What is valvular heart disease? | Circulatory System and Disease | NCLEX-RN | Khan Academy
What is valvular heart disease? | Circulatory System and Disease | NCLEX-RN | Khan Academy
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Content
5.307 -> - So when most people think of the heart,
6.943 -> they think about something like this.
9.95 -> Or love or Valentine's
Day, and that's all great.
14.385 -> But what if you're a little
more medically inclined,
16.37 -> or scientifically inclined?
17.821 -> Well then maybe you think
about something such as
20.108 -> the heart sounds, or lub dub.
27.701 -> And I'm gonna give you a second
to put in your headphones
29.639 -> because those will actually help you
30.777 -> hear these sounds better during the video.
35.919 -> (heart sounds)
39.807 -> And so you can hear those
normal heart sounds.
41.629 -> But what happens if
maybe, when you visited
43.649 -> your cardiologist, he or
she heard something extra
47.4 -> while they were listening to your heart?
49.164 -> Well maybe they told you
that you have a murmur.
52.408 -> And so keep those headphones
in because I'm gonna play you
54.597 -> one of the more common murmurs.
56.836 -> (abnormal heart sounds)
59.142 -> You'll notice that you actually
hear the lub and the dub,
61.585 -> but in the middle you
actually hear this whishing
64.024 -> or blowing sound.
65.905 -> So what's a murmur?
67.739 -> Well, it's really pretty simple.
69.805 -> It's actually just the sound
of turbulent blood flow.
75.564 -> And when we say turbulent, all we mean is
78.002 -> the same thing that we
mean when we talk about
79.441 -> a turbulent plane ride, rough.
81.856 -> So it's the sound of rough blood flow
89.681 -> through a cardiac structure.
94.001 -> And in particular, we're gonna
be talking about the valves.
99.561 -> And so this is a good time to remind you
100.657 -> that we have four valves in the heart.
104.593 -> And those are the mitral,
110.096 -> the tricuspid,
115.631 -> the aortic,
119.187 -> and the pulmonic.
127.008 -> So when someone's told
that they have a murmur,
128.783 -> they automatically freak out.
130.734 -> And that shouldn't always be the case
132.313 -> because murmurs can actually be normal,
138.013 -> or abnormal.
143.688 -> And so normal murmurs are
also called functional,
149.88 -> or innocent murmurs.
154.776 -> And abnormal murmurs are also
called pathologic murmurs.
164.288 -> So you may be thinking,
well how can a murmur
166.462 -> be innocent or normal?
168.703 -> Well, let me draw you a picture here,
170.525 -> and see if we can help explain this.
172.359 -> So here we're just gonna
draw any normal valve.
178.141 -> And so this would be a valve
like the tricuspid valve
180.525 -> or the aortic value or
even the pulmonic valve.
183.59 -> Those all have three cusps, and so this
185.529 -> is a trileaflet valve.
196.767 -> And so in a normal, or functional murmur,
199.112 -> you simply have an increase in flow.
204.812 -> And when we say flow
here, we mean blood flow.
207.267 -> And so you really just
have a lot of blood flow
211.31 -> through this normal valve.
214.162 -> And that can actually cause
a little bit of turbulence
216.786 -> and lead to a murmur.
218.387 -> But the important point is that this valve
221.441 -> is absolutely normal.
223.852 -> Now in the abnormal murmurs,
225.721 -> the valve is actually dysfunctional.
236.657 -> And that is what's causing the
238.39 -> turbulent blood flow and murmur.
239.946 -> And so instead of it being nice like this,
242.488 -> well maybe you have a
little situation like this.
250.581 -> Or maybe some of these
edges are scarred up or old,
258.127 -> and not working correctly.
259.801 -> And so now either not enough
blood can get through,
269.263 -> or blood can actually leak
back when it's not supposed to.
277.149 -> And so again, it's really
important to know that
280.523 -> in this case, the valve
is what is abnormal.
284.285 -> And so in abnormal
murmurs, the valve can be
287.099 -> dysfunctional in one of two ways.
289.571 -> And the first is that the
valve can be stenotic,
294.052 -> where you can have a
situation of stenosis.
297.768 -> And the other is called regurgitation.
305.813 -> And you'll also see this as insufficient.
314.984 -> And so the way I like to think about this,
316.342 -> because I always used
to get them confused,
318.165 -> is by using a typical high school.
