NCLEX Focus - Valvular Disease
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The following are high yield points from the Valvular Disease tutorial to help you prepare for the NCLEX.
Review this Valvular Diseases flashcard for further details.
An elderly patient presents with exertional chest pain, shortness of breath, and a crescendo-decrescendo systolic murmur heard at the right upper sternal border. Based on the underlying pathology, what is the most likely cause of this patient’s condition?
A young adult patient with a history of untreated strep throat now presents with signs of mitral valve dysfunction. Which of the following structural changes are most likely to be found?
A patient with a mechanical mitral valve replacement is admitted for minor surgery. Which of the following medications is most likely part of this patient’s long-term regimen?
NCLEX Focus
General Concepts
- Valves ensure unidirectional blood flow through the heart.
- Stenosis = Narrowed valve orifice, obstructs forward flow.
- Regurgitation/Insufficiency = Incomplete valve closure, causing backflow of blood.
- Valve damage can be degenerative, congenital, or rheumatic.
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Valve Anatomy Highlights
Aortic Valve:
- Semilunar, 3 cusps (right, left, posterior)
- Controls flow from left ventricle to aorta
Pulmonary Valve:
- 3 cusps (anterior, right, left); controls flow from right ventricle to pulmonary artery
Mitral Valve (Bicuspid):
- 2 cusps (anterior/posterior); between left atrium & ventricle
Tricuspid Valve:
- 3 leaflets (anterior, posterior, septal); between right atrium & ventricle
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Aortic Valve Disorders
Aortic stenosis:
- Caused by degenerative calcification from mechanical stress and conditions like hyperlipidemia, hypertension, bicuspid aortic valve.
- Calcified masses obstruct valve opening → reduced forward flow.
Aortic regurgitation:
- Caused by aortic root dilation, including Marfan syndrome or aneurysms.
- Dilation leads to incomplete closure → backflow into left ventricle.
- Often asymptomatic early; can require valve repair or replacement.
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Mitral Valve Disorders
Mitral valve calcification:
- Commonly occurs in annular ring, not the leaflets.
- Can lead to stenosis or regurgitation, arrhythmias, and stroke.
Mitral valve prolapse (MVP):
- Leaflets balloon into left atrium during systole.
- Can lead to regurgitation and chronic injury, increasing thrombus and endocarditis risk.
Mitral stenosis:
- Most commonly due to rheumatic heart disease.
- Results from inflammation and scarring → fusion of chordae tendineae and valve thickening.
- Described as having a “button hole” or “fish mouth” appearance.
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Rheumatic Heart Disease
- Caused by immune response to Group A strep pharyngitis.
- Leads to:
- Deformity of valve cusps
- Fusion of commissures
- Thickening/fusion of chordae tendineae
- Associated with Jones criteria (carditis, arthritis, rash, etc.)
- Requires long-term antibiotic prophylaxis to prevent recurrence.
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Valve Replacement: Mechanical vs. Bioprosthetic
Mechanical valves:
- Last longer but require lifelong anticoagulation (e.g., warfarin + aspirin) due to high thromboembolism risk.
- From animal or human tissue; less thrombogenic but deteriorate faster.
- Infective endocarditis
- Valve leakage
- Require antibiotics before dental procedures to prevent bacteremia.
NCLEX Questions