Wednesday, March 30, 2011

Heart Valve Disorders

Heart Valve Disorders
If one heart valve does not open or closed properly then it will affect the flow of blood. If the valve can not open completely (usually due to stenosis), consequently the blood flow through the valve will be reduced. If the valve can not completely close the blood will leak as a process called regurgitation or insufficiency.

Abnormalities of the mitral valve was divided into the following categories:
1. mitralis valve prolapse syndrome
2. mitralis valve stenosis
3. mitralis valve insufficiency (regurgitation)

Aortic valve abnormalities are categorized as follows:
1. aortic valve stenosis
2. aortic valve insufficiency (regurgitation)

VALVE SYNDROME mitralis prolapse (MVP)

1. Definition
Mitralis valve prolapse syndrome is a dysfunction of the valve mitralis blades that can not be closed properly and cause regurgitation, so the blood seeped from the left ventricle into the left atrium.

2. Clinical manifestations
Many people who have this syndrome but have no symptoms. Sometimes symptoms were first discovered during a physical examination of the heart, with the discovery of additional heart sound, known as mitral click. The existence of click an early sign that the valve tissue bulging into the left atrium and has been an interruption of blood flow. Mitral clicks can be turned into murmurs along with the non-functioning of the blades of the valve. With the development of the disease process, the sound of murmurs became a sign of mitral regurgitation (backflow of blood). Mitral valve prolapse occurs more frequently in women than men.

3. Management
Medical Treatment aimed at controlling the symptoms that occur. Some patients suffered dysrhythmia disruptive and require antidisritmia, while others experience mild heart failure and require treatment. At the advanced stage, valve replacement may be necessary.

Patients with this syndrome should be given counseling about the importance of prophylactic antibiotic therapy before undergoing invasive procedures (eg dental care genitouriner or gastrointestinal procedures, IV therapy that could lead to the entry of infectious material into the body system. If the client feels any doubt about the risk factors and the need for antibiotics, it is recommended to consult a doctor.

Mitralis valve stenosis (SM)

1. Definition
Mitralis valve stenosis is narrowing of the valve hole between the left atrium and left ventricle.

2. Etiology
Mitralis valve stenosis is usually caused by scar tissue formation after rheumatic fever or other heart infection.

3. Pathophysiology
Mitral stenosis due to fibrosis and fusion of the mitral valve commissures during the healing phase of rheumatic fever. Connective tissue septum formation without calcification of the mitral valve resulting in holes in the diastolic time is smaller than normal.

The reduced effective area of ​​mitral holes cause a reduction in mitral valve flow capacity. This will increase the pressure in the left atrium space, which raised the pressure difference between the left atrium and left ventricle diastolic time. If this pressure increase in the number of unsuccessful drain enough blood to meet the needs of the body, there will be a dam on the left atrium and then the dam will cause pulmonary veins and capillaries. This dam will cause puffy swollen interstitial and alveolar may occur. The outbreak of bronchial vein will cause haemoptysis.

At the next stage pulmonary arterial pressure will increase, and then going right ventricular dilation and tricuspid valve insufficiency in or pulmonary. Finally, systemic veins will have a dam as well. Prolonged liver dam will cause liver dysfunction.

The first compensation body to increase cardiac output is tachycardia. But this compensation is not always increase cardiac output because at a certain level will reduce the diastolic filling. Strain on the muscles of the atrium can cause electrical interference resulting in atrial fibrillation. This will interfere with ventricular filling from the atrium and facilitate the formation of thrombus in the left atrium.

4. Clinical manifestations
- Clinical features may not exist or otherwise severe, depending on the level of stenosis.
- pulmonary congestion may occur, with the signs dispnu (shortness of breath) and pulmonary hypertension.
- There can be a sense of swing and fatigue caused by left ventricular reduction in spending. Heart rate may increase due to sympathetic stimulation.
- Can occur hypertrophy left atrium causing atrial dysrhythmias and right heart failure.

5. Examination Support
- Can be audible heart murmur systolic blood while entering through a narrow orifice.
- Can be used echocardiography to diagnose the structure and the abnormal valve motion.

