MS1 Chapter 23

• Rheumatic Fever:

  • Autoimmune reaction 2-3 weeks after an upper respiratory infection
  • Due to a group A beta-hemolytic streptococci infection
  • Rare complication of strep throat
  • Typically occurs between ages 5 and 15
  • Treatment must be with penicillin, as this is an streptococci infection
• Mitral Valve Prolapse (MVP):

  • Most common form of valvular heart disease
  • Pathophysiology: one or more bulging flaps of mitral valve into the left atrium, resulting in mitral regurgitation
  • Etiology: unknown, hereditary collagen tissue disorder, infection, ischemic heart disease, cardiomyopathy
  • Signs and symptoms: often none, murmur, anxiety, atypical chest pain, dizziness, arrhythmias/palpitations, dyspnea, fatigue
• Mitral Stenosis:

  • Pathophysiology: mitral valve thickening/shortening of chordae tendineae causing narrowing of mitral valve opening
  • Etiology: rheumatic fever, congenital defects of mitral valve, tumors, rheumatoid arthritis, systemic lupus erythematosus, calcium deposits
  • Signs and symptoms: usually asymptomatic, murmur, atrial fibrillation/palpitations, dizziness, syncope, edema, exertional dyspnea, cough, hemoptysis, fatigue
• Mitral Regurgitation:

  • Pathophysiology: mitral insufficiency, backflow of blood to left atrium, left atrium dilates, increases pressure, extra volume shifts to left ventricle
  • Etiology: rheumatic heart disease, endocarditis, hypertension, chordae tendineae dysfunction, myocardial infarction, MVP
  • Signs and symptoms: usually asymptomatic, murmur, dyspnea, cough, edema, fatigue, syncope, palpitations/atrial fibrillation
• Aortic Stenosis:

  • Pathophysiology: aortic valve narrowed, left ventricle hypertrophies, decreased cardiac output, eventual heart failure
  • Etiology: congenital defects, rheumatic heart disease, calcification of aortic valve with aging
  • Signs and symptoms: may not appear for many years, dizziness, syncope, dyspnea on exertion, activity intolerance, systolic murmur, angina, heart failure signs and symptoms, edema, fatigue, orthopnea
• Aortic Regurgitation:

  • Pathophysiology: aortic valve does not close, left ventricle's volume increases, left ventricle dilates, left ventricle fails, decreased cardiac output, pulmonary edema
  • Etiology: rheumatic heart disease, congenital defects or aging, syphilis, endocarditis
• Aortic Regurgitation:

  • Aortic valve does not close all the way
  • Etiology includes rheumatic heart disease, congenital defects, aging, syphilis, endocarditis, severe hypertension, ankylosing spondylitis, rheumatoid arthritis, and aortic dissection
• Signs and symptoms of Aortic Regurgitation:

  • None may appear for many years
  • Forceful pulse, worse when laying down
  • Fatigue, exertional dyspnea
  • Murmur
  • Corrigan pulse
  • Palpated pulse is forceful then quickly collapses
  • Widened pulse pressure from decrease in diastolic blood pressure
  • Atypical angina
• Complications of Aortic Regurgitation:

  • Endocarditis
  • Symptoms of shock
• Diagnostic tests for Aortic Regurgitation:

  • ECG/EKG
  • Chest x-ray confirms hypertrophy of the left ventricle and aorta
  • Echocardiogram
  • Coronary angiogram
• Therapeutic interventions for Aortic Regurgitation:

  • Vasodilator
  • Digitalis
  • Diuretics
  • Occasionally, surgical valve replacement or repair
• Nursing Diagnoses for Valvular Disorders:

  • Decreased Cardiac Output related to valvular stenosis or insufficiency or heart failure
  • Activity Intolerance related to decreased oxygen delivery from decreased cardiac output
• Assessment:

  • History
  • Vital signs
  • Auscultate heart tones to detect murmurs
  • Signs and symptoms of heart failure
• Planning:

