Lesson 1, Topic 1
In Progress

Heart Valve Diseases

April 11, 2024

Learning Objective: Describe heart valve diseases, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      There are many types of valvular disease. Two types of heart valve disease can occur with each of the valves: either stenosis or insufficiency (also called regurgitation or incompetence). When you name the disease, the valve is followed by stenosis or insufficiency (e.g., tricuspid stenosis, tricuspid insufficiency). With stenosis, the heart may need to work harder to push blood through the smaller opening. With insufficiency, the valve does not close completely, and blood leaks backward across the valve into the prior chamber (FIGURE 25.9). The following sections discuss more common valvular diseases.

Aortic Insufficiency
With aortic insufficiency, the aortic valve does not close tightly. The blood backs up into the left ventricle. This is more common in males between the ages of 30 and 60.
      Many conditions cause this disease, including high blood pressure, syphilis, congenital problems, and endocarditis. Signs and symptoms may not be present or may be slow to develop. They include a bounding pulse, angina, fainting, fatigue, palpitations, SOB, and swelling of the feet.
      Besides the physical exam, a person may have an aortic angiography, ECHO, left heart catheterization, magnetic resonance imaging (MRI), and transthoracic echocardiography done to diagnose the condition. The treatment goal is to reduce blood pressure through medications. The patient may need surgery to replace the valve.

Mitral Valve Prolapse
Mitral valve prolapse occurs when one or both cusps of the mitral valve protrude back into the left atrium during ventricular systole.
      This condition is congenital or genetic. The patient may experience palpitations, SOB, cough, fatigue, dizziness, anxiety, migraines, and chest discomfort.
      The provider will do a physical exam, and additional tests will be ordered, including ECHO, Doppler ultrasound, chest x-ray, and an ECG. Treatment consists of medications (beta-blockers, diuretics, vasodilators) and surgery to repair or replace the valve.

Rheumatic Fever
Rheumatic fever is an inflammatory reaction that affects the heart valves (valvulitis) and causes swelling and scarring of the valves. Permanent damage to the valves leads to rheumatic heart disease.
      Rheumatic fever occurs 2 to 4 weeks after a strep (group A Streptococcus) throat infection. Antibodies made by the body to attack the streptococcal infection start attacking the body tissues (joints and heart valves), causing inflammation, swelling, and scarring. The patient may have a fever, joint pain, stomach pain, weakness, SOB, nodules (small bumps) under the skin by the elbows and knees, and a rash on the chest, abdomen, or back.

FIGURE 25.8  Providers measure pitting edema from 1+ to 4+. From Ball J, et al: Seidel’s guide to physical examination, St. Louis, 2019, Mosby.

FIGURE 25.9  Valvular heart diseases. Disorders of the aortic, mitral, and tricuspid valves. From Shiland B: Medical terminology and anatomy for ICD-10 coding, ed 2, St. Louis, 2016, Mosby.

      After the physical exam, the provider may order blood tests, chest x-rays, ECHO, and an ECG. Treatment consists of antibiotics to address the infection and nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to reduce the inflammation. Surgery may be needed to repair the valve.

Metabolic Syndrome
Learning Objective: Discuss metabolic syndrome, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Metabolic syndrome is also called metabolic syndrome X and insulin resistance syndrome. Metabolic syndrome is a group of factors that increase a person’s risk for heart disease, type 2 diabetes, and stroke.
      Several causes act together. These include an inactive lifestyle, being overweight, obesity, and insulin resistance. With insulin resistance, the body cannot use insulin properly, which leads to elevated blood glucose levels. Other risk factors for metabolic syndrome include the following:
          • Age: The risk increases with age.
          • Ethnicity: Hispanic women have the greatest risk.
          • Obesity: Carrying too much weight in the abdomen increases the risk.
          • History of gestational diabetes, nonalcoholic fatty liver disease, polycystic ovary syndrome, or sleep apnea.
          • Family history of type 2 diabetes.
     The only signs include a large waist circumference and symptoms of diabetes if the blood glucose is elevated. These symptoms include increased thirst, frequent urination, fatigue, and blurred vision.
      The provider will diagnose metabolic syndrome based on the physical exam findings and the blood test results. A patient must have at least three of these risk factors to be diagnosed with metabolic syndrome:
          • A large waistline, which is defined as a waist measurement of 35 inches or more for females and 40 inches or more for males
          • A triglyceride level of 150 mg/dL or higher
          • A low high-density lipoprotein (HDL) cholesterol level of less than 50 mg/dL for females and less than 40 mg/dL for males
          • High blood pressure (which is 130/85 mm/Hg or higher)
          • A fasting blood glucose level of 100 mg/dL or higher
      Treatment is focused on maintaining a heart-healthy lifestyle. This includes following a heart-healthy eating plan that limits the saturated and trans fats eaten. It also includes managing stress, getting regular physical activity, smoking cessation, and aiming for a healthy weight.

