UNIT 2 AND 3 Chapter 32 Mitral and Aortic Valve Stenosis and Regurgitation, Valve Replacement Flashcards
What is Mitral Stenosis
stiffening of the mitral valve disrupts blood flow to the left ventricle
What is the cause of Mitral Stenosis?
A. Rheumatic fever
B. e coli
C. h. pylori
D. alteplase
A. Rheumatic fever
Results from Rheumatic Carditis /Endocarditis
What are the clinical manifestations of Mitral stenosis
-Pulmonary congestion and right-sided heart failure occur first.
Later, when the left ventricle receives insufficient blood volume, preload is decreased and cardiac output (CO) falls.
-dyspnea on exertion
-orthopnea,
-paroxysmal nocturnal dyspnea (sudden dyspnea at night)
palpitations, and
dry cough.
-Hemoptysis (coughing up blood) -pulmonary edema occurs as pulmonary hypertension and congestion progress.
Thrombi can occur
especially with atrial
fibrillation.
(LEFT SIDE OF CHEST) A rumbling, apical diastolic murmur is noted on auscultation(APICAL LOCATION IS FOUND IN THE MIDCLAVICULAR LINE 5 TH INTERCOASTAL SPACE.
**Right-sided HF hepatomegaly (enlarged liver), neck vein distention, and pi ing dependent edema late in the disorder.
What type of dysthymia would you find for a patient with Mitral Stenosis?
A. atrial fibrillation
B. Peak T waves
C. ST elevation
D. Proloned QT intervals
A. atrial fibrillation
What is the treatment of choice for atrial fibrillation?
A. Warfarin
B. CPR
C. Cardioversion
D. Thrombolytic
A. Warfarin
calcium channel blockers relax the heart , Verapamil, Nifedepine, Diltiazem
What is Mitral Regurgitation?
Incomplete closure of the valve OF THE MITRAL VALVE allows the backflow of blood into the left atrium when the left ventricle contracts. During diastole,
The fibrotic and calcific changes occurring in mitral regurgitation (insufficiency) prevent the mitral valve from closing completely during systole.
Cause of Mitral Valve Regurgitation
The causes of primary mitral regurgitation are mitral valve prolapse, rheumatic heart disease, infective endocarditis, myocardial infarction (MI), connective tissue diseases such as Marfan syndrome, and dilated cardiomyopathy.
Clinical Manifestations of Mitral Regurgitation
Initially no s/s
Fatigue
Chronic
weakness
Dyspnea
Anxiety
Palpitations
Dyspnea on exertion and orthopnea develop later.
anxiety,
atypical chest pains,
Assessment may reveal normal BP,
atrial fibrillation,
changes in respirations characteristic of left ventricular failure.
the neck veins become distended,
the liver enlarges (hepatomegaly),
Pitting edema develops.
A high-pitched systolic murmur at the apex, with radiation to the left axilla, is heard on auscultation.
Severe regurgitation often exhibits a third heart sound (S3).
What is Aortic Stenosis?
Aortic stenosis is the most common cardiac valve dysfunction in the United States and is often considered a disease of “wear and tear.”
aortic valve stiffens and has difficulty ejecting blood to the aorta
Which of the following valve surface areas for Aortic Stenosis requires emergency surgery?
A. 3CM
B. 2CM
C. 0.3CM
D. 5CM
C. 0.3CM
Valve surface area
1cm or less – surgery
URGENT
blood is not flowing through the rest of the body , which can cause shock
What is the cause of Aortic stenosis?
Congenital bicuspid or unicuspid aortic valves are the primary causes for aortic stenosis in many patients. Rheumatic aortic stenosis occurs with rheumatic disease of the mitral valve and develops in young and middle- age adults. Atherosclerosis and degenerative calcification of the aortic valve are the major causative factors in older adults. Aortic stenosis has become the most common valvular disorder in all countries with aging populations.
What are the clinical findings of Aortic Stenonis
- dyspnea,
angina, - syncope occurring on exertion. When cardiac output falls in the late stages of the disease, the patient experiences
- marked fatigue,
- debilitation,
peripheral cyanosis.
A narrow pulse pressure is noted when the BP is measured.
A diamond-shaped, systolic crescendo- decrescendo murmur is usually noted on auscultation.
What is the #1 tx for Aortic Stenosis
Surgical therapy is the only definitive treatment of aortic stenosis and is recommended when angina, syncope, or dyspnea on exertion develops.
What is Aortic Regurgitation
In patients with aortic regurgitation, the aortic valve leaflets do not close properly during diastole; and the annulus (the valve ring that a aches to the leaflets) may be dilated, loose, or deformed. This allows flow of blood from the aorta back into the left ventricle during diastole. The left ventricle, in compensation, dilates to accommodate the greater blood volume and eventually hypertrophies.
