Zwężenie mitralne – Charakterystyka, pielęgnacja i opieka

Zwężenie mitralne
Charakterystyka, pielęgnacja i opieka

Zwężenie zastawki mitralnej (MS) to patologia charakteryzująca się postępującym zwężeniem ujścia mitralnego, najczęściej na tle gorączki reumatycznej, prowadzącym do utrudnionego przepływu krwi z lewego przedsionka do lewej komory. W efekcie dochodzi do powiększenia lewego przedsionka, nadciśnienia płucnego oraz objawów takich jak duszność wysiłkowa, zmęczenie, krwioplucie, migotanie przedsionków i obrzęki obwodowe. Diagnostyka opiera się na badaniu fizykalnym (głośny S1, trzask otwarcia zastawki, śródrozkurczowy szmer) oraz echokardiografii, która pozwala ocenić powierzchnię zastawki i stopień zwężenia. Wartości diagnostyczne obejmują m.in. powierzchnię zastawki mitralnej, która w zaawansowanym zwężeniu może być znacznie zmniejszona (do szerokości ołówka). Monitorowanie echokardiograficzne zaleca się co najmniej raz w roku, a u pacjentów bezobjawowych – coroczne badania kontrolne, w tym EKG i RTG klatki piersiowej.

Zwężenie zastawki mitralnej – wprowadzenie
Patofizjologia zwężenia mitralnego
Objawy zwężenia mitralnego
Diagnozowanie zwężenia mitralnego

Badanie fizykalne
Badania diagnostyczne

Leczenie zwężenia mitralnego

Leczenie zachowawcze
Leczenie chirurgiczne

Opieka pielęgniarska w zwężeniu mitralnym

Diagnoza pielęgniarska
Ocena pielęgniarska
Postępowanie pielęgniarskie
Edukacja pacjenta

Opieka pooperacyjna
Zwężenie mitralne w ciąży
Podsumowanie zaleceń dla pacjentów
Profilaktyka zwężenia mitralnego

Kolejne rozdziały

Zwężenie zastawki mitralnej – wprowadzenie

Zwężenie mitralne (ang. Mitral Stenosis, MS) jest formą choroby zastawkowej serca, charakteryzującą się zwężeniem ujścia zastawki mitralnej, co powoduje utrudniony przepływ krwi z lewego przedsionka do lewej komory¹. Zwężenie to powoduje zmniejszenie objętości krwi niosącej tlen z płuc, co może prowadzić do uczucia zmęczenia i duszności. Zwiększone ciśnienie i objętość krwi pozostającej w lewym przedsionku powoduje jego powiększenie oraz gromadzenie się płynu w płucach². Najczęstszą przyczyną zwężenia zastawki mitralnej jest gorączka reumatyczna, ale może być również spowodowane przez inne schorzenia, takie jak złośliwy zespół rakowiaka, toczeń rumieniowaty układowy czy reumatoidalne zapalenie stawów³.

Patofizjologia zwężenia mitralnego

W zwężeniu mitralnym dochodzi do postępującego zgrubienia i zwężenia płatków zastawki mitralnej i strun ścięgnistych, co powoduje stopniowe zwężanie ujścia i postępujące utrudnienie przepływu krwi⁴. Normalnie, ujście zastawki mitralnej ma szerokość odpowiadającą średnicy trzech palców. W przypadkach znacznego zwężenia, otwór może zwęzić się do szerokości ołówka⁵.

Zwężona zastawka mitralna uniemożliwia prawidłowy przepływ krwi z lewego przedsionka do lewej komory podczas rozkurczu serca. To zaburzenie prowadzi do gromadzenia się krwi w lewym przedsionku, powodując zwiększone ciśnienie w tej komorze. Podwyższone ciśnienie przenosi się wstecznie do żył płucnych, a następnie do naczyń włosowatych płuc, prowadząc do zwiększonego ciśnienia żylnego i włośniczkowego w płucach (nadciśnienia płucnego). To ciśnienie może wypychać płyn do pęcherzyków płucnych, prowadząc do obrzęku płuc i objawów związanych z przekrwieniem płucnym⁶.

Objawy zwężenia mitralnego

Pacjenci z łagodnym do umiarkowanego zwężeniem zastawki mitralnej mogą nie doświadczać żadnych objawów i nie wymagać leczenia poza rutynowym monitorowaniem, o ile nie wykazują zewnętrznych objawów, a ich codzienne życie nie jest zakłócone przez schorzenie⁷. Jednak wraz z postępem choroby mogą pojawić się następujące objawy:

Duszność wysiłkowa (z powodu nadciśnienia żylnego w płucach) jako pierwszy objaw⁸
Postępujące zmęczenie (wynik niskiego rzutu serca)⁹
Krwioplucie i kaszel¹⁰
Nawracające infekcje dróg oddechowych¹¹
Słaby i często nieregularny puls (z powodu migotania przedsionków)¹²
Duszność, ortopnoe, napadowa duszność nocna¹³
Obrzęki obwodowe¹⁴

Diagnozowanie zwężenia mitralnego

Dokładne diagnozowanie zwężenia mitralnego jest kluczowe dla określenia odpowiedniego planu leczenia. Proces diagnostyczny zwykle obejmuje:

Badanie fizykalne

Przed przystąpieniem do osłuchiwania, facies mitralis (rumieniowate policzki z sinymi plamami), uderzenie koniuszkowe i rozkurczowe drżenie koniuszkowe mogą sugerować obecność zwężenia mitralnego¹⁵. Podczas osłuchiwania serca można zauważyć:

Pierwszy ton serca (S1) jest typowo głośny z powodu szybkości, z jaką wzrasta ciśnienie w prawej komorze (dP/dt) w momencie zamknięcia zastawki mitralnej¹⁶
Trzask otwarcia zastawki mitralnej to wysokotonowy wczesnorozkurczowy dźwięk spowodowany nagłym napięciem płatków zastawki i aparatu podzastawkowego na końcu ruchu otwarcia¹⁷
Klasyczny śródrozkurczowy, niskotonowy szmer zwężenia mitralnego z przedskurczowym nasileniem, najlepiej słyszalny na koniuszku, w pozycji na lewym boku, przy użyciu części membranowej stetoskopu¹⁸

Badania diagnostyczne

Echokardiografia jest badaniem z wyboru do diagnozowania i oceny stopnia zwężenia mitralnego. Jest również przydatna do uzyskania dokładnej powierzchni zastawki, oceny funkcji prawej komory i określenia przydatności do balonowej walwuloplastyki mitralnej¹⁹. Badania kontrolne echokardiograficzne powinny być wykonywane przynajmniej raz w roku²⁰.

U pacjentów, którzy są bezobjawowi, zaleca się coroczny wywiad i badanie fizykalne, a także zdjęcie rentgenowskie klatki piersiowej i EKG²¹.

Leczenie zwężenia mitralnego

Leczenie zwężenia mitralnego zależy od nasilenia choroby i obecności objawów lub innych problemów zdrowotnych wynikających ze zwężenia. Pacjent i lekarz mogą zdecydować, które leczenie jest odpowiednie²².

Leczenie zachowawcze

Wiele osób z łagodnym zwężeniem zastawki mitralnej, które nie mają objawów, nie wymaga leczenia. W takich przypadkach zwykle zaleca się regularne monitorowanie zastawki za pomocą echokardiografii²³. W przypadku łagodnych objawów należy:

Stosować diuretyki, które mogą być pomocne w obniżeniu ciśnienia w lewym przedsionku i zmniejszeniu objawów²⁴
Stosować beta-blokery lub blokery kanału wapniowego przy migotaniu przedsionków do kontroli częstości akcji serca²⁵
Stosować antykoagulanty w celu zapobiegania powikłaniom zakrzepowo-zatorowym²⁶
Stosować profilaktykę antybiotykową w celu zapobiegania nawrotom infekcji i gorączki reumatycznej²⁷

Ponieważ gorączka reumatyczna jest główną przyczyną zwężenia mitralnego, zalecana jest wtórna profilaktyka przeciwko paciorkowcom z grupy A beta-hemolitycznych²⁸.

Leczenie chirurgiczne

Leczenie chirurgiczne zwężenia mitralnego obejmuje walwulotomię mitralną (która może być chirurgiczna lub przezskórna) lub wymianę zastawki mitralnej²⁹.

Przezskórna balonowa komisurotomia (walwuloplastyka) – podczas tego zabiegu cienki cewnik z balonem na końcu jest wprowadzany przez naczynie krwionośne do serca, gdzie balon jest rozprężany, aby rozciągnąć zwężoną zastawkę³⁰
Komisurotomia mitralna – zabieg chirurgiczny, który rozdziela płatki zastawki mitralnej, jeśli zlały się ze sobą z powodu bliznowacenia spowodowanego przez gorączkę reumatyczną³¹
Wymiana zastawki mitralnej – jeśli zastawka jest zbyt uszkodzona, może być konieczna jej wymiana na zastawkę mechaniczną lub biologiczną³²

Pacjenci, którzy otrzymują sztuczne zastawki serca, będą wymagać dożywotniej terapii przeciwzakrzepowej. Muszą być poinformowani o środkach ostrożności związanych z terapią przeciwzakrzepową, w tym o używaniu golarek elektrycznych i szczoteczek do zębów z miękkim włosiem, oraz o tym, jak często będą potrzebować monitorowania, jeśli w ogóle³³.

Metoda leczenia	Wskazania	Korzyści	Potencjalne powikłania
Obserwacja i monitorowanie	Łagodne zwężenie bez objawów	Brak inwazyjności, regularne kontrole	Możliwość progresji choroby
Leczenie farmakologiczne	Kontrola objawów, migotanie przedsionków	Nieinwazyjne, zmniejszenie objawów	Efekty uboczne leków, niewystarczająca kontrola
Balonowa walwuloplastyka	Umiarkowane/ciężkie zwężenie, korzystna anatomia	Małoinwazyjność, szybka rekonwalescencja	Restenoza, perforacja, tamponada
Wymiana zastawki	Ciężkie zwężenie, niekorzystna anatomia dla walwuloplastyki	Trwałe rozwiązanie, poprawa jakości życia	Powikłania operacyjne, potrzeba antykoagulacji przy zastawkach mechanicznych

Opieka pielęgniarska w zwężeniu mitralnym

Diagnoza pielęgniarska

Ryzyko nieadekwatnej perfuzji związane z przewodnieniem, objawiające się przyrostem masy ciała większym niż 3 funty dziennie³⁴.

