Mitral Stenosis (stiff)

Aortic Stenosis (entropy)

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–         
Cause by rheumatic fever (untreated strep throat),
endocarditis, hardening of valve etc
–         
Left atrial pressure increase and cause dilation, this
lead to pulmonary hypertension and cause hypertrophy of ventricle
–         
Left side heart failure eventually cause right side heart
failure. As the disease progress, patient will develop right side heart failure
symptoms as well.
–         
Asymptomatic or paroxysmal nocturnal dyspnea, dry cough,
orthopnea, hemoptysis, and heart palpitation. In the later stage (right side
heart failure)-hepatomegaly, neck vein distention, pitting dependent edema.
–         
Rumbling apical diastolic murmur present
–         
Monitor for irregular heart rhythm

–         
Most common cardiac valve dysfunction (wear tear)
–         
Congenital bicuspid is the most common cause, also atherosclerosis
and degeneration of valve
–         
Increase afterload, hypertrophy & decrease CO, and
eventually cause congestion in left atrium which can lead to pulmonary congestion
–         
Symptoms includes dyspnea, angina, syncope, fatigue,
debilitation, peripheral cyanosis
–         
Systolic murmur present
 

Treatment (both)
–         
Diuretics, beta blockers, digoxin, O2 is used to
treat heart failure
–         
Vasodilator (Ca+ channel blocker) use to decrease
regurgitant flow
–         
Anticoagulation therapy
–         
Cardioversion to reset the cardiac rhythm (assess
s&s for stroke, TEE prior), management of atrial fib
–         
rest
–         
Balloon valvuloplasty, direct open commissurotomy (remove
Ca & scar tissue), heart valve replacement procedure using xenograft
& pulmonary autographs
 

–         
Mitral valve annuloplasty
 

–         
Nitrate is used for decreased in preload
–         
Patient who are not surgical candidate, transcatheter
aortic valve replacement can be done

 

Mitral Regurgitation (systole)

Aortic Regurgitation (diastole)

–         
Increase blood volume & pressure and cause L. atrium
&ventricle hypertrophy
–         
Primary cause is degeneration by aging and RH
disease
–         
Symptom: asymptomatic until left ventricle fails, fatigue,
weakness, dyspnea, orthopnea, anxiety, chest pain, palpitation

–         
Blood flow back in to the left ventricle during diastole
causing increase in volume & pressure and hypertrophy
–         
Caused from non-rheumatic condition like infective
endocarditis, HTN, Marfan syndrome, congenital anatomic aortic valvular
abnormalities
–         
Asymptomatic until left ventricle fails, diaphoresis,
bounding pulse, wide pulse pressure

Treatment: similar as
stenosis

 

Mitral Valve Prolapse

–         
Valve leaf enlarge and prolapse into left atrium
during systole
–         
Marfan syndrome and other congenital defects
–         
Asymptomatic, chest pain, palpitation, exercise
intolerance, dizziness, syncope
–         
Midsystolic click and murmur present at apex

 

 

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