NSG 223 Exam 1
Mitral Valve Prolapse: Pathophysiology - answer a portion of one or both mitral valve
leaflets balloons back into the atrium during systole.
Mitral Valve Prolapse: Assessment and Diagnostic Findings - answer- extra heart
sound, referred to as a mitral click.
Mitral valve regurgitation: Pathophysiology - answer With each beat of the left ventricle,
some blood is forced back into the left atrium, adding to blood flowing in from the lungs
- Lungs become congested
- The volume overload causes ventricular hypertrophy
Mitral valve regurgitation: Assessment and Diagnostic Findings - answer- A high-pitched
systolic murmur, blowing sound at the apex that may radiate to the left axilla
Mitral valve stenosis: Pathophysiology - answer Obstruction to blood flowing from the
left atrium into the left ventricle. Mitral valve narrows and progressively obstructs blood
flow into the ventricle
Mitral valve stenosis Cause: - answer rheumatic endocarditis, which thickens mitral
valve leaflets and chordae tendineae
- HR increases, diastole is shortened and more blood backs up into pulmonary veins
Mitral valve stenosis: Clinical Manifestations - answer- The first symptom of mitral
stenosis often is dyspnea on exertion (DOE)
Mitral valve stenosis: Assessment and Diagnostic Findings - answer- atrial fibrillation
- low-pitched, rumbling diastolic murmur is heard at the apex
- Echocardiography diagnosis
- An episode of loss of consciousness may be a sign that the aortic stenosis is
becoming worse and not enough blood flow to brain
Aortic Regurgitation: Pathophysiology - answerBlood from the aorta returns to the left
ventricle during diastole.
Aortic Regurgitation: Clinical Manifestations - answer- Heart palpitations feel in the neck
and head
- Visible carotid or temporal arteries
,Aortic Regurgitation: Assessment and Diagnostic Findings - answer- Auscultate for a
high-pitched, blowing diastolic murmur at the 3rd or 4th intercostal space at the left
sternal border
- Wide pulse pressure (difference between sys & dis)
- ECHO- every 6 months
Aortic Stenosis: Pathophysiology - answerThe heart's aortic valve narrows which
reduces or blocks blood flow from your heart, into the aorta, and to the rest of the body.
Aortic Stenosis: Clinical Manifestations - answer- patients usually first have exertional
dyspnea
- Angina pectoris is a frequent symptom
- Pulse pressure may be low (30 mm Hg or less) because of diminished blood flow.
Aortic Stenosis: Assessment and Diagnostic Findings - answera loud, harsh systolic
murmur may be heard over the aortic area, right second intercostal space, and may
radiate to the carotid arteries and apex of the left ventricle.
Mitral Valve Prolapse: Medical Management - answer- Medical management is directed
at controlling symptoms.
- the patient is advised to eliminate caffeine and alcohol from the diet and to stop the
use of tobacco products.
- antiarrhythmic medications.
- Prophylactic antibiotics are not recommended prior to dental or invasive procedures
- calcium channel blockers or beta-blockers to control chest pains and palpitations
Mitral valve regurgitation: Medical Management - answerbenefit from afterload reduction
(arterial dilation) by treatment with:
- angiotensin-converting enzyme (ACE) inhibitors such as captopril, enalapril lisinopril
- angiotensin receptor blockers (ARBs) such as losartan or valsartan
- beta-blockers such as carvedilol
Mitral valve stenosis: Medical Management - answer- anticoagulants to decrease the
risk of developing atrial thrombus
- If atrial fibrillation develops, cardioversion is attempted to restore normal sinus rhythm.
If unsuccessful, the ventricular rate is controlled with beta-blockers, digoxin, or calcium
channel blockers;
- Patients with mitral stenosis are advised to avoid strenuous activities, competitive
sports, and pregnancy,
Prevention: Mitral valve stenosis: - answer- Long term antibiotics
- Antibiotic prophylaxis for recurrent rheumatic fever with rheumatic carditis may require
10 or more years of antibiotic coverage
Aortic Regurgitation: Medical management
Prevention: - answer- Antibiotics for bacterial infections
, - Symptomatic: avoid physical exertion, competitive sports, and isometric exercises
- Sodium restriction
Aortic stenosis: Medical management - answer- surgical replacement of the aortic valve.
