NUR 4110 Medsurg 2 Exam 2
Chapter 28 Management of Patients With Structural, Infectious, and
Inflammatory Cardiac Disorders
• Valvular Disorders
o Regurgitation: The valve does not close properly, and blood backflows
through the valve
▪ Backward flow of blood through a heart valve
o Stenosis: The valve does not open completely, and blood flow through the
valve is reduced
▪ Narrowing or obstruction of a cardiac valve’s orifice
o Valve prolapse: The stretching of an atrioventricular valve leaflet into the
atrium during diastole
• Valves of the Heart
• Know where the valves are located:
o Atrioventricular valves separate the atria from the ventricles
▪ Both valves have chordae tendineae that anchor valve leaflets to
papillary muscles of the ventricles.
▪ mitral valve: atrioventricular valve located between the left atrium
and left ventricle
• has two leaflets
▪ tricuspid valve: atrioventricular valve located between the right atrium
and right ventricle
• has three leaflets
o Semilunar valves are located between the ventricles and their corresponding
arteries
▪ pulmonic valve: semilunar valve located between the right ventricle
and pulmonary artery
▪ aortic valve: semilunar valve located between the left ventricle and
aorta
• Specific Valvular Disorders
o Depending on the severity of symptoms, patients with valve disorders may
not require treatment, or they may need to make lifestyle changes, take
medications, or require surgical repair or replacement of the valve.
o Disorders of the mitral and aortic valve cause more symptoms, require
treatment, and cause more complications than disorders of the tricuspid and
pulmonic valves.
o Mitral valve prolapse
▪ Know what the patient is at risk for
, NUR 4110 Medsurg 2 Exam 2
▪ stretching of the valve leaflet into the atrium during systole
▪ Mitral valve prolapse is a deformity that usually produces no
symptoms. Rarely, it progresses and can result in sudden
death.
, NUR 4110 Medsurg 2 Exam 2
▪ Occurs in up to 2.5% of the general population
▪ twice as frequently in women than in men
▪ cause may be an inherited connective tissue disorder resulting in
enlargement of one or both of the mitral valve leaflets, but in many
cases the cause is unknown.
▪ The annulus often dilates; chordae tendineae and papillary muscles
may elongate or rupture
▪ Often the first and only sign of mitral valve prolapse is an extra heart
sound, referred to as a mitral click
▪ A systolic click is an early sign that a valve leaflet is ballooning into the
left atrium
▪ a murmur of mitral regurgitation may be heard if the valve opens
during systole and blood flows back into the left atrium
▪ Echocardiography is used to diagnose and monitor progression
of mitral valve prolapse
▪ Clinical manifestations:
• SOB
o Not correlated with activity levels or pulmonary function
• Lightheadedness
• Dizziness
• Syncope
• Palpitations
o Atrial or ventricular dysrhythmias
• Angina
o not correlated with activity and may last for days
• Anxiety
• Fatigue
o may occur regardless of activity level and amount of rest
or sleep
▪ Medical Management
• directed at controlling symptoms
• If dysrhythmias are documented and cause symptoms, the
patient is advised to eliminate caffeine and alcohol from the diet
and to stop the use of tobacco products
• Most patients do not require medication, but some are prescribed
antiarrhythmic medications
• Chest pain that does not respond to nitrates may respond to
calcium channel blockers or beta-blockers
• Patients with severe mitral regurgitation and symptomatic heart
failure may require mitral valve repair or replacement
▪ Nursing Management
• educates the patient about the diagnosis and the possibility that
the condition is hereditary
o First-degree relatives (e.g., parents, siblings) may be
advised to have echocardiograms
• may be at risk for infective endocarditis from bacteria entering
the bloodstream and adhering to abnormal valve structures
o educates the patient how to minimize this risk
• instructs the patient to avoid caffeine and alcohol
o read product labels, particularly on over-the-counter
, NUR 4110 Medsurg 2 Exam 2
products such as cough medicine, because these products
Chapter 28 Management of Patients With Structural, Infectious, and
Inflammatory Cardiac Disorders
• Valvular Disorders
o Regurgitation: The valve does not close properly, and blood backflows
through the valve
▪ Backward flow of blood through a heart valve
o Stenosis: The valve does not open completely, and blood flow through the
valve is reduced
▪ Narrowing or obstruction of a cardiac valve’s orifice
o Valve prolapse: The stretching of an atrioventricular valve leaflet into the
atrium during diastole
• Valves of the Heart
• Know where the valves are located:
o Atrioventricular valves separate the atria from the ventricles
▪ Both valves have chordae tendineae that anchor valve leaflets to
papillary muscles of the ventricles.
