S U B J E C T: A D VA N C E C O N C E P T

IN NURSING
TO P I C : VA LV U L A R D I S O R D E R

Iram Shaheen
 VA LV U L A R D I S O R D E R :

Valves of the heart control the flow of blood through the heart
into the pulmonary artery and aorta by opening and closing in
response to blood pressure changes during each cardiac cycle(heart
contraction and relaxation)
 VALVES IN THE HEART:

Atrioventricular valves:

Atrioventricular valve separates the atria from the ventricles and include the
tricuspid valve, which separates the right atrium form the right ventricle ,
and the mitral valve which separates the left atrium from the left ventricle.

The tricuspid valve have three leaflets, the mitral valve has two. Both valves
have chordae tendineae that anchor valve leaflets to papillary muscles of
the heart.
 C O N T. .

Semilunar valves are located between ventricles and their corresponding

arteries. The pulmonic valve lies between the right ventricle and the
pulmonary artery , the aortic valve lies between the left ventricle and aorta.
When any heart valve does not open or close properly the blood flow is
effected. When valve does not close completely the blood flows backward
through the valve , a condition called regurgitation. When valve does not
open completely a condition called stenosis blood flow through the valve is
reduced .
 C O N T.

Regurgitation and stenosis affect all the heart valves. The mitral
valve may also prolapse (i.e. Stretching of the valve leaflets into
the atrium during systole.
Depending upon the sign and symptoms patients with valve
disorders may not require treatment or they may need to make life
style changes , take medication , surgical repair or replacement of
the heart valve.
 MITRAL VALVE PROLAPSE:

Mitral valve prolapse, also known as click-murmur syndrome,

Barlow's syndrome, balloon mitral valve, or floppy valve syndrome,
is the bulging of one or both of the mitral valve flaps (leaflets)
into the left atrium during the contraction of the heart.

Mitral valve prolapse is a deformity that usually produce no

symptoms. Rarely it progresses and can result in sudden death.
 CAUSE:

This condition occurs in up to 2.5% of the general population and

more frequently in women than men.
The cause may be an inherited connective tissue disorder resulting
in enlargement of one or both of the mitral valve leaflets ,but in
many cases the cause is unknown.
The annulus often dilates ; chordae tendineae and papillary
muscles may elongate or rupture.
 PATHOPHYSIOLOGY:

In mitral valve prolapse the portion of one or both mitral valve
leaflets balloon back into the atrium during systole. Rarely, the
ballooning stretches the leaflets to the point that valve does not
remain closed during systole. Blood then regurgitates from the left
ventricle back into the left atrium. About 15% of patients who
develop murmurs eventually experience heart enlargement , atrial
fibrillation, pulmonary hypertension or heart failure.
 C L I N I C A L M A N I F E S TAT I O N S :

Most people with mitral valve prolapse never have symptoms a few have :
Fatigue
Shortness of breath

Lightheadedness
Dizziness

Syncope
Palpitations

Chest pain
Anxiety
 MANIFESTATIONS:

Fatigue may occur regardless of activity level and amount of sleep and rest
shortness of breath is not correlated with activity level or pulmonary
function .
 Atrial and ventricular dysrhythmias may produce the sensation of
palpitations ,but palpitations have been reported while the heart has been
beating normally.
Anxiety may be a response to symptoms, some patients report the anxiety
as only symptoms.
 ASSESSMENT AND DIAGNOSTIC
FINDINGS

Often the first and only sign of mitral valve prolapse is an extra heart
sound , referred to as a mitral click.
A systolic click is an early sign that the valve leaflets is ballooning into
the left atrium. In addition to the mitral click , a murmur of mitral
regurgitation is heard if the valve open during systole and blood flow
back into the left atrium.
If the mitral regurgitation exist , a patient may experience the sign of
heart failure, echocardiography is used to diagnose and monitor the
progression of mitral valve prolapse.
 MEDICAL MANAGEMENT:

Medical management is directed at controlling symptoms . If the

dysrhythmias are documented and cause symptoms the patient is
advised to stop caffeine and alcohol and to stop the use of tobacco
products. Most patients do not require medications but some are
prescribed with antiarrhythmic medications. Prophylactic
antibiotics are not prescribed prior to dental and invasive
procedures.
 MEDICAL MANAGEMENT:

Chest pain that dose not respond to nitrates may respond to

calcium channel blockers or beta blockers. Heart failure is treated
the same as it would be for any other case of heart failure .
Patients with severe mitral regurgitations and symptomatic heart
failure may require mitral valve repair or replacement.
 NURSING MANAGEMENT:

The nurse educates the patient about the diagnosis and possibility
that the condition is hereditary . First degree relatives ( parents,
siblings) may be advised to have echocardiograms, patients with
mitral valve prolapse may be at risk for infective endocarditis from
bacteria entering into blood stream and adhering to the abnormal
valve structure. The nurse educates the patient how to minimize the
risk of infection.
 C O N T.

Because most patients with mitral valve prolapse are asymptomatic , the
nurse explains the need to inform the patients primary provider about any
symptoms that develop.
To minimize symptom the nurse instructs the patient to avoid caffeine and
alcohol.
The nurse encourages the patient to read the product label particular on
over the counter drugs such as cough syrups that may contain alcohol and
caffeine , ephedrine, epinephrine which may produce dysrhythmias and
other symptoms.
 CONT .
The nurse also explores the diet, activity level , rest sleep and
other life style factors that may correlate with symptoms.
Women with mitral valve prolapse without mitral regurgitation
or other complications may complete pregnancies with vaginal
deliveries.