Surgical care for Mitral valve regurgitation: - answer- Valve replacement or repair
Surgical care for Mitral valve stenosis - answer- Valvuloplasty
- Valve replacement
Surgical care for Aortic valve stenosis: - answer- Left side catheterization
- Surgical replacement
Valve Replacement Anticoagulant care - answer- COUMADIN: 2 and 3.5 for mitral valve
replacement and 1.8 and 2.2 for aortic valve replacement.
Angiotensin-Converting Enzyme Inhibitors - answer- Captopril, the prototype ACE
inhibitor, and other drugs in this class as first-line agents for treating hypertension to
reduce vasoconstriction
Calcium channel blockers: Amlodipine (Norvasc) and Diltiazem (Cardizem) -
answerObstructs the movement of calcium causing slower conduction through the SA
and AV nodes
- Slows HR
- Decreases strength on contractility
- Decreases workload of the heart
Beta blockers: Lopressor- Metoprolol and Atenolol - answerSelective beta-blocker:
Slows down the heart which allows it to put less pressure on the body's blood vessels
- Slows down heart allows heart ot use less oxygen to improve chest pain
- Titrated to achieve resting HR of 50-60
- Treat High BP- 100-450 mg by mouth divided
- Treat chest pain- 100-400 mg by mouth 2 doses
Vitamin K Antagonists: - answer- Warfarin (Coumadin) is the most commonly used oral
anticoagulant.
- long-term prevention or management of venous thromboembolic disorders, including
DVT, pulmonary embolism, and embolization associated with atrial fibrillation and
prosthetic heart valves.
Endocarditis Pathophysiology: Rheumatic Endocarditis - answerRheumatic Endocarditis
- Rheumatic heart disease is a condition in which the heart valves have been
permanently damaged by rheumatic fever
- Heart valve damage may start shortly after untreated streptococcal infection such as
strep throat or scarlet fever
Mitral Valve Prolapse: Pathophysiology - answer a portion of one or both mitral valve
leaflets balloons back into the atrium during systole.
Mitral Valve Prolapse: Assessment and Diagnostic Findings - answer- extra heart
sound, referred to as a mitral click.
Mitral valve regurgitation: Pathophysiology - answer With each beat of the left ventricle,
some blood is forced back into the left atrium, adding to blood flowing in from the lungs
- Lungs become congested
- The volume overload causes ventricular hypertrophy
Mitral valve regurgitation: Assessment and Diagnostic Findings - answer- A high-pitched
systolic murmur, blowing sound at the apex that may radiate to the left axilla
Mitral valve stenosis: Pathophysiology - answer Obstruction to blood flowing from the
left atrium into the left ventricle. Mitral valve narrows and progressively obstructs blood
flow into the ventricle
Mitral valve stenosis Cause: - answer rheumatic endocarditis, which thickens mitral
valve leaflets and chordae tendineae
- HR increases, diastole is shortened and more blood backs up into pulmonary veins
Mitral valve stenosis: Clinical Manifestations - answer- The first symptom of mitral
stenosis often is dyspnea on exertion (DOE)
Mitral valve stenosis: Assessment and Diagnostic Findings - answer- atrial fibrillation
- low-pitched, rumbling diastolic murmur is heard at the apex
- Echocardiography diagnosis
- An episode of loss of consciousness may be a sign that the aortic stenosis is
becoming worse and not enough blood flow to brain
Aortic Regurgitation: Pathophysiology - answerBlood from the aorta returns to the left
ventricle during diastole.
Aortic Regurgitation: Clinical Manifestations - answer- Heart palpitations feel in the neck
and head
- Visible carotid or temporal arteries
,Aortic Regurgitation: Assessment and Diagnostic Findings - answer- Auscultate for a
high-pitched, blowing diastolic murmur at the 3rd or 4th intercostal space at the left
sternal border
- Wide pulse pressure (difference between sys & dis)
- ECHO- every 6 months
Aortic Stenosis: Pathophysiology - answerThe heart's aortic valve narrows which
reduces or blocks blood flow from your heart, into the aorta, and to the rest of the body.