6. Management
Antibiotic therapy given to prevent recurrence of infection. The management of congestive heart failure is to provide kardiotonikum and diuretics. Surgical intervention include komisurotomi to open or 'rip' the mitral valve commissures are sticky or replace the mitral valve with a valve prosthesis. In some cases where surgery is contraindicated and medical therapy are not able to produce the expected results, it can be done valvuloplasti percutaneous transluminal to reduce some symptoms.

VALVE mitralis insufficiency (regurgitation) (IM)

1. Definition
Mitralis valve insufficiency (regurgitation) is the return of blood into the left atrium from the left ventricle through a valve mitralis, which mainly occurs when the ventricles contract.

2. Etiology
Mitralis valve insufficiency caused by an incompetent mitralis. Mitralis valve fails to close completely during ventricular systole begins. Mitralis valve regurgitation is usually caused by rheumatic fever, other bacterial infections of the heart, or rupture valve in coronary artery disease.

3. Pathophysiology
Due to rheumatic mitral insufficiency due to valve can not close the perfect time systolic. Changes to the valve cover classification, thickening, and distortion of the valve leaflets. This resulted in an imperfect koaptasi systolic time. In addition to shortening lead valve chordae tendineae attracted to the ventricles, especially the posterior part, may also occur annulus dilatation or ruptured chordae tendineae. During the systolic phase, there was a flow of regurgitation into the left atrium, resulting in a high V wave in the left atrium, while the flow into the aorta is reduced. At the time of diastolic blood flow from left atrium to the ventricle. Blood except from the lungs through the pulmonary vein, there are also blood regurgitan of left ventricular systolic time previously. Rapid distention of the left ventricle, the apex abruptly moves downward, pulling the valve, chordae, and papillary muscles. This raises the vibration to form a third heart sound. In chronic mitral insufficiency, systolic regurgitation into the left atrium and pulmonary veins can be tolerated without increasing the aorta and pulmonary wedge pressure.

4. Clinical manifestations
- Clinical features may not exist or otherwise severe, depending on the level of regurgitation.
- pulmonary congestion may occur, with signs and hypertension dispnu pulmonaris, when the blood back into the pulmonary vascular system.
- Decrease in cardiac output due to reduced volume sekuncup can cause intense shaking and fatigue. Heart rate may increase due to sympathetic stimulation.
- left ventricular hypertrophy and left atrium can occur, causing congestive heart failure.

5. Examination Support
- systolic heart murmur can be heard at the time of blood with a strong push through the valve.
- echocardiography can be used to diagnose the existence and structure of the abnormal valve motion.

6. Management
Giving antibiotics to prevent rheumatic reactivation and the incidence of infective endocarditis. Surgical intervention include mitral valve replacement.

Aortic valve stenosis (AS)

1. Definition
Aortic valve stenosis is a narrowing of the lumen of the valve between the left ventricle and aorta.

2. Etiology
Stenosis can be caused by congenital abnormalities such as bicuspid aortic valve with a small hole and unikuspid aorta, which usually cause symptoms early. In older people, rheumatic heart disease and perkapuran a common cause.

3. Pathophysiology
Normal aortic orifice size 2-3 cm2. Aortic stenosis causes resistance and the pressure difference between the left ventricle during systolic and aorta. Increased left ventricular pressure to produce an excessive pressure load on left ventricle, which is solved by increasing the thickness of the left ventricular wall (ventricular hypertrophy). Left ventricular chamber dilation occurs to decreased myocardial contractility. Left ventricular end diastolic pressure increased. Atrial contraction increase left ventricular diastolic blood volume. This will lead to an enlarged left atrium. Finally, left ventricular load constant will cause dilation of the left ventricle and reduce myocardial contractility. Myocardial ischemia caused by a lack of coronary blood flow to myocardial hypertrophy.

cardiac work exceeds Had, be heart failure to function properly, the signs are shortness of breath easily.

Those who obesiti also likely to get high blood pressure because blood vessels become narrow due to fat deposits.

The combination of high blood pressure and obesiti applying pressure to the heart and cause heart wall thickening and lack of oxygen.

This situation again expedite problem of heart failure to function properly and so causes the heart to continue to be damaged.