 Welcome to Nursing School Explained in this video on heart valve disorders. Pretty much we have to distinguish between two different types of disorders here. And those are synosis and regurgitation. In heart valve synosis, there is a problem with the opening of the valve, which can be due to a narrow valve and this can be a variety of reasons, but also congenital. And then there can be calcium deposits. So as we age, more calcium deposits in our arteries or in our blood vessels also make the blood vessels stiffer. And the cardiologist once told me that the older we get, the more likely we're going to get these calcium deposits and have synosed valves. And the most commonly synosed valves is the aorta. So aortic synosis is a very common disorder. As you can see over here, I highlighted in red the O from synosis as well as the O of the opening. This is something that I like to remember. So synosis is the problem with the opening, that way you can kind of relate this back. Now the second problem that can happen with the heart valve is regurgitation, which is a problem with the closing of the valve and sometimes referred to as insufficiency or incompetence. So now when the heart valve is synosed, it basically, if it would typically open up this way, when there are calcium deposits, the valves get more stiff and the leaflets can't really open. Where in regurgitation, there's a problem with the closing. So now that the valve closes, it might not close all the way or one side might close one and the other. So there's a problem with the closure. And really, if we look over here at the anatomy of the heart with our right and left side, on the right side of the heart, we have the tricuspid and the pulmonic valves. And then on the left side, we have mitral and aortic valves. And either way, whether the valve is synosed, not opening all the way or regurgitating, meaning not closing all the way, the blood flow will be not as smooth as it would usually be. And then what occurs is that the blood will kind of back up into the previous chamber. So if there's a problem with the pulmonic valve, then the blood will back up into the right ventricle and then into the right atrium. And the same thing could happen on the left side. And if we think about that usually in our blood vessels, the blood flow happens pretty steadily and kind of like a straight flow. But if there is any kind of obstruction happening, so not if that valve is not opening or not closing, that blood flow is going to leak through because the valve is supposed to be closed, but the blood is going to leak through and kind of cause a turbulence here. And this turbulence that occurs here, we can hear that with our stethoscope, which leads us to over here signs and symptoms. So many times the first sign of a valve problem is an audible murmur that somebody detects maybe a routine physical or during some sort of an exam or all of a sudden, there might be a little bit of a murmur here, which is that turbulent blood flow as the blood leaks through the valve, whether it's not opening or not closing appropriately. Most common hard murmurs are aortic stenosis and mitral regurgitation, just for your information. And then as things, as the blood flow through the heart doesn't occur in the normal and atomic way and there's that black, that backup signs and symptoms of hard failure will develop depending on where the valve is that is affected. And you probably already know signs and symptoms of heart failure. So left side of heart failure typically backs the fluid back up into the lungs resulting in shortness of breath and crackles. Those are the most significant symptoms that the patient might also have signs and symptoms of angina as well as syncope present with dysrhythmias and or complain of palpitations. Now when the valves on the right side are affected, the fluid will back up into the body causing weight gain, edema, JVD, as well as hepatitis minimally insignificant or severe cases. And then looking at the diagnostic tests here. So an echocardiogram that ultrasound of the heart will give us a better idea of the heart valves. Are they closing appropriately or maybe they are regurgitating? There's some blood flow when they're supposed to be closed. And it's a very nice test also to give us an indication of the size and the blood flow through the heart valves as well as the chambers of the heart. Certainly a chest X-ray would be a very important test to see if there's enlargement of the heart from maybe more advanced heart failure. A stress test will test the heart under stress so either medication induced or exercise induced to see how much worse does the heart valve perform under stress. A cardiac catheterization might be needed to take a closer look inside to kind of evaluate the patient for angina and dysrhythmias and maybe take a closer look at the valves right there inside the chambers. And certainly CTs and MRIs can be indicated to evaluate the valves in more detail. Now treatment for heart valves is treatment of heart failure because that is the signs and symptoms that we're going to see. Those include all those medications that we also treat patients with heart failure with, ACE inhibitors, angiotensin receptor blockers, A&RIs, angiotensin oryloctin receptor inhibitors which is kind of like a brand new drug class that's evolving in the treatment of heart failure as well as diuretics to deal with all that fluid that's backing up. Now when the valve gets significantly impaired then sometimes valve replacement is required. And there are always new technologies and new methods of how to do this so please read up in your book and see whatever the last of the latest version is for valve replacements. But typically there are two different ways of doing this which is the valve can be replaced with a mechanical valve or a tissue valve that would come from a cadaver or maybe an animal such as a pig. And when there's a mechanical valve the patient after valve replacement will need to be on anticoagulants for life because there's a high risk that things will attach to this valve such as platelets and other coagulation factors and kind of stuff that helps us with our immune response because it is a form body and so the mechanical valves are at higher risk for developing clots or even just developing growth and then the valve forgettable being impaired. Well with tissue valves typically the anticoagulation is only needed for about six months post-op and then the patient can come off the anticoagulation of course they'll need close follow-up and monitoring. But either way whether it's mechanical or tissue replacement the valve they both need to be or both of these types of patients need to bring prophylactic antibiotics for dental work because there is a risk that bacteria could get into the bloodstream from the dental work and then it could basically latch on to the artificial or the replaced valve and that could lead again to problems and severe complications and maybe even malfunctioning of the heart valve. So those are very important things to do these prophylactic antibiotics and this is something that likes to come up on exams as well. Now as for nursing care certainly if we're caring for a patient that we know has a known valve disorder or maybe that will undergo or has undergone valve replacement we'll need to monitor the vital signs very carefully as well as have them on telemetry to see any kind of dysrhythmias that are occurring. We will have to pay close attention to their cardiovascular system and monitor them for all these signs and symptoms of heart failure or peripheral circulation impairment. Then because we know that it's heart failure related we need to monitor the patient's daily weight as well as eyes and nose very carefully and monitor their fluid status. And teaching is always a very important part of the nurse's responsibilities and the more we can teach our patients about their medications that they need for treatment such as these for heart failure the more compliant the patient will be. And besides the medications for treatment we also need to emphasize the need for the prophylactic antibiotics for the patient to share this information with their dentist so that they can be aware as well. And then the need for anti-coagulants because as you can imagine a lifelong need for anti-coagulants of patients with mechanical heart valves that can be some compliance issues because of some concerns the patient might have or maybe forgetfulness or maybe they don't think it's necessary anymore. So this teaching here as with many topics in nursing is very very important. So thank you for watching this video on heart valve disorders and the difference between regurgitation and synosis. Please also watch the other videos specifically the one on heart failure to kind of refresh your memory on what that all entails how it develops and signs and symptoms that you might see. Thanks for watching. See you soon here on Nursing School Explained.