Aortic Stenosis: Clinical Manifestations - answer- patients usually first have exertional
dyspnea
- Angina pectoris is a frequent symptom
- Pulse pressure may be low (30 mm Hg or less) because of diminished blood flow.
Aortic Stenosis: Assessment and Diagnostic Findings - answera loud, harsh systolic
murmur may be heard over the aortic area, right second intercostal space, and may
radiate to the carotid arteries and apex of the left ventricle.
Mitral Valve Prolapse: Medical Management - answer- Medical management is directed
at controlling symptoms.
- the patient is advised to eliminate caffeine and alcohol from the diet and to stop the
use of tobacco products.
- antiarrhythmic medications.
- Prophylactic antibiotics are not recommended prior to dental or invasive procedures
- calcium channel blockers or beta-blockers to control chest pains and palpitations
Mitral valve regurgitation: Medical Management - answerbenefit from afterload reduction
(arterial dilation) by treatment with:
- angiotensin-converting enzyme (ACE) inhibitors such as captopril, enalapril lisinopril
- angiotensin receptor blockers (ARBs) such as losartan or valsartan
- beta-blockers such as carvedilol
Mitral valve stenosis: Medical Management - answer- anticoagulants to decrease the
risk of developing atrial thrombus
- If atrial fibrillation develops, cardioversion is attempted to restore normal sinus rhythm.
If unsuccessful, the ventricular rate is controlled with beta-blockers, digoxin, or calcium
channel blockers;
- Patients with mitral stenosis are advised to avoid strenuous activities, competitive
sports, and pregnancy,
Prevention: Mitral valve stenosis: - answer- Long term antibiotics
- Antibiotic prophylaxis for recurrent rheumatic fever with rheumatic carditis may require
10 or more years of antibiotic coverage
Aortic Regurgitation: Medical management
Prevention: - answer- Antibiotics for bacterial infections
, - Symptomatic: avoid physical exertion, competitive sports, and isometric exercises
- Sodium restriction
Aortic stenosis: Medical management - answer- surgical replacement of the aortic valve.
Surgical care for Mitral valve regurgitation: - answer- Valve replacement or repair
Surgical care for Mitral valve stenosis - answer- Valvuloplasty
- Valve replacement
Surgical care for Aortic valve stenosis: - answer- Left side catheterization
- Surgical replacement
Valve Replacement Anticoagulant care - answer- COUMADIN: 2 and 3.5 for mitral valve
replacement and 1.8 and 2.2 for aortic valve replacement.
Angiotensin-Converting Enzyme Inhibitors - answer- Captopril, the prototype ACE
inhibitor, and other drugs in this class as first-line agents for treating hypertension to
reduce vasoconstriction
Calcium channel blockers: Amlodipine (Norvasc) and Diltiazem (Cardizem) -
answerObstructs the movement of calcium causing slower conduction through the SA
and AV nodes
- Slows HR
- Decreases strength on contractility
- Decreases workload of the heart
Beta blockers: Lopressor- Metoprolol and Atenolol - answerSelective beta-blocker:
Slows down the heart which allows it to put less pressure on the body's blood vessels
- Slows down heart allows heart ot use less oxygen to improve chest pain
- Titrated to achieve resting HR of 50-60
- Treat High BP- 100-450 mg by mouth divided
- Treat chest pain- 100-400 mg by mouth 2 doses
Vitamin K Antagonists: - answer- Warfarin (Coumadin) is the most commonly used oral
anticoagulant.
- long-term prevention or management of venous thromboembolic disorders, including
DVT, pulmonary embolism, and embolization associated with atrial fibrillation and
prosthetic heart valves.
Endocarditis Pathophysiology: Rheumatic Endocarditis - answerRheumatic Endocarditis
- Rheumatic heart disease is a condition in which the heart valves have been
permanently damaged by rheumatic fever
- Heart valve damage may start shortly after untreated streptococcal infection such as
strep throat or scarlet fever