▪ mitral valve: atrioventricular valve located between the left atrium
and left ventricle
• has two leaflets
▪ tricuspid valve: atrioventricular valve located between the right atrium
and right ventricle
• has three leaflets
o Semilunar valves are located between the ventricles and their corresponding
arteries
▪ pulmonic valve: semilunar valve located between the right ventricle
and pulmonary artery
▪ aortic valve: semilunar valve located between the left ventricle and
aorta
• Specific Valvular Disorders
o Depending on the severity of symptoms, patients with valve disorders may
not require treatment, or they may need to make lifestyle changes, take
medications, or require surgical repair or replacement of the valve.
o Disorders of the mitral and aortic valve cause more symptoms, require
treatment, and cause more complications than disorders of the tricuspid and
pulmonic valves.
o Mitral valve prolapse
▪ Know what the patient is at risk for
, NUR 4110 Medsurg 2 Exam 2
▪ stretching of the valve leaflet into the atrium during systole
▪ Mitral valve prolapse is a deformity that usually produces no
symptoms. Rarely, it progresses and can result in sudden
death.
, NUR 4110 Medsurg 2 Exam 2
▪ Occurs in up to 2.5% of the general population
▪ twice as frequently in women than in men
▪ cause may be an inherited connective tissue disorder resulting in
enlargement of one or both of the mitral valve leaflets, but in many
cases the cause is unknown.
▪ The annulus often dilates; chordae tendineae and papillary muscles
may elongate or rupture
▪ Often the first and only sign of mitral valve prolapse is an extra heart
sound, referred to as a mitral click
▪ A systolic click is an early sign that a valve leaflet is ballooning into the
left atrium
▪ a murmur of mitral regurgitation may be heard if the valve opens
during systole and blood flows back into the left atrium
▪ Echocardiography is used to diagnose and monitor progression
of mitral valve prolapse
▪ Clinical manifestations:
• SOB
o Not correlated with activity levels or pulmonary function
• Lightheadedness
• Dizziness
• Syncope
• Palpitations
o Atrial or ventricular dysrhythmias
• Angina
o not correlated with activity and may last for days
• Anxiety
• Fatigue
o may occur regardless of activity level and amount of rest
or sleep
▪ Medical Management
• directed at controlling symptoms
• If dysrhythmias are documented and cause symptoms, the
patient is advised to eliminate caffeine and alcohol from the diet
and to stop the use of tobacco products
• Most patients do not require medication, but some are prescribed
antiarrhythmic medications
• Chest pain that does not respond to nitrates may respond to
calcium channel blockers or beta-blockers
• Patients with severe mitral regurgitation and symptomatic heart
failure may require mitral valve repair or replacement
▪ Nursing Management
• educates the patient about the diagnosis and the possibility that
the condition is hereditary
o First-degree relatives (e.g., parents, siblings) may be
advised to have echocardiograms
• may be at risk for infective endocarditis from bacteria entering
the bloodstream and adhering to abnormal valve structures
o educates the patient how to minimize this risk
• instructs the patient to avoid caffeine and alcohol
o read product labels, particularly on over-the-counter
, NUR 4110 Medsurg 2 Exam 2
products such as cough medicine, because these products