Ocena pielęgniarska

Ocena objawów niewydolności serca: zmęczenie, duszność przy wysiłku, nasilony kaszel, krwioplucie, nawracające infekcje dróg oddechowych, ortopnoe lub napadowa duszność nocna³⁵
Ocena zaburzeń rytmu serca poprzez badanie tętna pacjenta pod kątem siły i rytmu (tj. regularnego lub nieregularnego) oraz pytanie, czy pacjent doświadczył kołatania serca lub odczuwał silne uderzenia serca³⁶
Ocena pod kątem zawrotów głowy, omdleń, zwiększonej słabości lub dusznicy bolesnej³⁷
Nasłuchiwanie szmeru – najłatwiejszym sposobem dla pielęgniarki na stwierdzenie obecności zaburzeń zastawkowych jest nasłuchiwanie szmerów. Szmer wskazuje na nieprawidłowy lub turbulentny przepływ krwi przez zastawkę³⁸
Ocena stanu oddechowego – jeśli krew nie przepływa do przodu lub cofa się, może to powodować przekrwienie płuc prowadzące do obrzęku płuc. Spowodowałoby to obniżone SpO2, trzeszczenia w płucach, a nawet różową, pienistą plwocinę³⁹

Postępowanie pielęgniarskie

Opieka pielęgniarska w zwężeniu mitralnym obejmuje:

Monitorowanie parametrów życiowych, uniwersalne środki ostrożności w kontroli zakażeń w celu zapobiegania zapaleniu wsierdzia i zmniejszenia gorączki reumatycznej⁴⁰
Zarządzanie objawami, monitorowanie objawów zakrzepicy żył głębokich, unoszenie nóg powyżej poziomu serca⁴¹
Monitorowanie przyjmowania płynów, aby uniknąć przewodnienia, ocena EKG, monitorowanie INR⁴²
Osłuchiwanie płuc, ponieważ obrzęk płuc jest częsty, osłuchiwanie serca – zwężenie mitralne objawia się głośnym S1⁴³
Zachęcanie do przestrzegania diety (niewydolność rozwoju jest częsta), edukacja pacjentów na temat choroby i operacji⁴⁴
Pomoc pacjentowi w relaksacji w celu promowania utlenowania. Umieszczenie pacjenta w wysokiej pozycji Fowlera, aby poprawić rozszerzanie płuc/utlenowanie. Podawanie tlenu zgodnie z zaleceniami⁴⁵
Uważne rejestrowanie czasu podania morfiny i podanej ilości⁴⁶
Obserwacja pod kątem powikłań leczenia, takich jak utrata elektrolitów. Zachęcanie pacjenta do przestrzegania przepisanego schematu leczenia, aby uniknąć przyszłych epizodów obrzęku płuc⁴⁷

Edukacja pacjenta

Edukacja pacjenta jest kluczowym elementem opieki nad pacjentem ze zwężeniem mitralnym:

Wyjaśnienie wszystkich procedur pacjentowi i jego rodzinie w celu edukacji i złagodzenia niepokoju związanego z procedurą⁴⁸
Podkreślenie zgłaszania wczesnych objawów przewodnienia, ponieważ może to powodować zaburzenia wymiany gazowej i zagrażać utlenowaniu⁴⁹
Pozwolenie pacjentowi na wyrażenie swoich obaw związanych z niemożnością spełnienia swoich obowiązków z powodu ograniczeń aktywności⁵⁰
Omówienie wszystkich przepisanych leków z pacjentem w celu edukacji pacjenta i promowania zachowań kooperacyjnych⁵¹
Pomoc pacjentowi w kąpieli w razie potrzeby, aby chronić pacjenta przed urazami i zachować zapas energii⁵²
Poinstruowanie pacjenta o konieczności utrzymania diety niskosodowej⁵³

Pielęgniarki kardiochirurgiczne powinny edukować pacjenta na temat dostępnych rodzajów zastawek protetycznych i tego, które mogą być dla nich najlepsze⁵⁴.

Opieka pooperacyjna

Opieka pielęgniarska dla pacjentów poddawanych naprawie zastawki jest podobna do opieki pielęgniarskiej w przypadku innych operacji kardiotorakochirurgicznych. W fazie ostrego powrotu do zdrowia monitoruje się pacjenta pod kątem niestabilnych wartości hemodynamicznych, krwawienia, arytmii, zakażenia miejsca operacyjnego i powikłań związanych z wentylacją mechaniczną⁵⁵.

Ryzyko powikłań pooperacyjnych jest niższe lub podobne do ryzyka po wymianie zastawki. Pacjenci, którzy przechodzą naprawę zastawki mitralnej z powodu niedokrwiennej choroby tętnic wieńcowych, mają takie samo ryzyko krwawienia i udaru jak osoby, które mają wymianę zastawki. Ryzyko migotania przedsionków u pacjenta wynosi 27% w przypadku obu procedur⁵⁶.

Stres związany z operacją i hospitalizacją sprawia, że pacjenci i rodziny prawdopodobnie zapomną wiele z tego, czego nauczono ich przed operacją. Należy przewidzieć powtórzenie szczegółów naprawy zastawki w tym emocjonalnie intensywnym okresie⁵⁷.

Zwężenie mitralne w ciąży

Umiarkowane do ciężkiego zwężenie mitralne (MS) jest źle tolerowane w ciąży. Wraz ze wzrostem częstości akcji serca czas napełniania rozkurczowego ulega skróceniu, co prowadzi do zwiększonego nadciśnienia płucnego i przekrwienia żylnego płuc. W rezultacie kobiety z umiarkowanym do ciężkiego MS, które były bezobjawowe przed ciążą, mogą stać się objawowe w czasie ciąży⁵⁸.

Arytmie, szczególnie migotanie przedsionków (AF) i częstoskurcz nadkomorowy, są zwiększone i występują u nawet 11% w jednym badaniu kobiet z reumatyczną chorobą zastawki mitralnej. Złe wyniki płodowe, w tym ograniczenie wzrostu płodu, niska masa urodzeniowa i przedwczesny poród, zwiększają się wraz ze wzrostem nasilenia MS⁵⁹.

Zaleca się seryjne obrazowanie za pomocą echokardiografii oprócz ścisłego monitorowania klinicznego. Echokardiografia raz na trymestr jest wystarczająca, przy czym echokardiogram trzeciego trymestru wykonuje się około 32. tygodnia ciąży, w czasie szczytowego obciążenia hemodynamicznego⁶⁰.

Leczenie medyczne niewydolności serca związanej ze zwiększonymi gradientami zastawkowymi obejmowało zwiększenie dawki leków blokujących węzły, co może poprawić gradienty zastawkowe poprzez redukcję częstości akcji serca. Metoprolol, propranolol i diltiazem są bezpieczne w stosowaniu do blokady węzłowej podczas ciąży. Diuretyki, takie jak furosemid, mogą być stosowane w celu zmniejszenia przekrwienia żylnego płuc, ale należy zachować ostrożność, aby uniknąć nadmiernej diurezy⁶¹.

Podsumowanie zaleceń dla pacjentów

Dla pacjentów ze zwężeniem mitralnym istotne są następujące zalecenia:

Przyjmowanie leków dokładnie zgodnie z zaleceniami. Nie pomijanie dawek⁶²⁶³
Umówienie wizyty kontrolnej u lekarza lub zgodnie z zaleceniami⁶⁴
Natychmiastowe wezwanie pomocy medycznej w przypadku bólu w klatce piersiowej lub duszności, osłabienia mięśni twarzy, ramion lub nóg, problemów z mówieniem, omdleń lub zawrotów głowy, obrzęku rąk, stóp lub kostek, nieregularnego, szybkiego lub mocnego bicia serca⁶⁵
Uważne obserwowanie zmian w stanie zdrowia i kontakt z lekarzem w przypadku jakichkolwiek problemów⁶⁶
Utrzymanie zdrowej wagi. Uzyskanie pomocy w pozbyciu się dodatkowych kilogramów⁶⁷
Zmiana diety. Zastosowanie umiarkowanego ograniczenia soli (nie dodawanie soli do jedzenia)⁶⁸
Kontakt z lekarzem w przypadku wystąpienia działań niepożądanych leków⁶⁹
Kontakt z lekarzem w przypadku wystąpienia nowych lub nasilających się objawów, takich jak ból w klatce piersiowej, duszność lub obrzęk nóg⁷⁰
Kontakt z lekarzem w przypadku przyjmowania leków przeciwzakrzepowych i skaleczenia, które nie przestaje krwawić⁷¹
Nie ignorowanie nasilających się objawów⁷²

W przypadku kobiet planujących ciążę, ważne jest, aby przed zajściem w ciążę porozmawiać z pracownikiem służby zdrowia. Ciąża powoduje, że serce pracuje ciężej. To, jak serce ze zwężeniem zastawki mitralnej radzi sobie z dodatkową pracą, zależy od tego, jak wąska jest zastawka i jak dobrze pompuje serce. Jeśli jesteś w ciąży i masz zwężenie zastawki mitralnej, zespół opieki powinien ściśle monitorować cię podczas ciąży⁷³.

Profilaktyka zwężenia mitralnego

Najlepszym sposobem zapobiegania zwężeniu zastawki mitralnej jest zapobieganie gorączce reumatycznej. Można to zrobić, upewniając się, że ty i twoje dzieci odwiedzacie pracownika służby zdrowia w przypadku bólu gardła. Nieleczone infekcje paciorkowcowe gardła mogą rozwinąć się w gorączkę reumatyczną. Paciorkowcowe zapalenie gardła jest zwykle łatwo leczone antybiotykami⁷⁴.

Osoby z nieprawidłowymi lub uszkodzonymi zastawkami serca są narażone na ryzyko infekcji zwanej zapaleniem wsierdzia. Wszystko, co powoduje przedostanie się bakterii do krwiobiegu, może prowadzić do tej infekcji. Działania mające na celu uniknięcie tego problemu obejmują: unikanie niehigienicznych zastrzyków, szybkie leczenie infekcji paciorkowcowych, aby zapobiec gorączce reumatycznej, zawsze informowanie lekarza i dentysty o historii choroby zastawkowej serca lub wrodzonej choroby serca przed leczeniem⁷⁵.

Higiena jamy ustnej ma zasadnicze znaczenie dla zapobiegania zapaleniu wsierdzia po naprawie zastawki. Może się to wydawać błahe, ale to OGROMNA sprawa. Badania wykazały, że bakterie z jamy ustnej są wysoce podatne na translokację (przemieszczanie się) do serca i osadzanie się w/na zastawkach. Dlatego pacjenci powinni unikać zabiegów stomatologicznych przez 6 miesięcy po operacji zastawki. Bardzo ważne jest, aby pielęgniarka edukował ich, dlaczego jest to tak ważne⁷⁶.