What is the cause of Aortic Regurgutation
Aortic insufficiency usually results from nonrheumatic conditions such as
-infective endocarditis,
-congenital anatomic aortic valvular abnormalities,
- hypertension, and
-Marfan syndrome (a rare, generalized, systemic connective tissue disease).
What are the clinical manifestations ofAortic Regurgitation
left sided failurethe major symptoms are exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea
. Palpitations may be noted with severe disease, especially when the patient lies on the left side. Nocturnal angina with diaphoresis often occurs.
On palpation, the nurse notes a “bounding” arterial pulse.
The pulse pressure is usually widened,with an elevated systolic pressure and diminished diastolic pressure.
The classic auscultatory finding is a high- pitched, blowing, decrescendo diastolic murmur.
Drug of choice for valuvar disease?
Diuretics, beta blockers, ACE inhibitors, digoxin, and oxygen are often administered to improve the symptoms of HF.
Nitrates are administered cautiously to patients with aortic stenosis because of the potential for syncope associated with a reduction in left ventricular volume (preload).
Vasodilators such as calcium channel blockers may be used to reduce the regurgitant flow for patients with aortic or mitral stenosis.
Verapimil
Nifedepine
Diltiazem
Patient teaching - Prophylaxis Antibiotics
Teach pt’s with valve disease the importance of prophylactic antibiotic therapy before any invasive dental or oral procedure.
This includes patients with a previous history of endocarditis and cardiac transplant or valve recipients.
Have patients demonstrate appropriate oral hygiene because optimal oral health is the best intervention to prevent endocarditis.
Prophylactic antibiotics are NOT recommended before GI procedures such as upper GI endoscopy, colonoscopy, or procedures requiring genitourinary instrumentation.
What is the best way to prevent endocarditis?
A. brush teeth twice a day and after eating
B. floss teeth
C. Use peroxide oral swish
D. Brush teeth for 5 minutes
A. brush teeth twice a day and after eating
Should patients with Endocarditis floss?
- Advise patients to use a soft toothbrush, to brush their teeth at least twice per day, and to rinse the mouth with water after brushing.
They should NOT use irrigation devices or floss the teeth because bacteremia may result.
What does the transcatheter aortic valve replacement (TAVR) do?
bioprosthetic valve placed over stenotic valves.
This procedure is usually performed through a small incision in the groin allowing for bilateral transfemoral access.
. One access is used to place the prosthetic valve while the other is used to place a temporary transvenous pacemaker.
After initial balloon aortic valvuloplasty, the new valve is wrapped around a balloon on a large catheter that is inserted via the femoral artery
The patient is then transvenously paced temporarily at a rate of about 200 beats/min to reduce cardiac output and cardiac motion.
Which of the following should the cardiovascular team be prepared to initiate during the transcatheter aortic valve replacement (TAVR)?
A. Heart Transplant
B. Coronary Artery Bypass Graft
C. Kidney replacement
D. surgical aortic valve replacement
D. surgical aortic valve replacement
The team must be prepared to convert to an open or surgical aortic valve replacement (SAVR) if necessary.
If SAVR is required, care of the patient is similar to that of the patient undergoing coronary artery bypass graft (CABG) (
Post-op care and teaching for transcatheter aortic valve replacement (TAVR)?
MONITOR FOR BLEEDING
institute postangiogram precautions
-Do not do strenuous exercise
-Do not lift, pull, or push anything heavy
BEDREST FOR 6 HOURS
LIFE LONG ANTIPLATELET THERAPY
Antiplatelet therapy with lifelong daily aspirin
Clopidogrel for the first 6 months
Your patient who is a body builder is coming out of the operation room following transcatheter aortic valve replacement. Which of the following statements made by the patient requires further teaching?
A. Since this procedure is minimally invasive I can start lifting weights when I get discharged.
B. I must remain on bedrest for 6 hour after the surgery.
C. I have to be on life long anticoagulant therapy and not lift anything heavy for 6 weeks
D. My provider may prescribe Clopidogre because it l has less side effects than aspirin
A. Since this procedure is minimally invasive I can start lifting weights when I get discharged.
MONITOR FOR BLEEDING
institute postangiogram precautions
-Do not do strenuous exercise
-Do not lift, pull, or push anything heavy
-FOR 6 WEEKS POST OPP
BEDREST FOR 6 HOURS
LIFE LONG ANTIPLATELET THERAPY
ADMINISTRATION OF CLOPIDOGREL AND ASPIRIN FOR THE FIRST 6 MONTHS
antiplatelet therapy with lifelong daily aspirin and clopidogrel for the first 6 months