Replacement; Mechanical or Bioprosthetic

Nursing Management

• Administer the required heart failure medication
• Provide oxygen as directed.
• Give out a diet reduced in salt
• Give digitalis and diuretics as directed
• If infectious endocarditis is present, take the prescription antibiotics. If atrial Fibrillation is present, use the prescribed antidysrhythmics and anticoagulants.
• As necessary, get ready the patient for operation
• Post-operative interventions:
  • Keep an eye out for any bleeding, cardiac output, or heart failure symptoms.
  • In addition to monitoring the incision and reporting any redness or drainage from the wound, administer medications as directed.
  • Impart health knowledge
• It's normal to feel tired, so get enough rest.
• Anticoagulation therapy is required if a mechanical valve is implanted.
• For six months, avoid getting any dental work done. Heavy lifting (above 10 lb) and other actions that could result in sternal injuries.
• Inform the patient of the negative effects of anticoagulants and to call their doctor if they experience bleeding or bruising. Maintaining adequate oral hygiene is essential to lowering the risk of infectious endocarditis. A soft toothbrush and an oral rinse should be used to brush your teeth twice a day. importance of pre-invasive procedures antibiotic prophylaxis. Get a medical ID card.

Aortic Stenosis

The aortic valve in the heart narrows, causing aortic stenosis. Due to this, the valve's blood flow is constrained. Therefore, in order to pump blood into the aorta, the heart must squeeze (contract) harder. Congenital bicuspid valve, idiopathic degenerative sclerosis with calcification, infectious endocarditis, and rheumatic fever are some of the contributing factors.

Aortic Regurgitation

The aortic valve in the heart narrows, causing aortic stenosis. Due to this, the valve's blood flow is constrained. Therefore, in order to pump blood into the aorta, the heart must squeeze (contract) harder. Congenital bicuspid valve, idiopathic degenerative sclerosis with calcification, infectious endocarditis, and rheumatic fever are some of the contributing factors.