CHARLES Z. ARIOLA JR., MSN., LPT, RN.

INSTRUCTOR I
MITRAL STENOSIS

- it usually results from rheumatic carditis which

causes valve thickening by fibrosis and
calcification.
- it is commonly caused by RHEUMATIC FEVER
- nonrheumatic causes include tumor, calcium
accumulation and thrombus formation
PATHOPHYSIOLOGY
VALVE LEAFLETS FUSE AND BECOME STIFF

CHORDAE TENDINAE CONTRACT AND SHORTEN

NARROWING OF THE VALVE OPENING

ALTERATION OF NORMAL BLOOD FLOW FROM LEFT ATRIUM TO LEFT

VENTRICLE

INCREASE IN ATRIAL PRESSURE

DILATION OF LEFRT VENTRICLES

PATHOPHYSIOLOGY...cont
INCREASE IN PULMONARY ARTERY PRESSURE

RIGHT VENTRICLE HYPERTROPHY

PULMONARY CONGESTION AND RIGHT-SIDED HEART FAILURE

LEFT VENTRICLE RECEIVES INSUFFICIENT BLOOD VOLUME

DECREASED CARDIAC OUTPUT

 ASSESSMENT

1. Pt with mild stenosis is usually asymptomatic

2. dyspnea on exertion
3. paroxysmal nocturnal dyspnea
4. orthopnea
5. palpitations
6. dry cough
ASSESSMENT... cont

7. hemoptysis
8. pulmonary edema
9. Right-sided heart failure signs and symptoms
10. pulse may be normal, rapid or irregularly
irregular as atrial fibrillation
MITRAL REGURGITATION

- It is commonly caused by Rheumatic Heart

Disease
- it affects women more often than men
- Nonrheumatic causes include Ischemic Heart
Disease affect men other than women
PATHOPHYSIOLOGY
FIBROSIS AND CALCIFICATION OF VALVE

PREVENTS CLOSURE OF MITRAL VALVE DURING

SYSTOLE

NARROWING OF THE VALVE OPENING

BLOOD FLOWS BACK INTO LEFT ATRIUM WHEN

LEFT VENTRICLE CONTRACTS
PATHOPHYSIOLOGY...cont
DURING DIASTOLE, RGURGITANT OUTPUT AGAIN FLOWS FROM LEFT
ATRIUM TO LEFT VENTRICLE ALONG WITH NORMAL BLOOD FLOW

INCREASE IN VOLUME AND PREESSURE

LEFT ATRIAL AND VENTRICULAR DILATION AND

HYPERTROPHY
 ASSESSMENT
1. fatigue
2. dyspnea on exertion
3. orthopnea
4. palpitation
5. atrial fibrillation
6. neck vein distention
7. hepatomegaly
8. pitting edema
9. high-pitch systolic murmur
MITRAL VALVE PROLAPSE

- the etilogy is variable and is usually associated

with Marfan Syndrome
- it occurs when the leaflets enlarge and prolapse
into the left atrium during systole.
- it is benign and may progress with regurgitation
PATHOPHYSIOLOGY
PROLAPSE OF LEAFLETS DURING SYSTOLE

PREVENTS CLOSURE

BLOOD FLOWS BACK INTO LEFT ATRIUM WHEN

LEFT VENTRICLE CONTRACTS
PATHOPHYSIOLOGY...cont
DURING DIASTOLE, RGURGITANT OUTPUT AGAIN FLOWS FROM LEFT
ATRIUM TO LEFT VENTRICLE ALONG WITH NORMAL BLOOD FLOW

INCREASE IN VOLUME AND PREESSURE

LEFT ATRIAL AND VENTRICULAR DILATION AND

HYPERTROPHY
 ASSESSMENT
1. chest pain
2. dizziness
3. palpitations
4. atrial tachycardia
5. ventricular tachycardia
 AORTIC STENOSIS

- often considered as disease of “wear and tear”

- common cardiac dysfunction among countries
- it is caused by atherosclerosis and degenerative
calcification of the aortic valve
PATHOPHYSIOLOGY
NARROWING OF THE AORTIC VALVE ORIFICE

OBSTRUCTION OF LEFT VENTRICULAR OUTFLOW

DURING SYSTOLE

INCREASED RESISTANCE TO EJECTION OR

AFTERLOAD

VENTRICULAR HYPERTROPHY
PATHOPHYSIOLOGY...cont
VETRICULAR FAILURE

PULMONARY SYSTEM BECOMES CONGESTED

RIGHT-SIDED HEART FAILURE

 ASSESSMENT
1. dyspnea
2. angina
3. syncope on exertion
4. fatigue
5. orthopnea
6. paroxysmal nocturnal dyspnea
7. systolic murmur
AORTIC REGURGITATION

- results from nonrheumatic conditions such as

infective endocarditis, hypertension, Marfan
Syndrome
- it is sometime caused by congenital anatomic
aortic valvular abnormalities
PATHOPHYSIOLOGY
NON-CLOSURE OF THE VALVE LEAFLETS DURING DIASTOLE

DILATION OR DEFORMATION OF THE VALVE RING

BLOOF FLOWS BACK FROM AORTA TO LEFT VENTRICLE

DILATION OF LEFT VENTRICLE

VENTRICULAR HYPERTROPHY
 ASSESSMENT
1. palpitations
2. dyspnea
3. orthopnea
4. paroxysmal nocturnal dyspnea
5. fatigue
6. angina
7. sinus tachycardia
8. high-pitched and blowing murmur
NONSURGICAL MANAGEMENT
DRUG THERAPY
1. Diuretics
2. Beta-blockers given to improve symptoms of HF
3. Digoxin
4. Oxygen
5. Nitrates are given cautiously because the potential syncope
from a decrease in left ventricular volume
6. Vasodilators such as Calcium Channel Blockers may be used to
reduce the regurgitant flow for patients with aortic or mitral
stenosis
NONSURGICAL MANAGEMENT
FOR ATRIAL FIBRILLATION
1. IV Diltiazem (Cardizem, Apo-Diltiaz)
2. Amiodarone (Cordarone, Pacerone)
3. Procainamide Hydrochloride (Procanbid)
4. Sodium Warfarin (Coumadin)
5. Cardioversion
 SURGICAL MANAGEMENT
BALOON VALVULOPLASTY
- invasive nonsurgical procedure for stenotic mitral and aortic
valve
- for mitral valvuloplasty, the physician passes a baloon catheter
via femoral vein, through atrial septum and to the mitral valve.
- for aortic valvuloplasty, the physician advances catheter
through the femoral artery and to the aortic valve
 NURSING RESPONSIBILITY
1. monitor patient closely for bleeding at insertion site
2. observe for signs of regurgitant valve by monitoring heart
sounds, CO and heart rhythm.
3. observe for signs of systemic emboli because of the possible
dislodge of thrombi in the valve
 SURGICAL MANAGEMENT
DIRECT (OPEN) COMMISSUROTOMY
-open heart surgery that repairs a mitral valve that is narrowed
from stenosis
- patient is placed on a heart-lung bypass machine
- the surgeon removes the calcium deposits and other scar issues
from the valve leaflets
 SURGICAL MANAGEMENT
MITRAL VALVE ANNULOPLASTY
- reconstruction or reparative procedure for mitral insufficiency
- the physician may suture the leaflets to make the annulus
smaller