Mitral valve insufficiency
Terms in this set (22)
Valvular disease of the mitral valve that allows the backflow of blood from the left ventricle to the left atrium
May be acute (sudden volume overload of the left ventricle), chronic compensated (left ventricle compensates and left ventricular enlargement occurs), or chronic decompensated (left ventricle unable to sustain forward cardiac output)
Also known as mitral regurgitation
Blood from the left ventricle flows back into the left atrium during systole, causing the atrium to enlarge to accommodate the backflow.
As a result, the left ventricle dilates to accommodate the increased volume of blood from the atrium and to compensate for diminishing cardiac output. (See Understanding mitral insufficiency.)
Ventricular hypertrophy and increased end-diastolic pressure result in increased pulmonary artery pressure, eventually leading to left- and right-sided heart failure.
Mitral valve prolapse
Ruptured chordae tendineae
Severe left-sided heart failure
Systemic lupus erythematosus
Mitral valve insufficiency can occur at any age.
It affects both sexes equally.
It is the second most common valvular problem.
Prosthetic valve infection or dysfunction
Crackles in the lungs
Hepatomegaly (right-sided failure)
Holosystolic murmur at the apex (See Identifying the murmur of mitral valve insufficiency)
Possible wide splitting S2
Diagnostic Test Results-Imaging
Chest X-ray reveals left atrial and ventricular enlargement and pulmonary congestion.
Transthoracic or transesophageal echocardiogram shows abnormal valve leaflet motion and left atrial enlargement.
Diagnostic Test Results-Diagnostic Procedures
Results of cardiac catheterization reveal mitral valve insufficiency with increased left ventricular end diastolic volume and pressure, increased atrial pressure and pulmonary artery wedge pressure, and decreased cardiac output.
Electrocardiography may show left atrial and ventricular hypertrophy, sinus tachycardia, or atrial fibrillation; ischemia or infarction with papillary muscle rupture (acute); or left ventricular dilatation and hypertrophy with increased QRS voltage and ST-T wave changes in the lateral precodial leads (chronic).
Appropriate treatment of underlying cause
Biventricular pacing for left ventricular dysfunction
Intra-aortic balloon counterpulsation for acute mitral insufficiency with hemodynamic compromise
Nitrates (such as nitroglycerin), antihypertensive agents (such as angiotensin-converting enzyme [ACE] inhibitors, including captopril, enalapril, and lisinopril), and diuretics (such as furosemide) to reduce afterload in patients with symptomatic mitral insufficiency and/or left ventricular dysfunction
Inotropic agents (such as digoxin) for severe symptomatic mitral insufficiency
Anticoagulants for atrial fibrillation and patients who have had mitral valve replacement
Prophylactic antibiotics such as cephalexin or ampicillin before and after surgery or dental care to prevent endocarditis (for those with prosthetic valves or prosthetic valve repair)
Beta-adrenergic blockers, calcium channel blockers, or digoxin to treat atrial fibrillation
Annuloplasty or valvuloplasty to reconstruct or repair the valve
Valve replacement with a prosthetic valve
Nursing Considerations-Nursing Diagnoses
Decreased cardiac output
Excess fluid volume
Impaired gas exchange
Impaired physical mobility
Risk for decreased cardiac perfusion
Risk for infection
Nursing Considerations-Expected Outcomes
carry out activities of daily living with minimal weakness or fatigue
maintain hemodynamic stability and adequate cardiac output and rhythm
experience no complications from fluid excess
verbalize the importance of balancing activity with adequate rest periods
maintain adequate ventilation and oxygenation
maintain joint mobility and muscle strength
exhibit adequate coping mechanisms
maintain adequate cardiopulmonary perfusion
remain free from signs and symptoms of infection.
Nursing Considerations-Nursing Interventions
Give prescribed oxygen based on oxygen saturation levels.
Assist with insertion of pulmonary artery catheter for hemodynamic monitoring if indicated.
Auscultate heart and lung sounds for changes.
Administer medications, such as diuretics and ACE inhibitors, as ordered.
Obtain a specimen for laboratory testing to establish baseline coagulation status if anticoagulant therapy is ordered.
Institute continuous cardiac monitoring if indicated to detect changes in heart rate and rhythm.
Elevate the head of the bed or assist the patient to the orthopneic position to ease the work of breathing as appropriate.
Obtain daily weights.
Provide for frequent rest periods; cluster nursing activities to provide rest and minimize energy expenditure.
Assist the patient in frequent position changes.
Allow the patient and his family to verbalize feelings and concerns related to the condition.
Provide a low-salt diet.
Watch for signs of heart failure or pulmonary edema.
Prepare the patient and his family for possible valve repair or replacement as indicated.
Oxygen saturation levels
Intake and output; fluid balance status
Adverse effects of ACE inhibitor, anticoagulant and/or inotropic drug therapy
Postoperative status, including cardiopulmonary function, vital signs, wound status, and signs and symptoms of complications
Nursing Considerations-Associated Nursing Procedures
Blood pressure assessment
Calculating and setting an IV drip rate
Cardiac output measurement with iced injectate
Intra-aortic balloon insertion, assisting
Intra-aortic balloon management
Intra-aortic balloon removal, assisting
Cardiac output measurement with room temperature injectate
IV bag preparation
IV bolus injection
IV catheter insertion
Oral drug administration
Preparing a patient for cardiac surgery, OR
12-lead electrocardiogram (ECG)
disorder, possible underlying cause, diagnosis, and treatment, including medication therapy and/or possible surgery
dietary restrictions, including the need for a low-salt diet and appropriate food choices
medication therapy regimen, including the use of diuretics, ACE inhibitors, oral anticoagulants as appropriate
energy conservation measures, including the need to plan for periodic rest in daily routine
how to take the pulse, including acceptable parameters for pulse rate and the need to notify the practitioner if the pulse rate is outside the parameters
dietary restrictions, including the need to maintain low salt intake
prescribed medications, such as diuretics and ACE inhibitors and potential adverse effects, such as orthostatic hypotension, dizziness, and lightheadedness
bleeding precautions while receiving oral anticoagulants and the need to report evidence of bleeding such as in urine or stool, excess bruising, or epistaxis
signs and symptoms to report, such as increased palpitations, irregularity of pulse rate, pulse rate outside parameters, increased shortness of breath, or swelling of extremities
need to use prophylactic antibiotics for invasive procedures such as dental work and to notify other health care practitioners of the condition and of oral anticoagulant use
postoperative care measures, including care of the wound, if indicated, activity level, and signs and symptoms of infection
importance of adhering to medication therapy and follow-up care, including laboratory and diagnostic testing as indicated.
Patient Teaching-Discharge Planning
Refer the patient to nutritional services for assistance with dietary planning.
Refer the patient to home care services, if indicated, for assistance with postoperative care.