1
Medsurg 2 Exam 2
Chapter 28: Management of Patients with Structural, Infections, and
Inflammatory Cardiac Disorders
Valvular Disorders
Regurgitation: The valve does not close properly, and blood backflows through the valve (issue with closure-
backflow)
Stenosis: The valve does not open completely, and blood flow through the valve is reduced (issue with
opening- flow reduced)
Valve prolapse: The stretching of an atrioventricular valve leaflet into the atrium during diastole (stretching of
the valve)
Valves of the Heart
● Pay attention to the closure
● Tricuspid- 3 leaflets
● Mitral/Bicuspid- 2 leaflets
● AV- tricuspid/mitral
● SL- pulmonic/aortic
● Valves control the flow of blood through the heart into pulmonary artery and aorta
Specific Valvular Disorders
Mitral valve prolapse (AV VALVE)
In this condition a portion of one or both mitral valve leaflets balloons back into atrium during
systole→ this is the prolapse piece- blood will then regurgitate from the left ventricle back into
left atrium
*This is hereditary*
Clinical Manifestations: SOB, fatigue, lightheadedness, dizziness, syncope, palpitations, chest pain, or
anxiety
● Some may be asymptomatic
● May hear a systolic click→ in a high-level practice. This is an early s/s of this prolapse and
can result in
Treatment:
● Antiarrhythmic medications
● No antibiotic prior dental treatments required
● Nitrates, CCB, or beta blockers
● A repair is a valvuloplasty
, 2
● A replacement is a valve replacement and the patient may need anticoagulation medication
Avoid: Caffeine, alcohol, tobacco
, 3
Complications: Pt can develop infective endocarditis and the pt may need antibiotic therapy
Mitral regurgitation
There is blood backflow from the left ventricle into the left atrium during systole. With each beat of the ventricle
blood is forced back into the left atrium and we get hypertrophy and the lungs will become congested and we
develop systolic HF (LEFT)
Etiology:
● Mitral valve prolapse, rheumatic heart disease
Clinical manifestations: (pt can be asymptomatic)
● severe congestive HF, dyspnea, fatigue, weakness, palpitations, SOB on exertion, cough, systolic
murmur, pulse deficit can occur
Management:
● Similar to HF - afterload reduction medications (ACE, ARBS, beta blockers)
Diagnostics:
● echocardiogram can determine if condition is progressing
Complication: HF
Mitral stenosis
Obstruction of blood flowing from the left atrium into the left ventricle. The leaflets fuse in this
case. We have an OPENING issue → the diameter will narrow, and the LA has difficulty moving
blood and we have decreased cardiac output. This will affect perfusion and the HR will increase and CO
decreases and pulmonary pressure increases
Etiology:
● Rheumatic Endocarditis
Clinical Manifestations:
● Pt may present with a fib and be at risk for clots
● Dyspnea on exertion, dry cough, wheezing, progressive fatigue, exercise intolerance, hemoptysis,
palpitations, orthopnea, PND, repeated respiratory infections
Diagnostic:
● Echo is used to diagnose how stenotic the valve is
● ECG
● Exercise testing
● Cardiac catheterization
Management:
● Anticoagulants necessary to decrease the chance of atrial thrombus
● If Afib develops→ cardioversion
● Control ventricular HR with beta-blockers, digoxin, or CCB
● Avoid activities that can increase HR
Aortic regurgitation
We have a closing problem this is the flow of blood back into the LV from the aorta during diastole
Etiology:
● inflammation, ineffective or rheumatic endocarditis
, 4
Clinical manifestations:
● Many patients will have no s/s
Medsurg 2 Exam 2
Chapter 28: Management of Patients with Structural, Infections, and
Inflammatory Cardiac Disorders
Valvular Disorders
Regurgitation: The valve does not close properly, and blood backflows through the valve (issue with closure-
backflow)
Stenosis: The valve does not open completely, and blood flow through the valve is reduced (issue with
opening- flow reduced)
Valve prolapse: The stretching of an atrioventricular valve leaflet into the atrium during diastole (stretching of
the valve)
Valves of the Heart
● Pay attention to the closure
● Tricuspid- 3 leaflets
● Mitral/Bicuspid- 2 leaflets
● AV- tricuspid/mitral
● SL- pulmonic/aortic
● Valves control the flow of blood through the heart into pulmonary artery and aorta
Specific Valvular Disorders
Mitral valve prolapse (AV VALVE)
In this condition a portion of one or both mitral valve leaflets balloons back into atrium during
systole→ this is the prolapse piece- blood will then regurgitate from the left ventricle back into
left atrium
*This is hereditary*
Clinical Manifestations: SOB, fatigue, lightheadedness, dizziness, syncope, palpitations, chest pain, or
anxiety
● Some may be asymptomatic
● May hear a systolic click→ in a high-level practice. This is an early s/s of this prolapse and
can result in
Treatment:
● Antiarrhythmic medications
● No antibiotic prior dental treatments required
● Nitrates, CCB, or beta blockers
● A repair is a valvuloplasty
, 2
● A replacement is a valve replacement and the patient may need anticoagulation medication
Avoid: Caffeine, alcohol, tobacco
, 3
Complications: Pt can develop infective endocarditis and the pt may need antibiotic therapy
Mitral regurgitation
There is blood backflow from the left ventricle into the left atrium during systole. With each beat of the ventricle
blood is forced back into the left atrium and we get hypertrophy and the lungs will become congested and we
develop systolic HF (LEFT)
Etiology:
● Mitral valve prolapse, rheumatic heart disease
Clinical manifestations: (pt can be asymptomatic)
● severe congestive HF, dyspnea, fatigue, weakness, palpitations, SOB on exertion, cough, systolic
murmur, pulse deficit can occur
Management:
● Similar to HF - afterload reduction medications (ACE, ARBS, beta blockers)
Diagnostics:
● echocardiogram can determine if condition is progressing
Complication: HF
Mitral stenosis
Obstruction of blood flowing from the left atrium into the left ventricle. The leaflets fuse in this
case. We have an OPENING issue → the diameter will narrow, and the LA has difficulty moving
blood and we have decreased cardiac output. This will affect perfusion and the HR will increase and CO
decreases and pulmonary pressure increases
Etiology:
● Rheumatic Endocarditis
Clinical Manifestations:
● Pt may present with a fib and be at risk for clots
● Dyspnea on exertion, dry cough, wheezing, progressive fatigue, exercise intolerance, hemoptysis,
palpitations, orthopnea, PND, repeated respiratory infections
Diagnostic:
● Echo is used to diagnose how stenotic the valve is
● ECG
● Exercise testing
● Cardiac catheterization
Management:
● Anticoagulants necessary to decrease the chance of atrial thrombus
● If Afib develops→ cardioversion
● Control ventricular HR with beta-blockers, digoxin, or CCB
● Avoid activities that can increase HR
Aortic regurgitation
We have a closing problem this is the flow of blood back into the LV from the aorta during diastole
Etiology:
● inflammation, ineffective or rheumatic endocarditis
, 4
Clinical manifestations:
● Many patients will have no s/s