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Materiały źródłowe

#1 Mitral Stenosis (Nursing) – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/NBK568793/
Mitral stenosis (MS) is a form of valvular heart disease. Mitral stenosis is characterized by narrowing of the mitral valve orifice. […] Nursing Diagnosis: Risk for inadequate perfusion related to fluid overload as evidenced by weight gain greater than 3 pounds daily. […] Nursing Management: Monitor vital signs, universal precaution for infection control to prevent endocarditis and decrease rheumatic fever, symptom management, monitor signs and symptoms of deep vein thrombosis, elevate legs above the heart, monitor fluid intake to avoid fluid overload, assess ECG, monitor INR, listen to the lungs as pulmonary edema is common, listen to the heart-MS presents with a loud S1, encourage diet (Failure to thrive is common), educate patients on the disease and surgery. […] Once the diagnosis of mitral stenosis is made, the patient should be educated about the need for surgery.
#2 Problem: Mitral Valve Stenosis | American Heart Association
https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-mitral-valve-stenosis
Mitral stenosis is a narrowing of the mitral valve opening. Mitral stenosis restricts blood flow from the left atrium to the left ventricle. […] Mitral stenosis causes reduced blood flow through the narrowed valve opening from the left atrium to the left ventricle. As a result, the volume of blood bringing oxygen from the lungs is reduced. This can make you feel tired and short of breath. The volume and pressure from blood remaining in the left atrium increases, which causes the left atrium to enlarge and fluid to build up in the lungs. […] Although medications canât fix a valve defect, they can help with symptoms. Your health care team may prescribe diuretics to reduce fluid accumulation in the lungs, blood thinners to prevent clots from forming or drugs to control the heart rhythm if those are indicated. The mitral valve can usually be repaired or replaced with surgery or a minimally invasive procedure.
#3 Nursing Care of Clients with Valvular Disorders | PPT
https://www.slideshare.net/slideshow/nursing-care-of-clients-with-valvular-disorders/14046874
Mitral stenosis Progressive thickening and contracture of valve cusps wit narrowing of the orifice and progressive obstruction to blood flow […] Mitral insufficiency (regurgitation) Incomplete closure of the mitral valve during systole, allowing blood to flow back into LA […] an obstruction of blood flowing from the left atrium into the left ventricle. […] most common cause rheumatic valvulitis rheumatic endocarditis other causes malignant carcinoid, SLE, RA […] causes progressively thickens the mitral valve leaflets and chordae tendineae. The leaflets often fuse (glued) together. Eventually, the mitral valve orifice narrows and progressively obstructs blood flow into the ventricle. […] Normally, the mitral valve opening is as wide as the diameter of three fingers. In cases of marked stenosis, the opening narrows to the width of a pencil.
#4 Valvular Disorder: Mitral Stenosis Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/valvular-disorder-mitral-stenosis-nursing-management/
Mitral stenosis is the progressive thickening and contracture of the mitral valve leaflets and chordate tendineae that cause narrowing of the orifice and progressive obstruction to blood flow. […] Dyspnea on exertion (due to pulmonary venous hypertension) as the first symptom […] Progressive fatigue (result of low cardiac output) […] Hemoptysis and cough […] Repeated respiratory infections […] Weak and often irregular pulse (because of atrial fibrillation) […] Prophylactic antibiotic therapy to prevent recurrence of infections […] Treatment of anemia if required […] Cardiotonics and diuretic for treatment of congestive heart failure […] Surgical intervention (valvuloplasty, commissurotomy, or replacement of the mitral valve) […] Percutaneous transluminal valvuloplasty for palliation of symptoms
#5 Nursing Care of Clients with Valvular Disorders | PPT
https://www.slideshare.net/slideshow/nursing-care-of-clients-with-valvular-disorders/14046874
Mitral stenosis Progressive thickening and contracture of valve cusps wit narrowing of the orifice and progressive obstruction to blood flow […] Mitral insufficiency (regurgitation) Incomplete closure of the mitral valve during systole, allowing blood to flow back into LA […] an obstruction of blood flowing from the left atrium into the left ventricle. […] most common cause rheumatic valvulitis rheumatic endocarditis other causes malignant carcinoid, SLE, RA […] causes progressively thickens the mitral valve leaflets and chordae tendineae. The leaflets often fuse (glued) together. Eventually, the mitral valve orifice narrows and progressively obstructs blood flow into the ventricle. […] Normally, the mitral valve opening is as wide as the diameter of three fingers. In cases of marked stenosis, the opening narrows to the width of a pencil.
#6 Valvular Disorder: Mitral Stenosis Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/valvular-disorder-mitral-stenosis-nursing-management/
Following prescribed medication therapy is crucial. Medications for conditions like mitral stenosis may include diuretics to manage fluid overload, anticoagulants to prevent thromboembolism (a significant risk due to blood stasis in the left atrium), and antiarrhythmics to manage atrial fibrillation (a common complication of mitral stenosis). Non-compliance with these medications can lead to exacerbation of symptoms, increase the risk of complications such as stroke (due to the formation of blood clots in the atrium), and potentially worsen the condition of the heart, making the surgical outcome less favorable and recovery more complicated. […] In mitral stenosis, the narrowed mitral valve impedes blood flow from the left atrium to the left ventricle during diastole (heart relaxation). This obstruction leads to an accumulation of blood in the left atrium, causing increased pressure in this chamber. The increased pressure is transmitted backward into the pulmonary veins and subsequently the pulmonary capillaries, leading to increased pulmonary venous and capillary pressures (pulmonary hypertension). This pressure can push fluid into the alveoli, leading to pulmonary edema and symptoms related to pulmonary congestion.
#7 Mitral Valve Stenosis | Boston Children’s Hospital
https://www.childrenshospital.org/conditions/mitral-valve-stenosis
Children with mild to moderate mitral valve stenosis may not need any treatment other than routine monitoring, as long as they are displaying no outward symptoms and their daily lives are not affected by the condition. […] Your child’s cardiologist will regularly evaluate your child for any sign of further narrowing in the mitral valve and related complications. Most often, routine monitoring will involve physical examinations and echocardiograms. […] Medication is not a cure for mitral valve stenosis but can be helpful in managing specific symptoms. […] A child with mitral valve stenosis may also need to periodically take antibiotics in order to prevent an infection called bacterial endocarditis, even if the valve has been surgically replaced. […] Boston Children’s Hospital has a program dedicated to interventional catheterization, the use of a thin tube called a catheter that is threaded from a vein or artery into the heart.
#8 Valvular Disorder: Mitral Stenosis Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/valvular-disorder-mitral-stenosis-nursing-management/
Mitral stenosis is the progressive thickening and contracture of the mitral valve leaflets and chordate tendineae that cause narrowing of the orifice and progressive obstruction to blood flow. […] Dyspnea on exertion (due to pulmonary venous hypertension) as the first symptom […] Progressive fatigue (result of low cardiac output) […] Hemoptysis and cough […] Repeated respiratory infections […] Weak and often irregular pulse (because of atrial fibrillation) […] Prophylactic antibiotic therapy to prevent recurrence of infections […] Treatment of anemia if required […] Cardiotonics and diuretic for treatment of congestive heart failure […] Surgical intervention (valvuloplasty, commissurotomy, or replacement of the mitral valve) […] Percutaneous transluminal valvuloplasty for palliation of symptoms
#9 Valvular Disorder: Mitral Stenosis Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/valvular-disorder-mitral-stenosis-nursing-management/
Mitral stenosis is the progressive thickening and contracture of the mitral valve leaflets and chordate tendineae that cause narrowing of the orifice and progressive obstruction to blood flow. […] Dyspnea on exertion (due to pulmonary venous hypertension) as the first symptom […] Progressive fatigue (result of low cardiac output) […] Hemoptysis and cough […] Repeated respiratory infections […] Weak and often irregular pulse (because of atrial fibrillation) […] Prophylactic antibiotic therapy to prevent recurrence of infections […] Treatment of anemia if required […] Cardiotonics and diuretic for treatment of congestive heart failure […] Surgical intervention (valvuloplasty, commissurotomy, or replacement of the mitral valve) […] Percutaneous transluminal valvuloplasty for palliation of symptoms
#10 Valvular Disorder: Mitral Stenosis Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/valvular-disorder-mitral-stenosis-nursing-management/
Mitral stenosis is the progressive thickening and contracture of the mitral valve leaflets and chordate tendineae that cause narrowing of the orifice and progressive obstruction to blood flow. […] Dyspnea on exertion (due to pulmonary venous hypertension) as the first symptom […] Progressive fatigue (result of low cardiac output) […] Hemoptysis and cough […] Repeated respiratory infections […] Weak and often irregular pulse (because of atrial fibrillation) […] Prophylactic antibiotic therapy to prevent recurrence of infections […] Treatment of anemia if required […] Cardiotonics and diuretic for treatment of congestive heart failure […] Surgical intervention (valvuloplasty, commissurotomy, or replacement of the mitral valve) […] Percutaneous transluminal valvuloplasty for palliation of symptoms
#11 Valvular Disorder: Mitral Stenosis Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/valvular-disorder-mitral-stenosis-nursing-management/
Mitral stenosis is the progressive thickening and contracture of the mitral valve leaflets and chordate tendineae that cause narrowing of the orifice and progressive obstruction to blood flow. […] Dyspnea on exertion (due to pulmonary venous hypertension) as the first symptom […] Progressive fatigue (result of low cardiac output) […] Hemoptysis and cough […] Repeated respiratory infections […] Weak and often irregular pulse (because of atrial fibrillation) […] Prophylactic antibiotic therapy to prevent recurrence of infections […] Treatment of anemia if required […] Cardiotonics and diuretic for treatment of congestive heart failure […] Surgical intervention (valvuloplasty, commissurotomy, or replacement of the mitral valve) […] Percutaneous transluminal valvuloplasty for palliation of symptoms
#12 Valvular Disorder: Mitral Stenosis Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/valvular-disorder-mitral-stenosis-nursing-management/
Mitral stenosis is the progressive thickening and contracture of the mitral valve leaflets and chordate tendineae that cause narrowing of the orifice and progressive obstruction to blood flow. […] Dyspnea on exertion (due to pulmonary venous hypertension) as the first symptom […] Progressive fatigue (result of low cardiac output) […] Hemoptysis and cough […] Repeated respiratory infections […] Weak and often irregular pulse (because of atrial fibrillation) […] Prophylactic antibiotic therapy to prevent recurrence of infections […] Treatment of anemia if required […] Cardiotonics and diuretic for treatment of congestive heart failure […] Surgical intervention (valvuloplasty, commissurotomy, or replacement of the mitral valve) […] Percutaneous transluminal valvuloplasty for palliation of symptoms
#13 Valvular heart disease – EMCrit Project
https://emcrit.org/ibcc/valves/
