valvular disorders by megan rice annie halverson sara sabelhaus michelle chung

Valvular Disorders

By

Megan Rice

Annie Halverson

Sara Sabelhaus

Michelle Chung

Rheumatic Fever…

• Rheumatic fever – an inflammatory disease of the heart

involving all layers

• Rheumatic heart disease– Chronic condition resulting from rheumatic

fever characterized by scarring and deformity of heart valves

Rheumatic Fever…

• Acute Rheumatic Fever– Manifests as an abnormal immunologic

response to group A Streptococcal Pharyngitis cell membrane antigens

– ARF affects heart, joints, CNS, and skin– Rheumatic endocarditis forms in the

valves: valve deformities!

Valve Review…

• Heart contains 2 AV valves: – Mitral and Tricuspid

• 2 Semilunar valves– Aortic and Pulmonic

• Valvular heart disease is defined according to valves affected and type of functional alteration

Valvular Disorders

Valvular Heart Disease

• Defects in structure or function of valves intereferes with proper cardiac circulation:

– Stenosis: heart valve leaflets are constricted, opening is narrow, stiff, unable to open and close properly, impending forward flow of blood

– Regurgitation (insufficiency): improper or incomplete closure of heart valves resulting in backflow of blood

– Prolapse: leaflets of valve buckles back

Stenosis

Regurgitation

Prolapse

Mitral Valve Stenosis

• Scarring of valve leaflets and chordae tendinae cause contractures and adhesions between the commissures (junctional areas)

• A thickening and shortening of the valve structure occurs

• These structural deformities create an obstruction of blood flow and pressure difference between the left atruim and left ventricle during diastole.


Clinical Manifestations:

ºPrimary symptom is exertional dyspnea due to reduced lung compliance.

ºFatigue

ºPalpitations from atrial fibrillation


Mitral Stenosis Sound

ºHeart sounds: loud first heard sound and a low-pitched, rumbling diastolic murmer at the apex of the heart.

Mitral Valve Regurgitation

• Any defect in the following valve structures: mitral leaflets, mitral annulus, chordae tendinae, papillary muscles, left atrium and left ventricle.

• Allows blood to flow backward from the left ventricle to the left atrium due to incomplete valve closure during systole.



ºAcute MR: thready, peripheral pulses and cool, clammy extremities.

ºChronic MR: May remain asymptomatic for many years. Initial symptoms of left

ventricular failure may include weakness, fatigue, palpitations, and dyspnea that

gradually progress to orthopnea, paroxysmal nocturnal dyspnea, and peripheral edema.


Mitral Regurgitation Sound

ºHeart sounds: An audible third heard sound (S3). The murmur is a loud holo-

or pansystolic murmur at the apex radiating to the left axilla.

Mitral Valve Prolapse

• An abnormality of the valve leaflets and the papillary muscles or chordae that allows the leaflets to buckle back into the left atrium during systole.

• Usually benign but serious complications such as Mitral regurgitation, infective endocarditis, Sudden cardiac death, and cerebral ischemia can occur.



ºMost patients are asymptomatic for life.

ºPossible chest pain accompanied by dyspnea, palpitations, and syncope

ºDysrhythmias, most commonly premature ventricular contractions, paroxysmal

supraventricular tachycardia, and ventricular tachycardia, may case palpitations, light-

headedness, and dizziness.


Mitral Prolapse Sound

ºHeart sounds: murmur from regurgitation that gets more intense through systole.

This could be a late or holosystolic murmur. Another major sign is one or more clicks usually heard during mid-

late systole.

Aortic Valve Stenosis

• Causes obstruction of flow from the left ventricle to the aorta during systole.

• The effect is ventricular hypertrophy and increased myocardial oxygen consumption due to increased myocardial mass.

• As the disease progresses, reduced CO leads to pulmonary hypertension and HF.

• If aortic stenosis occurs from rheumatic heart disease, mitral valve disease accompanies it.


ºDevelop once the valve orifice becomes approximately 1/3 its normal size.

ºClassic triad of angina, syncope, and exertional dyspnea (which reflect left

ventricular failure).


Aortic Stenosis

ºHeart sounds: normal or soft S1, diminished or absent S2, a systolic,

crescendo-decrescendo murmur that ends before S2, and a prominent fourth

heart sound (S4)

Aortic Valve Regurgitation

• May be the result of primary disease of the aortic valve leaflets or the aortic root.

• Causes a retrograde blood flow from the ascending aorta into the left ventricle during diastole, resulting in volume overload.

• At first, the left ventricle compensates by AR dilation and hypertrophy. Eventually, the contractility declines which results in pulmonary hypertension and right ventricular failure.



ºSudden symptoms of cardiovascular collapse.

ºSevere dyspnea, chest pain, and hypotension indicating left ventricular failure and shock

(medical emergency!).

ºIn Chronic, AR, there may be a “water-hammer pulse”, which is a strong, quick beat that

collapses immediately.


Aortic Regurgitation Sound

ºHeart Sounds: May include a soft or absent S1, presence of S3 or S4, and a soft, decrescendo, high-pitched diastolic murmur. A systolic ejection click and a

low-frequency diastolic murmur (Austin-Flint Murmur) may be heard.

Tricuspid & Pulmonic Valve Disease

• Uncommon• Stenosis occurs more frequently than regurgitation.• Result in an increase in blood volume in the right

atrium (tricuspid) and right ventricle (pulmonic).• Tricuspid stenosis: results in right atrial enlargement

and elevated systemic venous pressures.• Pulmonic stenosis: results in right ventricular

hypertension and hypertrophy.


Tricuspid Stenosis

valvular disorders by megan rice annie halverson sara sabelhaus michelle chung

Documents

mitral valve stenosis

heart valve leaflets

valve review heart

mitral leaflets

valve deformities

leaflets of valve buckles

mitral annulus

atrial fibrillation