Valvular Disorder: Mitral Stenosis Nursing Management

Notes

Definition
  • Mitral stenosis is the progressive thickening and contracture of the mitral valve leaflets and chordate tendineae that cause narrowing of the orifice and progressive obstruction to blood flow.
Risk Factors
  • Congenital
  • Infection
image credit to : http://www.heartpoint.com/

image credit to : http://www.heartpoint.com/

Pathophysiology
  • Normally, the mitral valve opening is as wide as three fingers. In cases of marked stenosis, the opening narrows to the width of a pencil. The left atrium dilates and hypertrophies because it has great difficulty moving blood into the ventricle and because of the increased blood volume the atria must now hold. Because there is no valve to protect the pulmonary veins from the backward flow of blood from the atrium, the pulmonary circulation becomes congested. The resulting high pulmonary pressure can eventually lead to right ventricular failure.
Assessment/Clinical Manifestations/Signs And Symptoms
  • Dyspnea on exertion (due to pulmonary venous hypertension) as the first symptom
  • Progressive fatigue (result of low cardiac output)
  • Hemoptysis and cough
  • Repeated respiratory infections
  • Weak and often irregular pulse (because of atrial fibrillation)
Medical Management
  • Prophylactic antibiotic therapy to prevent recurrence of infections
  • Treatment of anemia if required
  • Cardiotonics and diuretic for treatment of congestive heart failure
  • Surgical intervention (valvuloplasty, commissurotomy, or replacement of the mitral valve)
  • Percutaneous transluminal valvuloplasty for palliation of symptoms
  • 12-Lead ECG and echocardiogram
  • Cardiac catheterization with angiography to reveal the severity

Exam

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