Rheumatic heart disease. […] Dyspnea, orthopnea, paroxysmal nocturnal dyspnea. […] Atrial fibrillation management: AF is generally poorly tolerated due to: [i] Loss of atrial kick. [ii] Tachycardia. […] Noninvasive ventilation (BIPAP or CPAP) may be helpful in acute cardiogenic pulmonary edema. […] Diuresis to manage pulmonary congestion. […] Anticoagulation indicated for: MS plus AF. […] Surgical repair should ideally be performed before significant LV dysfunction develops.
#14 Discharge Instructions for Mitral Valve Stenosis | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/discharge-instructions-mitral-valve-stenosis
Maintain a healthy weight. Get help to lose any extra pounds. […] Take your medicines exactly as directed. Dont skip doses. […] Make a follow-up appointment with your provider, or as directed. […] Call 911 right away if: You have chest pain or shortness of breath. You have weakness in the muscles of your face, arms, or legs. You have trouble speaking. You faint or are dizzy. You have swelling in your hands, feet, or ankles. Your heartbeat is irregular, rapid, or pounding.
#15 Mitral valve disease: clinical features focusing on auscultatory findings including auscultation of mitral valve prolapse
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-disease-clinical-features-focusing-on-auscultatory-findings-including-auscultation-of-mitral-valve-prolapse
Most cases of mitral stenosis are caused by rheumatic heart disease. […] Some of the signs of mitral stenosis are very subtle and hence physical examination, particularly auscultation, should be carried out in a quiet setting in a systematic way. […] Before proceeding to auscultation, mitral facies (plethoric cheeks with bluish patches), tapping apex and apical diastolic thrill may suggest the presence of mitral stenosis. […] The first heart sound (S1) is typically loud due to the rapidity with which RV pressure rises (dP/dt) at the time of mitral valve closure. […] The opening snap (OS) of the mitral stenosis is a high-pitched early diastolic sound due to sudden tensing of the valve leaflets and subvalvular apparatus at the end of the opening excursion. […] The classic mid-diastolic low-pitched rumbling murmur of mitral stenosis with pre-systolic accentuation is best audible at the apex, in the left lateral position with the bell of the stethoscope.
#16 Mitral valve disease: clinical features focusing on auscultatory findings including auscultation of mitral valve prolapse
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-disease-clinical-features-focusing-on-auscultatory-findings-including-auscultation-of-mitral-valve-prolapse
Most cases of mitral stenosis are caused by rheumatic heart disease. […] Some of the signs of mitral stenosis are very subtle and hence physical examination, particularly auscultation, should be carried out in a quiet setting in a systematic way. […] Before proceeding to auscultation, mitral facies (plethoric cheeks with bluish patches), tapping apex and apical diastolic thrill may suggest the presence of mitral stenosis. […] The first heart sound (S1) is typically loud due to the rapidity with which RV pressure rises (dP/dt) at the time of mitral valve closure. […] The opening snap (OS) of the mitral stenosis is a high-pitched early diastolic sound due to sudden tensing of the valve leaflets and subvalvular apparatus at the end of the opening excursion. […] The classic mid-diastolic low-pitched rumbling murmur of mitral stenosis with pre-systolic accentuation is best audible at the apex, in the left lateral position with the bell of the stethoscope.
#17 Mitral valve disease: clinical features focusing on auscultatory findings including auscultation of mitral valve prolapse
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-disease-clinical-features-focusing-on-auscultatory-findings-including-auscultation-of-mitral-valve-prolapse
Most cases of mitral stenosis are caused by rheumatic heart disease. […] Some of the signs of mitral stenosis are very subtle and hence physical examination, particularly auscultation, should be carried out in a quiet setting in a systematic way. […] Before proceeding to auscultation, mitral facies (plethoric cheeks with bluish patches), tapping apex and apical diastolic thrill may suggest the presence of mitral stenosis. […] The first heart sound (S1) is typically loud due to the rapidity with which RV pressure rises (dP/dt) at the time of mitral valve closure. […] The opening snap (OS) of the mitral stenosis is a high-pitched early diastolic sound due to sudden tensing of the valve leaflets and subvalvular apparatus at the end of the opening excursion. […] The classic mid-diastolic low-pitched rumbling murmur of mitral stenosis with pre-systolic accentuation is best audible at the apex, in the left lateral position with the bell of the stethoscope.
#18 Mitral valve disease: clinical features focusing on auscultatory findings including auscultation of mitral valve prolapse
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-disease-clinical-features-focusing-on-auscultatory-findings-including-auscultation-of-mitral-valve-prolapse
Most cases of mitral stenosis are caused by rheumatic heart disease. […] Some of the signs of mitral stenosis are very subtle and hence physical examination, particularly auscultation, should be carried out in a quiet setting in a systematic way. […] Before proceeding to auscultation, mitral facies (plethoric cheeks with bluish patches), tapping apex and apical diastolic thrill may suggest the presence of mitral stenosis. […] The first heart sound (S1) is typically loud due to the rapidity with which RV pressure rises (dP/dt) at the time of mitral valve closure. […] The opening snap (OS) of the mitral stenosis is a high-pitched early diastolic sound due to sudden tensing of the valve leaflets and subvalvular apparatus at the end of the opening excursion. […] The classic mid-diastolic low-pitched rumbling murmur of mitral stenosis with pre-systolic accentuation is best audible at the apex, in the left lateral position with the bell of the stethoscope.
#19 Valvular Heart Disease: Review and Update | AAFP
https://www.aafp.org/pubs/afp/issues/2001/0601/p2201.html
Echocardiography is the study of choice for diagnosing and assessing the severity of mitral stenosis. It is also useful for obtaining an accurate valve area, assessing right ventricular function and determining suitability for balloon mitral valvotomy. […] In patients who are asymptomatic, an annual history and physical examination, as well as a chest x-ray and ECG, are recommended. Apart from endocarditis prophylaxis, no medical therapy is indicated. When mild symptoms develop, diuretics may be helpful in reducing left atrial pressure and decreasing symptoms. If atrial fibrillation develops, rate control is critical since tachycardia will further decrease left ventricular filling, reduce cardiac output and increase left atrial pressure, leading to more symptoms. The timing of surgery correlates with the clinical outcome. If symptoms are more than mild or if there is evidence of pulmonary hypertension, mechanical intervention is warranted and delaying intervention worsens prognosis. Unlike valvotomy for aortic stenosis, balloon valvotomy for mitral stenosis provides excellent mechanical relief with long-term benefit. Mitral balloon valvotomy is recommended for patients who have New York Heart Association class II, III or IV, moderate or severe mitral stenosis and favorable valve morphology. The valves must be pliable, noncalcified and free of subvalvular distortion. Candidates for valvotomy must have no significant mitral regurgitation. Open commissurotomy mitral valve reconstruction and mitral valve replacement improve survival and reduce symptoms. Mitral valve replacement is indicated in patients with severe mitral stenosis who are not candidates for valvotomy or commissurotomy.
#20 Mitral valve stenosis | Beacon Health System
https://www.beaconhealthsystem.org/library/diseases-and-conditions/mitral-valve-stenosis?content_id=CON-20310183
Medicines are used to reduce the symptoms of mitral valve stenosis. They may include diuretics, blood thinners, beta blockers, calcium channel blockers, and antibiotics. […] If you have mild to moderate mitral valve stenosis with no symptoms, you might not need immediate treatment. Instead, you need regular health checkups to see if your condition gets worse. […] Regular health checkups are important if you have mitral valve stenosis. You should have an echocardiogram at least every year. If you frequently feel your heart pounding or beating fast, get medical help. Fast heart rhythms that aren’t treated can quickly get worse in people with mitral valve stenosis.
#21 Valvular Heart Disease: Review and Update | AAFP
https://www.aafp.org/pubs/afp/issues/2001/0601/p2201.html
Echocardiography is the study of choice for diagnosing and assessing the severity of mitral stenosis. It is also useful for obtaining an accurate valve area, assessing right ventricular function and determining suitability for balloon mitral valvotomy. […] In patients who are asymptomatic, an annual history and physical examination, as well as a chest x-ray and ECG, are recommended. Apart from endocarditis prophylaxis, no medical therapy is indicated. When mild symptoms develop, diuretics may be helpful in reducing left atrial pressure and decreasing symptoms. If atrial fibrillation develops, rate control is critical since tachycardia will further decrease left ventricular filling, reduce cardiac output and increase left atrial pressure, leading to more symptoms. The timing of surgery correlates with the clinical outcome. If symptoms are more than mild or if there is evidence of pulmonary hypertension, mechanical intervention is warranted and delaying intervention worsens prognosis. Unlike valvotomy for aortic stenosis, balloon valvotomy for mitral stenosis provides excellent mechanical relief with long-term benefit. Mitral balloon valvotomy is recommended for patients who have New York Heart Association class II, III or IV, moderate or severe mitral stenosis and favorable valve morphology. The valves must be pliable, noncalcified and free of subvalvular distortion. Candidates for valvotomy must have no significant mitral regurgitation. Open commissurotomy mitral valve reconstruction and mitral valve replacement improve survival and reduce symptoms. Mitral valve replacement is indicated in patients with severe mitral stenosis who are not candidates for valvotomy or commissurotomy.
#22 Mitral Valve Stenosis | CommonSpirit Health
https://www.commonspirit.org/conditions-treatments/mitral-valve-stenosis
Mitral valve stenosis is a heart problem in which the mitral valve becomes stiff and doesn’t open as wide as it should. This forces your heart to work harder to pump blood through the valve, which can weaken the heart and cause other problems. […] Treatment for mitral valve stenosis depends on how severe the disease is and if you have symptoms or other health problems from the stenosis. You and your doctor can decide what treatment is right for you. […] You will have regular checkups and echocardiograms if your stenosis is mild or moderate. […] Your doctor will likely recommend a heart-healthy lifestyle. […] You may take medicines to prevent or treat complications. These include atrial fibrillation, heart failure, and stroke. […] You may choose to have the mitral valve repaired or replaced if you have symptoms or the stenosis is severe.
#23 Discharge Instructions for Mitral Valve Stenosis | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/discharge-instructions-mitral-valve-stenosis
You have been diagnosed with mitral valve stenosis. This means that the mitral valve, located between the left atrium (left upper chamber) and left ventricle (left lower chamber) of the heart, is stiff and doesnt open correctly. Because the valve is narrowed, blood must move through a smaller opening. In moderate to severe cases, fluid can build up in the lungs. That can lead to coughing and breathing problems. You can also develop heart rhythm problems, such as atrial fibrillation. Over time, mitral valve stenosis may slowly get worse. Most cases of mitral valve stenosis are caused by rheumatic fever. […] Many people with mild mitral valve stenosis who don’t have symptoms don’t need treatment. In such cases, regular monitoring of the valve with echocardiograms is typically recommended. Sometimes symptoms can be controlled with medicines alone. In some cases, you may need surgery or a minimally invasive catheter-based procedure to repair or replace the mitral valve. Your cardiologist will recommend treatment based on your own condition.
