Valve Disorders

MITRAL STENOSIS

 Definition

• Mitral valve thickens and gets narrower, blocking blood flow fro. the left atrium to left ventricle

Physiology

• Function of the heart is the transport of oxygen, carbon dioxide, nutrients and waste products
• Cardiac cycle consists of:
• Systole - the phase of contraction during which the chambers eject blood
• Diastole - the phase of relaxation during which the chambers fill with blood. When heart pumps, myocardial layer contracts and relaxes.
• Blood flow:
1. Deoxygenated blood enters the right atrium through the superior and inferior vena cava
2. Enters the right ventricle via the tricuspid valve
3. Travels through the pulmonic valve to pulmonary arteries and lungs
4. Oxygenated blood returns from the lungs through the pulmonary veins into the left atrium and enters the left ventricle via the bicuspid (mitral) valve
5. From the left ventricle, through the aortic valve through the aorta to the systemic cicrculation
• The heart itself is supplied with blood by the left and right coronary arteries
• The vascular system is a continuous network of blood vessels
• the arterial system consists of arteries, arterioles and capillaries and delivers oxygenated blood to tissues
• Oxygen, nutrients and metabolic waste are exchanged at the cellular level
• The venous system, veins and venules, returns the blood to the heart

Epidemiology

• Of clients with mitral stenosis, 2/3 are female
• Most cases of mitral stenosis area caused by rheumatic fever

Findings

• Mild - no findings
• Moderate to Severe
• Dyspnea on exertion
• Paroxysmal nocturnal dyspnea
• Orthopnea
• Weakness, fatigue, and palpitations
• Peripheral and facial cyanosis in severe cases
• Jugular vein distention
• With severe pulmonary hypertension or tricuspid stenosis - ascites
• Edema
• Hepatomegaly
• Diastolic thrill at the cardiac apex
• When client lies on the left side, loud S1 or opening snap and a diastolic murmur at the apex
• Crackles in the lungs

Management

• Antiarrhythmics if needed
• If medication fails, atrial fibrillation is treated with cardioversion
• Low sodium diet - to prevent fluid retention
• Oxygen if needed - to prevent hypoxia
• Surgery - mitral commissurotomy or valvotomy

Nursing Interventions

• The Cardio-Care Six
• Observe closely for findings of heart failure, pulmonary edema and reactions to drug therapy
• If client has had surgery, watch for hypotension, arrhythmias and thrombus formation
• Monitor the Cardio-Seven
• Client and Family (Teach the Cardio-Five: TDDS)
• Explain the need for long-term antibiotic therapy and the need for additional antibiotics before dental care
• Report early findings of heart failure such as dyspnea or a hacking, nonproductive cough

Diagnostic Studies/Findings

• History and physical exam
• EKG - for changes of left atrial enlargemebnt and right ventricle enlargement
• Echocardiogram - for restricted movement of the mitral valves and diastolic turbulance

MONITOR THE CARDIO-SEVEN:

"Charlie's Ex Packed ruth In Granny's VW"

1. Chemistry - blood chemistry (Charlie's)
2. Xrays (Chest) - (Ex)
3. Pulmonary-Artery catheter readings - if available - (Packed Ruth)
4. Intake and Output - (In)
5. Gases: Arterial Blood Gas levels - (Granny's)
6. Vital signs - (V)
7. Weight: daily - (W)

MITRAL VALVE INSUFFICIENCY WITH REGURGITATION

 

Definition & Related Terms

• A damaged mitral valve allows blood from the left ventricle to flow back into the left atrium during systole
• To handle the backflow, the atrium enlarges. So does the left ventricle, in part to make up for its lower output of blood

Epidemiology

• Follows birth defects such as Transposition of the Great Arteries (TGA)
• In older clients, the mitral annulus may have become calcified
• Cause unknown - may be linked to a degenerative process
• Occurs in 5-10% of adults

Findings

• Client may be asymptomatic
• Orthopnea, dyspnea, fatigue, weakness, weight loss
• Chest pain and palpitations
• Jugular vein distention
• Peripheral edema

Management

1. Low Sodium Diet - to prevent fluid retention
2. Oxygen as needed - to prevent tissue hypoxia
3. Antibiotics - to treat infection
4. Prophylactic antibiotics - to prevent infection
5. Surgery - mitral valvuloplasty or valve replacement

Nursing Interventions

• Cardio-Care Six
• Monitor the Cardio-Seven
• Monitor for:
1. Left-sided heart failure
2. Pulmonary edema
3. Adverse reaction to drug therapy
4. Cardiac dysrrhythmias - especially atrial and ventricular fibrillation
• If client has surgery - monitor postoperatively for:
1. Hypotension
2. Arrhythmias
3. Thrombus formation
• Client and Family Teachings:
1. Diet restrictions and drugs
2. Explain test and treatments
3. Prepare client for long-term antibiotics and followup care
4. Stress the need for prophylactic antibiotics during dental care
5. Teach client and family to report findings of heart failure:
• Dyspnea and hacking
• Nonproductive cough

Diagnostic Findings

• EKG - for arrhythmias and changes of left ventricular enlargement
• Echocardiogram - to visualize regurgitant jets and flail chordae/leaflets
• Cardiac catheterization - shows regurgitation of blood from left ventricle to the left atrium

TRICUSPID STENOSIS

Definition

• Narrowing of the tricuspid valve between the right atrium and the right ventricle

Epidemiology

• Relatively uncommon
• Usually associated with lesions of other valves
• Caused by Rheumatic Fever

Findings

• Dyspnea, fatigue, weakness, syncope
• Peripheral edema
• Jaundice with severe Peripheral Edema and Ascites - can mean that tricuspid stenosis has led to right ventricular failure
• May appear malnourished
• Distended jugular vein

Management

• Surgery - valvulotomy or valve replacement valvuloplasty

Nursing Interventions

• Cardio-Care Six
• Monitor the Cardio-Seven
• Monitor for findings of heart failure, pulmonary edema and adverse reaction to drug therapy
• Post-valve surgery - monitor client for hypotension, arrhythmias and thrombus formation
• When client sits, elevate legs - to prevent dependent edema
• Client and family teaching:
1. Teach the Cardio-Five
2. Client must comply with long-term antibiotics and followup care
3. Emphasize the need for prophylactic antibiotics during dental care

Dignostic Findings

• EKG - for arrhythmias
• Echocardiogram - right ventricular dilation and paradoxic septal motion

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