Valvular Heart Disease

Valvular heart disease refers to damage or defects involving one or more heart valves, and can be either stenosis, or narrowing of the valvular opening; or regurgitation, also called insufficiency or incompetence, or failure of the valve to adequately close.

Alright so, valvular heart disease is caused by damage or defects involving one or more heart valves. One cause of valvular heart disease is rheumatic fever, which is an inflammatory condition that typically occurs after a strep throat infection from Streptococcus pyogenes, also referred to as group A beta-hemolytic streptococcus.

Other important causes include congenital defects, infective endocarditis, atherosclerosis, myocardial infarction, as well as autoimmune diseases like rheumatoid arthritis or systemic lupus erythematosus; or connective tissue disorders, like Marfan syndrome.

Now, the heart valves control blood flow through the heart. The two atrioventricular, or AV, valves include the tricuspid valve that separates the right atrium from the right ventricle and the mitral valve, which separates the left atrium from the left ventricle.

The two semilunar valves are the pulmonary valve that separates the right ventricle from the pulmonary artery and the aortic valve that separates the left ventricle from the aorta.

The type of valvular heart disease depends on the affected valve and the type of defect. So, let’s start with mitral stenosis, which is where the valve leaflets either fuse together or stiffen, impairing the valve opening, making it harder for blood to flow from the left atrium to the left ventricle.

As a result, the pressure in the left atrium increases, which compensates by undergoing hypertrophy and dilation to accommodate the extra blood.

Then there's mitral valve regurgitation, where the valve fails to close completely during systole; or sometimes, the leaflets bulge back, or prolapse, into the left atrium.

Either way, blood flows back from the left ventricle into the left atrium. As with mitral stenosis, left atrial pressure increases, resulting in hypertrophy and dilation.

Now, eventually blood will start backing up from the left atrium into the lungs, resulting in pulmonary edema, which can make it harder for the right ventricle to pump blood into the pulmonary artery.

Over time, the right ventricle can also undergo hypertrophy, and ultimately fail, which is known as right-sided heart failure.

Next up is aortic stenosis, where the leaflets of the aortic valve become stiff, so they can’t open fully, making it harder for blood to flow from the left ventricle into the aorta.

To compensate, the left ventricle undergoes hypertrophy and dilation to accommodate the extra blood. In aortic regurgitation, the valve doesn’t close properly during diastole, so blood leaks from the aorta, back into the left ventricle.

To compensate, the left ventricle undergoes hypertrophy and dilation; but eventually, the left ventricle begins to fail, and blood starts to back up into the left atrium and into pulmonary circulation, causing pulmonary edema.

Initially, patients with valvular heart disease are typically asymptomatic; but when symptoms do develop, they usually include dyspnea, orthopnea, fatigue, as well as angina, palpitations, dysrhythmias, dizziness, and syncope.

Upon auscultation, patients may present heart murmurs. Mitral stenosis is characterized by a low-pitched mid-to-late diastolic murmur; while in mitral prolapse, there’s a mid-systolic click, sometimes followed by a systolic murmur; and in mitral regurgitation, there’s a pansystolic, or holosystolic, high-pitched murmur, and an audible S3 heart sound.

Aortic stenosis is characterized by a systolic crescendo-decrescendo murmur and decreased S2 sound; and lastly, aortic regurgitation is associated with a decrescendo diastolic murmur.

The diagnosis of valvular heart disease starts with history and physical assessment. Diagnostic tests include chest X-ray, which can reveal heart size and the presence of pulmonary edema; ECG, to evaluate heart rhythm; and echocardiography, to visualize valve structure and function.

Other diagnostic tests include cardiac catheterization to detect pressure changes in the heart chambers, and doppler color-flow imaging to visualize the velocity and direction of blood flow.

Now, the treatment of valvular heart disease can involve pharmacological treatments to address heart failure and pulmonary edema, including diuretics, ACE inhibitors, positive inotropes, and beta-blockers.

Anticoagulants and antidysrhythmics may also be required. For valvular stenosis, percutaneous transluminal balloon valvuloplasty can dilate the valve using a balloon.

Valve replacement, in which the affected valve is replaced with a new one, can also be done. Alright, let’s look at the nursing care you’ll be providing for a patient with valvular heart disease.

Begin by assessing your patient’s cardiopulmonary function, and institute continuous cardiac monitoring and pulse oximetry.

Then, check their vital signs; auscultate their heart and lung sounds; check for peripheral edema; and monitor their intake and output.

Support breathing and oxygenation as needed by assisting them into a high Fowler position and providing supplemental oxygen.

Also administer their prescribed medications and evaluate the effectiveness of therapy. When providing education for your patient, focus your teaching on self-care at home.

Be sure they understand why each of their medications are prescribed and instruct them to take them exactly as directed.

Also talk about lifestyle modifications, including maintaining a healthy weight and engaging in moderate physical activity, as tolerated.

Provide them with a list of healthy, low sodium foods to choose from, review the importance of limiting their consumption of alcohol and caffeine and avoiding any products that contain nicotine or tobacco.

Refer them to resources for support, like for smoking cessation, as needed. Also be sure to teach them to recognize symptoms that their valve is not functioning properly and instruct them to immediately seek emergency care if they experience dizziness, palpitations, chest pain, or trouble breathing.

Alright, as a quick recap... Valvular heart disease refers to damage or defect involving one or more heart valves.

Causes include rheumatic fever following a strep throat infection, infective endocarditis, atherosclerosis and myocardial infarction, as well autoimmune or congenital causes.

Patients with valvular heart disease present with dyspnea, orthopnea, fatigue, as well as angina, palpitations, dysrhythmias, and heart murmurs.

Diagnosis is established by performing various diagnostic tests, and treatment consists of pharmacological management, as well as procedures to repair or replace the affected valve.

Nursing considerations are focused on managing symptoms and providing patient education for promoting a healthy lifestyle, self-care at home, and when to seek emergency care.