#24 Valvular Heart Disease: Review and Update | AAFP
https://www.aafp.org/pubs/afp/issues/2001/0601/p2201.html
Echocardiography is the study of choice for diagnosing and assessing the severity of mitral stenosis. It is also useful for obtaining an accurate valve area, assessing right ventricular function and determining suitability for balloon mitral valvotomy. […] In patients who are asymptomatic, an annual history and physical examination, as well as a chest x-ray and ECG, are recommended. Apart from endocarditis prophylaxis, no medical therapy is indicated. When mild symptoms develop, diuretics may be helpful in reducing left atrial pressure and decreasing symptoms. If atrial fibrillation develops, rate control is critical since tachycardia will further decrease left ventricular filling, reduce cardiac output and increase left atrial pressure, leading to more symptoms. The timing of surgery correlates with the clinical outcome. If symptoms are more than mild or if there is evidence of pulmonary hypertension, mechanical intervention is warranted and delaying intervention worsens prognosis. Unlike valvotomy for aortic stenosis, balloon valvotomy for mitral stenosis provides excellent mechanical relief with long-term benefit. Mitral balloon valvotomy is recommended for patients who have New York Heart Association class II, III or IV, moderate or severe mitral stenosis and favorable valve morphology. The valves must be pliable, noncalcified and free of subvalvular distortion. Candidates for valvotomy must have no significant mitral regurgitation. Open commissurotomy mitral valve reconstruction and mitral valve replacement improve survival and reduce symptoms. Mitral valve replacement is indicated in patients with severe mitral stenosis who are not candidates for valvotomy or commissurotomy.
#25 Mitral Stenosis Treatment & Management: Medical Care, Surgical Care, Consultations
https://emedicine.medscape.com/article/155724-treatment
Atrial fibrillation is common in mitral stenosis and often leads to a rapid ventricular rate with reduced diastolic filling time and increased left atrial pressure. […] The ventricular rate of atrial fibrillation can be slowed acutely by the administration of intravenous beta-blocker or calcium channel blocker therapy (diltiazem or verapamil). […] In the patient with mild mitral stenosis and recent-onset ( 6 mo) atrial fibrillation, conversion to sinus rhythm can be accomplished with pharmacologic agents or electrical cardioversion. […] Surgical correction of the mitral stenosis is indicated if embolization is recurrent, despite adequate anticoagulation therapy. […] The patient should start a low-salt diet if pulmonary vascular congestion is present. […] In most patients with mitral stenosis, recommendations for exercise are symptom limited. Patients should be encouraged to pursue a low-level aerobic exercise program for maintenance of cardiovascular fitness.
#26 Mitral stenosis: MedlinePlus Medical EncyclopediaLock
https://medlineplus.gov/ency/article/000175.htm
Mitral stenosis is a disorder in which the mitral valve does not fully open. This restricts the flow of blood. […] Treatment depends on the symptoms and condition of the heart and lungs. People with mild symptoms or none at all may not need treatment. For severe symptoms, you may need to go to the hospital for diagnosis and treatment. […] Medicines which can be used to treat symptoms of heart failure, high blood pressure and to slow or regulate heart rhythms include: Diuretics (water pills), Nitrates, beta-blockers, Calcium channel blockers, ACE inhibitors, Angiotensin receptor blockers (ARBs), Digoxin, Medicines to treat abnormal heart rhythms. […] Anticoagulants (blood thinners) are used to prevent blood clots from forming and traveling to other parts of the body. […] Some people may need heart surgery or procedures to treat mitral stenosis. These include: Percutaneous mitral balloon valvotomy (also called valvuloplasty).
#27 Valvular Disorder: Mitral Stenosis Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/valvular-disorder-mitral-stenosis-nursing-management/
Mitral stenosis is the progressive thickening and contracture of the mitral valve leaflets and chordate tendineae that cause narrowing of the orifice and progressive obstruction to blood flow. […] Dyspnea on exertion (due to pulmonary venous hypertension) as the first symptom […] Progressive fatigue (result of low cardiac output) […] Hemoptysis and cough […] Repeated respiratory infections […] Weak and often irregular pulse (because of atrial fibrillation) […] Prophylactic antibiotic therapy to prevent recurrence of infections […] Treatment of anemia if required […] Cardiotonics and diuretic for treatment of congestive heart failure […] Surgical intervention (valvuloplasty, commissurotomy, or replacement of the mitral valve) […] Percutaneous transluminal valvuloplasty for palliation of symptoms
#28 Mitral Stenosis Treatment & Management: Medical Care, Surgical Care, Consultations
https://emedicine.medscape.com/article/155724-treatment
The goal of medical treatment for mitral stenosis is to reduce recurrence of rheumatic fever, provide prophylaxis for infective endocarditis, reduce symptoms of pulmonary congestion (eg, orthopnea, paroxysmal nocturnal dyspnea), control the ventricular rate if atrial fibrillation is present, and prevent thromboembolic complications. […] Because rheumatic fever is the primary cause of mitral stenosis, secondary prophylaxis against group A beta-hemolytic streptococci (GAS) is recommended. […] Initial symptoms of pulmonary congestion can be safely treated by diuretics. Dietary sodium restriction and nitrates decrease preload and can be of additional benefit. […] In a randomized crossover study, Saggu et al investigated the comparative efficacy of ivabradine and metoprolol on symptoms, hemodynamics, and exercise parameters in 33 patients with mild-to-moderate mitral stenosis (mitral valve area, 1-2 cm) in normal sinus rhythm.
#29 Mitral Stenosis Treatment & Management: Medical Care, Surgical Care, Consultations
https://emedicine.medscape.com/article/155724-treatment
Surgical therapy for mitral stenosis consists of mitral valvotomy (which can be either surgical or percutaneous) or mitral valve replacement. […] Asymptomatic patients with moderate or severe mitral stenosis (mitral valve area 1.5 cm2) and a suitable valve should be considered for percutaneous balloon commissurotomy if the pulmonary arterial systolic pressure is 50 mm Hg at rest or 60 mm Hg with exercise, or pulmonary capillary wedge pressure is 25 mm Hg with exercise. […] Symptomatic patients with moderate or severe mitral stenosis (mitral valve area 1.5 cm2) and suitable valve are also candidates for percutaneous balloon commissurotomy. […] If percutaneous balloon commissurotomy is not an option, patients should be referred for surgical repair or mitral valve replacement. […] Patients who have chronic atrial fibrillation and who undergo mitral valve surgery can have simultaneous Cox Maze procedure or pulmonary vein ablation, which helps to maintain sinus rhythm in up to 80% of the cases during the postoperative period. […] Serial follow-up testing of a patient with mitral stenosis should be based on whether the results of a test will dictate either a change in therapy or a recommendation for a procedure.
#30 Mitral Valve Stenosis | Lehigh Valley Health Network
https://www.lvhn.org/conditions/mitral-valve-stenosis
Mitral valve stenosis is a narrowing of the heartâs mitral valve that can cause blood to back up in your heart and fluid to build in your lungs. […] The team at Lehigh Valley Heart and Vascular Institute has the experience and leading-edge technology to diagnose and treat mitral valve stenosis. […] If you are diagnosed with mitral valve stenosis, you may need surgery. Types of surgeries offered by Lehigh Valley Heart and Vascular Institute include: […] Balloon valvuloplasty: To treat narrowed valves, or valve stenosis, your doctor threads a catheter with a balloon on its tip through a blood vessel. The balloon inflates to stretch the valve opening and deflates for removal from the blood vessel. […] Mitral valve repair: Surgery using traditional surgical tools to make repairs to the valve itself. […] Mitral valve replacement: The diseased valve can be replaced with a mechanical or tissue valve.
#31 Mitral Valve Stenosis | Heart and Vascular
https://health.ucdavis.edu/conditions/mitral-valve-stenosis
With the care of our experts in structural heart disease, you can get treatment for mitral stenosis and prevent complications like heart failure. […] Our world-renowned specialists in structural heart disease can help identify if you have mitral stenosis. We detect and treat the disease early with heart valve repair and replacement to potentially prevent heart failure. […] Your physician may prescribe medication(s) to treat your mitral valve stenosis. These include drugs to: […] A commissurotomy is a procedure that separates your mitral valve leaflets if they fused together from scarring due to rheumatic fever. It can be performed using a balloon or with surgery. […] Your physician may recommend surgery to replace your damaged mitral valve using either a mechanical or tissue valve.
#32 Mitral Valve Stenosis | Heart and Vascular
https://health.ucdavis.edu/conditions/mitral-valve-stenosis
With the care of our experts in structural heart disease, you can get treatment for mitral stenosis and prevent complications like heart failure. […] Our world-renowned specialists in structural heart disease can help identify if you have mitral stenosis. We detect and treat the disease early with heart valve repair and replacement to potentially prevent heart failure. […] Your physician may prescribe medication(s) to treat your mitral valve stenosis. These include drugs to: […] A commissurotomy is a procedure that separates your mitral valve leaflets if they fused together from scarring due to rheumatic fever. It can be performed using a balloon or with surgery. […] Your physician may recommend surgery to replace your damaged mitral valve using either a mechanical or tissue valve.
#33 Nursing Care Plan (NCP) for Heart Valve Disorders | Free NURSING.com Courses
https://nursing.com/lesson/nursing-care-plan-for-heart-valve-disorders
If the valve should be open, but doesn’t open fully stenosis […] If the valve should be closed but doesn’t close fully regurgitation […] Notify the provider of new or sudden onset or murmurs, especially if accompanied by signs of poor perfusion or pulmonary edema […] Patients who receive artificial valve replacements will require lifelong anticoagulant therapy. They need to be taught precautions for anticoagulant therapy, including using electric razors and soft bristle toothbrushes and how often they will require monitoring, if at all. […] Patients with artificial heart valves are at high risk of developing endocarditis. They need to be taught about preventative measures, including receiving prophylactic antibiotics before any invasive procedures. […] Oral hygiene is imperative for the prevention of endocarditis after valve repair. This may seem silly but it is a HUGE deal. The evidence has shown that bacteria from the oral cavity are highly likely to translocate (move) to the heart and become lodged in/on the valves. This is also why patients should avoid dental procedures for 6 months after valve surgery. It is so important that you, as the nurse, educate them on why this is so important.
#34 Mitral Stenosis (Nursing) – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/NBK568793/
Mitral stenosis (MS) is a form of valvular heart disease. Mitral stenosis is characterized by narrowing of the mitral valve orifice. […] Nursing Diagnosis: Risk for inadequate perfusion related to fluid overload as evidenced by weight gain greater than 3 pounds daily. […] Nursing Management: Monitor vital signs, universal precaution for infection control to prevent endocarditis and decrease rheumatic fever, symptom management, monitor signs and symptoms of deep vein thrombosis, elevate legs above the heart, monitor fluid intake to avoid fluid overload, assess ECG, monitor INR, listen to the lungs as pulmonary edema is common, listen to the heart-MS presents with a loud S1, encourage diet (Failure to thrive is common), educate patients on the disease and surgery. […] Once the diagnosis of mitral stenosis is made, the patient should be educated about the need for surgery.