321.346 -> And so here we're gonna draw
the halls of a high school.
327.023 -> And we're gonna use
double doors as our valve.
329.504 -> And so when the kids are still in class
331.907 -> and the bell hasn't rung
yet, these doors are closed.
337.189 -> And no one's going in or out of them.
342.286 -> Now when the bell rings,
students push open the door,
346.37 -> and if everything's working normally,
347.775 -> these doors open very wide,
just about all the way.
353.87 -> And all of the students can get through,
355.34 -> and they do this in a
pretty orderly fashion,
358.138 -> and everything's kinda smooth,
and everyone gets to go home.
365.232 -> But what if these doors
were a little bit sticky,
368.406 -> or maybe the hinges hadn't
been greased in a while?
372.248 -> Well now you get a situation like this.
377.345 -> And so now when students try and get out,
380.607 -> they're kinda forced from
all over to get through
382.592 -> this tighter space, and not
as many of them can get out.
386.702 -> And so there's all this
pushing and shoving,
389.245 -> and this is the picture of stenosis.
394.011 -> In this case, we have a stenotic door,
396.108 -> or in the case of the heart,
we would have a stenotic valve.
398.732 -> And so let me go ahead and
label the normal conditions.
401.135 -> So this is normally how
we want the door to open.
405.114 -> So this is normal open.
408.008 -> And then this is normally how
we want the door to close.
410.643 -> So this is normal closed.
415.02 -> Now let's talk about the
same thing for regurgitation,
417.364 -> but in this case, we're gonna start with
419.489 -> the normal open scenario.
421.347 -> Se let me draw these hallways again.
428.022 -> So in the normal open
situation, remember these doors
430.623 -> are all the way open.
432.19 -> And we're gonna assume this
is a little bit later in time,
434.442 -> and so that the kids are
actually a little bit
437.124 -> further ahead here.
444.252 -> And so the doors are
getting ready to close.
446.55 -> Now once those kids have
left, we need the doors
450.451 -> to close properly so that
no one else can get back in.
455.688 -> And so normally these doors will close,
458.729 -> and no one can get back
in, even if they'd want to.
464.208 -> And you'll see these are kinda
like students coming back
469.004 -> for after school activities,
but they're not gonna be
472.23 -> allowed in because the doors are closed.
475.748 -> Now what happens if these
doors become a little floppy?
481.81 -> Well now, let's say maybe
one comes back to normal,
485.504 -> but the other one overshoots
or something like that?
488.128 -> And the details of that are not important,
489.823 -> but what is important is that you now have
492.028 -> this little pathway through
which students can kinda
495.709 -> get back through, but not
many, and there's still some
498.39 -> pushing and shoving.
499.901 -> And so this is the case of regurgitation.
508.194 -> And then we'll go ahead and
label the normals again.
510.266 -> And so this is normal closed.
517.081 -> And this is normal open.
522.464 -> And so what you really
need to remember from this,
524.716 -> because it'll help so
much when you're trying
526.423 -> to remember the different
valvular diseases down the road
529.604 -> is that stenosis is a
problem with opening.
533.841 -> So this is an opening problem.
539.635 -> The valve, for some reason
or another, is stenotic,
542.097 -> and it can't open enough,
meaning not enough blood
544.535 -> can get out.
545.337 -> And so again, this is an opening problem.
550.619 -> Now regurgitation is kind of the opposite.
553.556 -> And so this is a closing problem.
564.875 -> Now the valve, for whatever
reason, is regurgitant,
567.773 -> and can't close all the way.
569.56 -> And so now this can
cause back leak of blood,
572.754 -> and again, this is a closing problem.
576.515 -> So you can imagine that
if we're having problems
578.139 -> opening valves or closing
them in the heart,
581.356 -> that we can actually get some
signs and symptoms, such as
592.536 -> fatigue, and then you can
see this guy laying down
597.017 -> and not feeling so well.
614.419 -> Shortness of breath, and
you'll see I've drawn you
617.663 -> a little pair of lungs here
that's just a little too short.
622.454 -> And finally swelling, and
this is usually swelling
627.156 -> of the extremities, such as the feet.
632.601 -> And so these are some
general signs and symptoms
634.122 -> that would be associated
with valvular heart disease.
Source: https://www.youtube.com/watch?v=Wyxz0fgp6-A