  • Maintain vital signs/oxygen saturation
  • Maintain desired activities
  • Maintain clear lung sounds
  • Understand disease/treatment
• Interventions:

  • Monitor vital signs
  • Elevate HOB 45 degrees
  • Assist with ADLs as needed
  • Slow pace of ADLs
  • Energy conservation techniques
  • Maintain fluid volume
  • Daily weights
  • Monitor for edema
  • Intake/output
  • Diuretics as ordered
  • Monitor potassium levels
• Nursing Process for Valvular Disorders - Interventions - Cont’d:

  • Education
  • Include caregivers for older adult patient
  • Early recognition of symptoms
  • Medications: anticoagulants
  • Monthly international normalized ratio (INR) test
  • Medical information ID
  • Endocarditis prevention
  • Prophylactic antibiotics per American Heart Association (AHA) criteria
• Nursing Process for Valvular Disorders - Evaluation:

  • Vital signs normal/no heart failure signs
  • Reports fatigue reduced
  • Able to complete tasks
  • Remains free of edema, maintains weight, clear lung sounds
  • Verbalizes understanding of teaching
  • No symptom recurrence
• Pericarditis complications include pericardial effusion (buildup of fluid in the pericardial space) and cardiac tamponade (life-threatening compression of the heart caused by the presence of a pericardial effusion), which requires immediate pericardiocentesis
• Nursing management for pericarditis involves monitoring vital signs, assessing for signs of cardiac tamponade, and providing pain management with NSAIDs
• Myocarditis is inflammation of the myocardium that often follows viral infections
• Signs and symptoms of myocarditis include chest pain, tachycardia, and cardiac damage corresponding to the amount of muscle destruction
• Diagnostic tests for myocarditis include endomyocardial biopsy during cardiac catheterization, MRI, echocardiogram, and ECG/EKG
• Therapeutic interventions for myocarditis aim to reduce the heart's workload, treat the cause, and manage heart failure
• Cardiac trauma can be nonpenetrating (blunt trauma) or penetrating (external or internal injury), leading to complications like cardiac tamponade
• Cardiomyopathy is the enlargement of the heart muscle and comes in three types: dilated, hypertrophic, and restrictive
• Each type of cardiomyopathy has specific signs and symptoms, diagnostic tests, and therapeutic interventions
• Thrombophlebitis involves the formation of a clot within a vein, with complications like pulmonary embolism and chronic venous insufficiency
• Prevention and management of thrombophlebitis include identifying risk factors, prophylactic anticoagulants, and therapeutic interventions based on the type of thrombophlebitis
• Nursing interventions for thrombophlebitis focus on monitoring at-risk patients, administering medications, managing pain, and preventing complications like pulmonary embolism
• Regurgitation 


  Valve does not CLOSE completely, causing blood to back up
• Aneurysm - abnormal dilation or ballooning outward of an artery wall due to weakening of vessel walls
• Stenosis

  Valve does not OPEN completely; hindering forward blood flow
• S&S of Rheumatic Fever

  • Polyarthritis
  • SQ nodules
  • Chorea (brief, rapid, uncontrolled movements)
  • Carditis
  • Fever
  • Arthralgia
  • Pneumonitis
• Diagnostic Tests for Mitral Stenosis

  • ECG/EKG
  • chest X-ray
  • 2-D Doppler Echo & Doppler ultrasound
  • CT Scan
  • MRI
• Complications of Mitral Regurgitation?

  • A-Fib
  • Emboli
  • Pulmonary HTN
  • Heart Failure
  • Endocarditis
• Dx tests for mitral regurgitation?

  • ECG/EKG
  • Chest x-ray
  • 2-D Doppler Echo
  • Transesophageal Echo
• What is Orthopnea?

  Difficulty breathing while lying down.
• What is the gold standard for heart Dx tests?

  Echocardiogram
• Valvotomy

  Expansion of a balloon to open the aortic valve
• options for aortic valve replacement?

  Surgical replacement (SAVR), transcatheter aortic valve replacement (TAVR).