#35 Nursing Care of Clients with Valvular Disorders | PPT
https://www.slideshare.net/slideshow/nursing-care-of-clients-with-valvular-disorders/14046874
8/23/2012 Maria Carmela L. Domocmat […] Assess s/s HF fatigue, dyspnea with exertion, increase in coughing, hemoptysis, multiple respiratory infections, orthopnea, or PND […] Assess dysrhythmias by palpating the patients pulse for strength and rhythm (ie, regular or irregular) and asks if the patient has experienced palpitations or felt forceful heartbeats Assess for dizziness, syncope, increased weakness, or angina pectoris […] Peiop care – surgical valve replacement or valvuloplasty […] Repair of a cardiac valve Types Commissurotomy Annuloplasty Chordoplasty […] 8/23/2012 Maria Carmela L. Domocmat
#36 Nursing Care of Clients with Valvular Disorders | PPT
https://www.slideshare.net/slideshow/nursing-care-of-clients-with-valvular-disorders/14046874
8/23/2012 Maria Carmela L. Domocmat […] Assess s/s HF fatigue, dyspnea with exertion, increase in coughing, hemoptysis, multiple respiratory infections, orthopnea, or PND […] Assess dysrhythmias by palpating the patients pulse for strength and rhythm (ie, regular or irregular) and asks if the patient has experienced palpitations or felt forceful heartbeats Assess for dizziness, syncope, increased weakness, or angina pectoris […] Peiop care – surgical valve replacement or valvuloplasty […] Repair of a cardiac valve Types Commissurotomy Annuloplasty Chordoplasty […] 8/23/2012 Maria Carmela L. Domocmat
#37 Nursing Care of Clients with Valvular Disorders | PPT
https://www.slideshare.net/slideshow/nursing-care-of-clients-with-valvular-disorders/14046874
8/23/2012 Maria Carmela L. Domocmat […] Assess s/s HF fatigue, dyspnea with exertion, increase in coughing, hemoptysis, multiple respiratory infections, orthopnea, or PND […] Assess dysrhythmias by palpating the patients pulse for strength and rhythm (ie, regular or irregular) and asks if the patient has experienced palpitations or felt forceful heartbeats Assess for dizziness, syncope, increased weakness, or angina pectoris […] Peiop care – surgical valve replacement or valvuloplasty […] Repair of a cardiac valve Types Commissurotomy Annuloplasty Chordoplasty […] 8/23/2012 Maria Carmela L. Domocmat
#38 Nursing Care Plan for Heart Valve Disorders | Free NURSING.com Courses
https://nursing.com/lesson/nursing-care-plan-for-heart-valve-disorders-2
Mitral Stenosis mitral valve cannot open fully or is narrowed, therefore blood cant go into the LV […] Assess Heart SoundsTo identify murmur: […] The easiest way for a nurse to determine the presence of a valve disorder is to listen for murmurs. A murmur indicates abnormal or turbulent blood flow through the valve. […] If the valve should be open, but doesnt open fully stenosis […] Assess respiratory status […] If blood is not going forward or backing up, it can cause pulmonary congestion leading to pulmonary edema. This would cause decreased SpO2, crackles in the lungs, and possibly even pink-frothy sputum […] Educate patient about post-op requirements after valve replacement surgery […] Patients who receive artificial valve replacements will require lifelong anticoagulant therapy. […] Patients with artificial heart valves are at high risk of developing endocarditis. […] Oral hygiene is imperative to prevention of endocarditis after valve repair.
#39 Nursing Care Plan for Heart Valve Disorders | Free NURSING.com Courses
https://nursing.com/lesson/nursing-care-plan-for-heart-valve-disorders-2
Mitral Stenosis mitral valve cannot open fully or is narrowed, therefore blood cant go into the LV […] Assess Heart SoundsTo identify murmur: […] The easiest way for a nurse to determine the presence of a valve disorder is to listen for murmurs. A murmur indicates abnormal or turbulent blood flow through the valve. […] If the valve should be open, but doesnt open fully stenosis […] Assess respiratory status […] If blood is not going forward or backing up, it can cause pulmonary congestion leading to pulmonary edema. This would cause decreased SpO2, crackles in the lungs, and possibly even pink-frothy sputum […] Educate patient about post-op requirements after valve replacement surgery […] Patients who receive artificial valve replacements will require lifelong anticoagulant therapy. […] Patients with artificial heart valves are at high risk of developing endocarditis. […] Oral hygiene is imperative to prevention of endocarditis after valve repair.
#40 Mitral Stenosis (Nursing) – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/NBK568793/
Mitral stenosis (MS) is a form of valvular heart disease. Mitral stenosis is characterized by narrowing of the mitral valve orifice. […] Nursing Diagnosis: Risk for inadequate perfusion related to fluid overload as evidenced by weight gain greater than 3 pounds daily. […] Nursing Management: Monitor vital signs, universal precaution for infection control to prevent endocarditis and decrease rheumatic fever, symptom management, monitor signs and symptoms of deep vein thrombosis, elevate legs above the heart, monitor fluid intake to avoid fluid overload, assess ECG, monitor INR, listen to the lungs as pulmonary edema is common, listen to the heart-MS presents with a loud S1, encourage diet (Failure to thrive is common), educate patients on the disease and surgery. […] Once the diagnosis of mitral stenosis is made, the patient should be educated about the need for surgery.
#41 Mitral Stenosis (Nursing) – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/NBK568793/
Mitral stenosis (MS) is a form of valvular heart disease. Mitral stenosis is characterized by narrowing of the mitral valve orifice. […] Nursing Diagnosis: Risk for inadequate perfusion related to fluid overload as evidenced by weight gain greater than 3 pounds daily. […] Nursing Management: Monitor vital signs, universal precaution for infection control to prevent endocarditis and decrease rheumatic fever, symptom management, monitor signs and symptoms of deep vein thrombosis, elevate legs above the heart, monitor fluid intake to avoid fluid overload, assess ECG, monitor INR, listen to the lungs as pulmonary edema is common, listen to the heart-MS presents with a loud S1, encourage diet (Failure to thrive is common), educate patients on the disease and surgery. […] Once the diagnosis of mitral stenosis is made, the patient should be educated about the need for surgery.
#42 Mitral Stenosis (Nursing) – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/NBK568793/
Mitral stenosis (MS) is a form of valvular heart disease. Mitral stenosis is characterized by narrowing of the mitral valve orifice. […] Nursing Diagnosis: Risk for inadequate perfusion related to fluid overload as evidenced by weight gain greater than 3 pounds daily. […] Nursing Management: Monitor vital signs, universal precaution for infection control to prevent endocarditis and decrease rheumatic fever, symptom management, monitor signs and symptoms of deep vein thrombosis, elevate legs above the heart, monitor fluid intake to avoid fluid overload, assess ECG, monitor INR, listen to the lungs as pulmonary edema is common, listen to the heart-MS presents with a loud S1, encourage diet (Failure to thrive is common), educate patients on the disease and surgery. […] Once the diagnosis of mitral stenosis is made, the patient should be educated about the need for surgery.
#43 Mitral Stenosis (Nursing) – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/NBK568793/
Mitral stenosis (MS) is a form of valvular heart disease. Mitral stenosis is characterized by narrowing of the mitral valve orifice. […] Nursing Diagnosis: Risk for inadequate perfusion related to fluid overload as evidenced by weight gain greater than 3 pounds daily. […] Nursing Management: Monitor vital signs, universal precaution for infection control to prevent endocarditis and decrease rheumatic fever, symptom management, monitor signs and symptoms of deep vein thrombosis, elevate legs above the heart, monitor fluid intake to avoid fluid overload, assess ECG, monitor INR, listen to the lungs as pulmonary edema is common, listen to the heart-MS presents with a loud S1, encourage diet (Failure to thrive is common), educate patients on the disease and surgery. […] Once the diagnosis of mitral stenosis is made, the patient should be educated about the need for surgery.
#44 Mitral Stenosis (Nursing) – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/NBK568793/
Mitral stenosis (MS) is a form of valvular heart disease. Mitral stenosis is characterized by narrowing of the mitral valve orifice. […] Nursing Diagnosis: Risk for inadequate perfusion related to fluid overload as evidenced by weight gain greater than 3 pounds daily. […] Nursing Management: Monitor vital signs, universal precaution for infection control to prevent endocarditis and decrease rheumatic fever, symptom management, monitor signs and symptoms of deep vein thrombosis, elevate legs above the heart, monitor fluid intake to avoid fluid overload, assess ECG, monitor INR, listen to the lungs as pulmonary edema is common, listen to the heart-MS presents with a loud S1, encourage diet (Failure to thrive is common), educate patients on the disease and surgery. […] Once the diagnosis of mitral stenosis is made, the patient should be educated about the need for surgery.
#45 Mitral valve stenosis powerpoint | PPT
https://www.slideshare.net/kayanalevy25/mitral-valve-stenosis-powerpoint
Mitral valve stenosis Nursing Implications Mitral valve stenosis Help the patient relax to promote oxygenation. Place the patient in high Fowlers position to enhance lung expansion/oxygenation. Administer oxygen as ordered. Carefully record the time morphine is given and the amount administered. […] Mitral valve stenosis Watch for complications of treatment such as electrolyte depletion. Urge the patient to comply with the prescribed medication regimen to avoid future episodes of pulmonary edema. […] Mitral valve stenosis Explain all procedure to the patient and his family to educate and alleviate anxiety about procedure. Emphasize reporting early signs of fluid overload as this can cause impaired gas exchange and threaten oxygenation. […] Mitral valve stenosis Allow the patient to express his concerns over being unable to meet his/her responsibilities because of activity restrictions. Monitor vital signs for early detection of changes.
#46 Mitral valve stenosis powerpoint | PPT
https://www.slideshare.net/kayanalevy25/mitral-valve-stenosis-powerpoint
Mitral valve stenosis Nursing Implications Mitral valve stenosis Help the patient relax to promote oxygenation. Place the patient in high Fowlers position to enhance lung expansion/oxygenation. Administer oxygen as ordered. Carefully record the time morphine is given and the amount administered. […] Mitral valve stenosis Watch for complications of treatment such as electrolyte depletion. Urge the patient to comply with the prescribed medication regimen to avoid future episodes of pulmonary edema. […] Mitral valve stenosis Explain all procedure to the patient and his family to educate and alleviate anxiety about procedure. Emphasize reporting early signs of fluid overload as this can cause impaired gas exchange and threaten oxygenation. […] Mitral valve stenosis Allow the patient to express his concerns over being unable to meet his/her responsibilities because of activity restrictions. Monitor vital signs for early detection of changes.
#47 Mitral valve stenosis powerpoint | PPT
https://www.slideshare.net/kayanalevy25/mitral-valve-stenosis-powerpoint
Mitral valve stenosis Nursing Implications Mitral valve stenosis Help the patient relax to promote oxygenation. Place the patient in high Fowlers position to enhance lung expansion/oxygenation. Administer oxygen as ordered. Carefully record the time morphine is given and the amount administered. […] Mitral valve stenosis Watch for complications of treatment such as electrolyte depletion. Urge the patient to comply with the prescribed medication regimen to avoid future episodes of pulmonary edema. […] Mitral valve stenosis Explain all procedure to the patient and his family to educate and alleviate anxiety about procedure. Emphasize reporting early signs of fluid overload as this can cause impaired gas exchange and threaten oxygenation. […] Mitral valve stenosis Allow the patient to express his concerns over being unable to meet his/her responsibilities because of activity restrictions. Monitor vital signs for early detection of changes.