Myocardial Infarction
Learning Objective: Discuss myocardial infarction, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Myocardial infarction (MI), also called a heart attack, affects more than 1 million people in the United States each year, and about half of them die as a result. With an MI, the blood flow is limited or blocked, and the heart muscle cells die due to the lack of oxygen.
An MI can be caused by a blood clot or plaque buildup in the coronary arteries. The following risk factors can be changed:
          • Smoking, drinking alcohol, lack of exercise, obesity, and stress
          • High cholesterol, high blood pressure, and uncontrolled diabetes
These factors cannot be changed:
          • Age: Risk increases with age.
          • Sex: Males have a higher risk; after menopause, females have almost the same risk as males.
          • Genetics: Family history increases risk.
          • Race: African Americans, Mexican Americans, Native Americans, and Hawaiians have a greater risk.
The most common warning symptoms of MIs include these:
          • Angina pectoris (chest pain): May also be described as mild or severe heaviness, squeezing, pressure, or heartburn; pain may be constant or intermittent.
          • Upper body discomfort or pain in one or both arms, shoulders, neck, jaw, or upper part of the abdomen.
          • Shortness of breath with activity or rest.
          • Cold sweat, tiredness without a reason, nausea and vomiting, dizziness, lightheadedness, arrhythmias, or palpitations.
          • Females may have sharp, burning chest pain or back pain; two-thirds have no symptoms.
      Diagnostic tests for an MI include an ECG and blood tests (i.e., troponin, creatine kinase [CK], creatine kinase–MB [CK-MB], and serum myoglobin tests). CK-MB is an enzyme found in the heart muscle cell. Within hours of a heart attack, the CK-MB level increases in the blood. It peaks within 12 to 24 hours and returns to normal by 48 to 72 hours. The blood tests may be repeated over time to look for changes. Angiocardiography may be done to study the coronary blood flow and identify blockages. Immediate treatment involves the following:
          • Chewing aspirin to prevent additional clots
          • Nitroglycerin to dilate the coronary arteries and help increase the oxygen to the heart muscle
          • Oxygen therapy
     As soon as the diagnosis is determined, thrombolytic medications (also called “clot busters”) are given. These medications help the body’s natural process of dissolving blood clots. Percutaneous coronary intervention may be done to open the coronary artery. Medications, lifestyle changes, and cardiac rehabilitation may also be initiated.

25.6 Critical Thinking Application
Rebecca reviews the chest pain protocol with Lizzy. It states that patients with chest pain need to chew an aspirin. Nitroglycerin and oxygen must also be administered to the patient. Rebecca asks Lizzy why aspirin, nitroglycerin, and oxygen are important if a person is experiencing chest pain. How might Lizzy answer this question?

Additional Heart Diseases and Disorders
Learning Objective: Describe additional heart diseases and disorders.
      There are many cardiovascular diseases and disorders. The following list provides a brief description of some of them:
          • Cardiac tamponade: Blood or fluid buildup in the pericardial sac, causing pressure on the heart.
          • Endocarditis: Also called infective endocarditis (IE). The inner lining of the heart is inflamed. Bacterial endocarditis is most common and can damage the valves.
          • Pericarditis: Inflammation of the pericardium.