#48 Mitral valve stenosis powerpoint | PPT
https://www.slideshare.net/kayanalevy25/mitral-valve-stenosis-powerpoint
Mitral valve stenosis Nursing Implications Mitral valve stenosis Help the patient relax to promote oxygenation. Place the patient in high Fowlers position to enhance lung expansion/oxygenation. Administer oxygen as ordered. Carefully record the time morphine is given and the amount administered. […] Mitral valve stenosis Watch for complications of treatment such as electrolyte depletion. Urge the patient to comply with the prescribed medication regimen to avoid future episodes of pulmonary edema. […] Mitral valve stenosis Explain all procedure to the patient and his family to educate and alleviate anxiety about procedure. Emphasize reporting early signs of fluid overload as this can cause impaired gas exchange and threaten oxygenation. […] Mitral valve stenosis Allow the patient to express his concerns over being unable to meet his/her responsibilities because of activity restrictions. Monitor vital signs for early detection of changes.
#49 Mitral valve stenosis powerpoint | PPT
https://www.slideshare.net/kayanalevy25/mitral-valve-stenosis-powerpoint
Mitral valve stenosis Nursing Implications Mitral valve stenosis Help the patient relax to promote oxygenation. Place the patient in high Fowlers position to enhance lung expansion/oxygenation. Administer oxygen as ordered. Carefully record the time morphine is given and the amount administered. […] Mitral valve stenosis Watch for complications of treatment such as electrolyte depletion. Urge the patient to comply with the prescribed medication regimen to avoid future episodes of pulmonary edema. […] Mitral valve stenosis Explain all procedure to the patient and his family to educate and alleviate anxiety about procedure. Emphasize reporting early signs of fluid overload as this can cause impaired gas exchange and threaten oxygenation. […] Mitral valve stenosis Allow the patient to express his concerns over being unable to meet his/her responsibilities because of activity restrictions. Monitor vital signs for early detection of changes.
#50 Mitral valve stenosis powerpoint | PPT
https://www.slideshare.net/kayanalevy25/mitral-valve-stenosis-powerpoint
Mitral valve stenosis Nursing Implications Mitral valve stenosis Help the patient relax to promote oxygenation. Place the patient in high Fowlers position to enhance lung expansion/oxygenation. Administer oxygen as ordered. Carefully record the time morphine is given and the amount administered. […] Mitral valve stenosis Watch for complications of treatment such as electrolyte depletion. Urge the patient to comply with the prescribed medication regimen to avoid future episodes of pulmonary edema. […] Mitral valve stenosis Explain all procedure to the patient and his family to educate and alleviate anxiety about procedure. Emphasize reporting early signs of fluid overload as this can cause impaired gas exchange and threaten oxygenation. […] Mitral valve stenosis Allow the patient to express his concerns over being unable to meet his/her responsibilities because of activity restrictions. Monitor vital signs for early detection of changes.
#51 Mitral valve stenosis powerpoint | PPT
https://www.slideshare.net/kayanalevy25/mitral-valve-stenosis-powerpoint
Mitral valve stenosis Place the patient in an upright position to relieve dyspnea, if needed. Prepare the patient for valve replacement or percutaneous balloon valvuloplasty, as indicated. Keep the patient on a low-sodium diet. […] Mitral valve stenosis Review all prescribed medications with the patient to educate the patient and promote cooperative behaviors. Assist the patient with bathing as necessary to protect patient from injury, and maintain energy reserve.
#52 Mitral valve stenosis powerpoint | PPT
https://www.slideshare.net/kayanalevy25/mitral-valve-stenosis-powerpoint
Mitral valve stenosis Place the patient in an upright position to relieve dyspnea, if needed. Prepare the patient for valve replacement or percutaneous balloon valvuloplasty, as indicated. Keep the patient on a low-sodium diet. […] Mitral valve stenosis Review all prescribed medications with the patient to educate the patient and promote cooperative behaviors. Assist the patient with bathing as necessary to protect patient from injury, and maintain energy reserve.
#53 Mitral valve stenosis powerpoint | PPT
https://www.slideshare.net/kayanalevy25/mitral-valve-stenosis-powerpoint
Mitral valve stenosis Place the patient in an upright position to relieve dyspnea, if needed. Prepare the patient for valve replacement or percutaneous balloon valvuloplasty, as indicated. Keep the patient on a low-sodium diet. […] Mitral valve stenosis Review all prescribed medications with the patient to educate the patient and promote cooperative behaviors. Assist the patient with bathing as necessary to protect patient from injury, and maintain energy reserve.
#54 Mitral Stenosis (Nursing) – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/NBK568793/
Many of these patients will need anticoagulation with warfarin. Hence, the pharmacist should ensure that monthly blood work is done to ensure therapeutic anticoagulation. […] Cardiac surgery nurses should educate the patient on the type of prosthetic valves available and which may be best suited for them. […] Because atrial fibrillation is a persistent problem, anticoagulation will be required in most patients. Hence, close monitoring of the INR by a dedicated nurse is necessary.
#55 Mitral valve repair: A new choice
https://www.myamericannurse.com/mitral-valve-repair-a-new-choice/
Postoperative nursing care for patients undergoing valve repair is similar to nursing care for other cardiothoracic surgeries. During the acute recovery phase, you monitor the patient for unstable hemodynamic values, bleeding, arrhythmias, surgical-site infection, and complications from mechanical ventilation. […] The risk of postoperative complications is lower than or similar to the risk after valve replacement. Patients who have mitral valve repair for ischemic coronary artery disease face the same risk of bleeding and stroke as those who have valve replacement. A patients risk of atrial fibrillation is 27% for either procedure. […] The stress of surgery and hospitalization makes it likely that patients and families will forget much of what you teach them preoperatively. Anticipate repeating the details of the valve repair during this emotionally intense period.
#56 Mitral valve repair: A new choice
https://www.myamericannurse.com/mitral-valve-repair-a-new-choice/
Postoperative nursing care for patients undergoing valve repair is similar to nursing care for other cardiothoracic surgeries. During the acute recovery phase, you monitor the patient for unstable hemodynamic values, bleeding, arrhythmias, surgical-site infection, and complications from mechanical ventilation. […] The risk of postoperative complications is lower than or similar to the risk after valve replacement. Patients who have mitral valve repair for ischemic coronary artery disease face the same risk of bleeding and stroke as those who have valve replacement. A patients risk of atrial fibrillation is 27% for either procedure. […] The stress of surgery and hospitalization makes it likely that patients and families will forget much of what you teach them preoperatively. Anticipate repeating the details of the valve repair during this emotionally intense period.
#57 Mitral valve repair: A new choice
https://www.myamericannurse.com/mitral-valve-repair-a-new-choice/
Postoperative nursing care for patients undergoing valve repair is similar to nursing care for other cardiothoracic surgeries. During the acute recovery phase, you monitor the patient for unstable hemodynamic values, bleeding, arrhythmias, surgical-site infection, and complications from mechanical ventilation. […] The risk of postoperative complications is lower than or similar to the risk after valve replacement. Patients who have mitral valve repair for ischemic coronary artery disease face the same risk of bleeding and stroke as those who have valve replacement. A patients risk of atrial fibrillation is 27% for either procedure. […] The stress of surgery and hospitalization makes it likely that patients and families will forget much of what you teach them preoperatively. Anticipate repeating the details of the valve repair during this emotionally intense period.
#58 Valvular Heart Disease in Pregnancy
https://www.acc.org/Latest-in-Cardiology/Articles/2018/02/12/07/29/Valvular-Heart-Disease-in-Pregnancy
Moderate to severe mitral stenosis (MS) is poorly tolerated in pregnancy. As the heart rate increases, diastolic filling time is decreased, which leads to increased pulmonary hypertension and pulmonary venous congestion. As a result, women with moderate to severe MS who were asymptomatic prior to pregnancy may become symptomatic during pregnancy. Arrhythmias, specifically atrial fibrillation (AF) and supraventricular tachycardia, are increased and occur in as many as 11% in one study of women with rheumatic mitral valve disease. Poor fetal outcomes including fetal growth restriction, low birth weight and preterm birth increase with increasing severity of MS. […] We recommend serial imaging with echocardiography in addition to close clinical monitoring. Echocardiography once per trimester is sufficient, with the third trimester echocardiogram performed around 32 weeks gestation, at the time of peak hemodynamic load. Women with a congenital bicuspid valve should have imaging of the ascending and proximal aorta, given the association of coarctation of the aorta and aortopathy. The data obtained will assist with multidisciplinary delivery planning.
#59 Valvular Heart Disease in Pregnancy
https://www.acc.org/Latest-in-Cardiology/Articles/2018/02/12/07/29/Valvular-Heart-Disease-in-Pregnancy
Moderate to severe mitral stenosis (MS) is poorly tolerated in pregnancy. As the heart rate increases, diastolic filling time is decreased, which leads to increased pulmonary hypertension and pulmonary venous congestion. As a result, women with moderate to severe MS who were asymptomatic prior to pregnancy may become symptomatic during pregnancy. Arrhythmias, specifically atrial fibrillation (AF) and supraventricular tachycardia, are increased and occur in as many as 11% in one study of women with rheumatic mitral valve disease. Poor fetal outcomes including fetal growth restriction, low birth weight and preterm birth increase with increasing severity of MS. […] We recommend serial imaging with echocardiography in addition to close clinical monitoring. Echocardiography once per trimester is sufficient, with the third trimester echocardiogram performed around 32 weeks gestation, at the time of peak hemodynamic load. Women with a congenital bicuspid valve should have imaging of the ascending and proximal aorta, given the association of coarctation of the aorta and aortopathy. The data obtained will assist with multidisciplinary delivery planning.
#60 Valvular Heart Disease in Pregnancy
https://www.acc.org/Latest-in-Cardiology/Articles/2018/02/12/07/29/Valvular-Heart-Disease-in-Pregnancy
Moderate to severe mitral stenosis (MS) is poorly tolerated in pregnancy. As the heart rate increases, diastolic filling time is decreased, which leads to increased pulmonary hypertension and pulmonary venous congestion. As a result, women with moderate to severe MS who were asymptomatic prior to pregnancy may become symptomatic during pregnancy. Arrhythmias, specifically atrial fibrillation (AF) and supraventricular tachycardia, are increased and occur in as many as 11% in one study of women with rheumatic mitral valve disease. Poor fetal outcomes including fetal growth restriction, low birth weight and preterm birth increase with increasing severity of MS. […] We recommend serial imaging with echocardiography in addition to close clinical monitoring. Echocardiography once per trimester is sufficient, with the third trimester echocardiogram performed around 32 weeks gestation, at the time of peak hemodynamic load. Women with a congenital bicuspid valve should have imaging of the ascending and proximal aorta, given the association of coarctation of the aorta and aortopathy. The data obtained will assist with multidisciplinary delivery planning.
#61 Valvular Heart Disease in Pregnancy
https://www.acc.org/Latest-in-Cardiology/Articles/2018/02/12/07/29/Valvular-Heart-Disease-in-Pregnancy
Medical management for HF related to increased valvular gradients included uptitration of nodal blocking agents, which may improve valvular gradients via reduction in heart rate. Metoprolol, propranolol, and diltiazem are safe to use for nodal blockade during pregnancy. Diuretics such as furosemide may be used to decrease pulmonary venous congestion, but care should be given to avoid over-diuresis. Aortic or mitral valvuloplasty can also be considered in severely symptomatic patients who are refractory to medical management and with favorable anatomy. This is not recommended as a prophylactic measure. If surgical intervention is required during pregnancy, intervention during the second trimester, after organogenesis is complete and prior to fetal viability around 20-22 weeks, is generally recommended to maximize fetal outcomes.
#62 Discharge Instructions for Mitral Valve Stenosis | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/discharge-instructions-mitral-valve-stenosis
Maintain a healthy weight. Get help to lose any extra pounds. […] Take your medicines exactly as directed. Dont skip doses. […] Make a follow-up appointment with your provider, or as directed. […] Call 911 right away if: You have chest pain or shortness of breath. You have weakness in the muscles of your face, arms, or legs. You have trouble speaking. You faint or are dizzy. You have swelling in your hands, feet, or ankles. Your heartbeat is irregular, rapid, or pounding.
#63 Mitral Valve Stenosis | CommonSpirit Health
https://www.commonspirit.org/conditions-treatments/mitral-valve-stenosis
Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] Call your doctor if you have new symptoms or your symptoms get worse. […] Eat heart-healthy foods. These include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit sodium, sugar, and alcohol. […] Be active. Ask your doctor what type and level of exercise is safe for you. […] Do not smoke. Smoking increases your risk of heart attack and stroke. […] Stay at a healthy weight. Lose weight if you need to. […] Manage other health problems. If you think you may have a problem with alcohol or drug use, talk to your doctor. […] Avoid infections such as COVID-19, colds, and the flu. […] Take care of your teeth and gums. Get regular dental checkups. Good dental health is important because bacteria can spread from infected teeth and gums to the heart valves.
#64 Discharge Instructions for Mitral Valve Stenosis | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/discharge-instructions-mitral-valve-stenosis
Maintain a healthy weight. Get help to lose any extra pounds. […] Take your medicines exactly as directed. Dont skip doses. […] Make a follow-up appointment with your provider, or as directed. […] Call 911 right away if: You have chest pain or shortness of breath. You have weakness in the muscles of your face, arms, or legs. You have trouble speaking. You faint or are dizzy. You have swelling in your hands, feet, or ankles. Your heartbeat is irregular, rapid, or pounding.
#65 Discharge Instructions for Mitral Valve Stenosis | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/discharge-instructions-mitral-valve-stenosis
Maintain a healthy weight. Get help to lose any extra pounds. […] Take your medicines exactly as directed. Dont skip doses. […] Make a follow-up appointment with your provider, or as directed. […] Call 911 right away if: You have chest pain or shortness of breath. You have weakness in the muscles of your face, arms, or legs. You have trouble speaking. You faint or are dizzy. You have swelling in your hands, feet, or ankles. Your heartbeat is irregular, rapid, or pounding.
#66 Discharge Instructions for Mitral Valve Stenosis | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/discharge-instructions-mitral-valve-stenosis
Maintain a healthy weight. Get help to lose any extra pounds. […] Take your medicines exactly as directed. Dont skip doses. […] Make a follow-up appointment with your provider, or as directed. […] Call 911 right away if: You have chest pain or shortness of breath. You have weakness in the muscles of your face, arms, or legs. You have trouble speaking. You faint or are dizzy. You have swelling in your hands, feet, or ankles. Your heartbeat is irregular, rapid, or pounding.
#67 Discharge Instructions for Mitral Valve Stenosis | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/discharge-instructions-mitral-valve-stenosis
Maintain a healthy weight. Get help to lose any extra pounds. […] Take your medicines exactly as directed. Dont skip doses. […] Make a follow-up appointment with your provider, or as directed. […] Call 911 right away if: You have chest pain or shortness of breath. You have weakness in the muscles of your face, arms, or legs. You have trouble speaking. You faint or are dizzy. You have swelling in your hands, feet, or ankles. Your heartbeat is irregular, rapid, or pounding.
#68 Managing Your Mitral Stenosis â Symptoms & Treatment | Carle.org
https://carle.org/conditions/heart-and-vascular-conditions/mitral-stenosis
DO take your medicine as directed. […] DO change your diet. Use moderate salt restriction (dont add salt to your food). […] DO call your health care provider if you have side effects from your medicines. […] DO call your health care provider if you have new or worsening symptoms, such as chest pain, shortness of breath, or swelling in the legs. […] DO call your health care provider if you take anticoagulants and have a cut that doesnt stop bleeding. […] DONT ignore worsening symptoms.
#69 Managing Your Mitral Stenosis â Symptoms & Treatment | Carle.org
https://carle.org/conditions/heart-and-vascular-conditions/mitral-stenosis
DO take your medicine as directed. […] DO change your diet. Use moderate salt restriction (dont add salt to your food). […] DO call your health care provider if you have side effects from your medicines. […] DO call your health care provider if you have new or worsening symptoms, such as chest pain, shortness of breath, or swelling in the legs. […] DO call your health care provider if you take anticoagulants and have a cut that doesnt stop bleeding. […] DONT ignore worsening symptoms.
#70 Managing Your Mitral Stenosis â Symptoms & Treatment | Carle.org
https://carle.org/conditions/heart-and-vascular-conditions/mitral-stenosis
DO take your medicine as directed. […] DO change your diet. Use moderate salt restriction (dont add salt to your food). […] DO call your health care provider if you have side effects from your medicines. […] DO call your health care provider if you have new or worsening symptoms, such as chest pain, shortness of breath, or swelling in the legs. […] DO call your health care provider if you take anticoagulants and have a cut that doesnt stop bleeding. […] DONT ignore worsening symptoms.
#71 Managing Your Mitral Stenosis â Symptoms & Treatment | Carle.org
https://carle.org/conditions/heart-and-vascular-conditions/mitral-stenosis
DO take your medicine as directed. […] DO change your diet. Use moderate salt restriction (dont add salt to your food). […] DO call your health care provider if you have side effects from your medicines. […] DO call your health care provider if you have new or worsening symptoms, such as chest pain, shortness of breath, or swelling in the legs. […] DO call your health care provider if you take anticoagulants and have a cut that doesnt stop bleeding. […] DONT ignore worsening symptoms.
#72 Managing Your Mitral Stenosis â Symptoms & Treatment | Carle.org
https://carle.org/conditions/heart-and-vascular-conditions/mitral-stenosis
DO take your medicine as directed. […] DO change your diet. Use moderate salt restriction (dont add salt to your food). […] DO call your health care provider if you have side effects from your medicines. […] DO call your health care provider if you have new or worsening symptoms, such as chest pain, shortness of breath, or swelling in the legs. […] DO call your health care provider if you take anticoagulants and have a cut that doesnt stop bleeding. […] DONT ignore worsening symptoms.
#73 Mitral valve stenosis – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/diagnosis-treatment/drc-20353165
Our caring team of Mayo Clinic experts can help you with your mitral valve stenosis-related health concerns […] A doctor trained in heart disease typically provides care for people with mitral valve stenosis. This type of doctor is called a cardiologist. […] Regular health checkups are important if you have mitral valve stenosis. You should have an echocardiogram at least every year. If you frequently feel your heart pounding or beating fast, get medical help. Fast heart rhythms that aren’t treated can quickly get worse in people with mitral valve stenosis. […] If you have mitral valve stenosis and want to become pregnant, talk with a healthcare professional first. Pregnancy causes the heart to work harder. How a heart with mitral valve stenosis handles the extra work depends on how narrow the valve is and how well the heart pumps. If you are pregnant and have mitral valve stenosis, your care team should closely check you during pregnancy. A healthcare professional can explain which medicines are safe to take during pregnancy. You and your healthcare professional also can discuss whether you need heart valve treatment before pregnancy.
#74 Mitral valve stenosis – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-causes/syc-20353159
The best way to prevent mitral valve stenosis is to prevent rheumatic fever. You can do this by making sure you and your children see a healthcare professional for sore throats. Untreated strep throat infections can develop into rheumatic fever. Strep throat is usually easily treated with antibiotics.
#75 Mitral stenosis: MedlinePlus Medical EncyclopediaLock
https://medlineplus.gov/ency/article/000175.htm
Children often need surgery to either repair or replace the mitral valve. […] The outcome varies. The disorder may be mild, without symptoms, or may be more severe and become disabling over time. Complications may be severe or life threatening. In most cases, mitral stenosis can be controlled with treatment and improved with valvuloplasty or surgery. […] Contact your provider if: You have symptoms of mitral stenosis. You have mitral stenosis and symptoms do not improve with treatment, or new symptoms appear. […] People with abnormal or damaged heart valves are at risk for an infection called endocarditis. Anything that causes bacteria to get into your bloodstream can lead to this infection. Steps to avoid this problem include: Avoid unclean injections. Treat strep infections quickly to prevent rheumatic fever. Always tell your provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment. Some people may need antibiotics before dental procedures or surgery.
#76 Nursing Care Plan (NCP) for Heart Valve Disorders | Free NURSING.com Courses
https://nursing.com/lesson/nursing-care-plan-for-heart-valve-disorders
If the valve should be open, but doesn’t open fully stenosis […] If the valve should be closed but doesn’t close fully regurgitation […] Notify the provider of new or sudden onset or murmurs, especially if accompanied by signs of poor perfusion or pulmonary edema […] Patients who receive artificial valve replacements will require lifelong anticoagulant therapy. They need to be taught precautions for anticoagulant therapy, including using electric razors and soft bristle toothbrushes and how often they will require monitoring, if at all. […] Patients with artificial heart valves are at high risk of developing endocarditis. They need to be taught about preventative measures, including receiving prophylactic antibiotics before any invasive procedures. […] Oral hygiene is imperative for the prevention of endocarditis after valve repair. This may seem silly but it is a HUGE deal. The evidence has shown that bacteria from the oral cavity are highly likely to translocate (move) to the heart and become lodged in/on the valves. This is also why patients should avoid dental procedures for 6 months after valve surgery. It is so important that you, as the nurse, educate them on why this is so important.