MITRAL VALVE PROLAPSE
It is a deformity that usually produces no symptoms.
Rarely, it progresses and can result in sudden death.
PATHOPHYSIOLOGY
- A portion of one or both mitral valve leaflets
balloons back into the atrium during systole.
- The ballooning stretches the leaflet to the point
that the valve does not remain closed during systole
(i.e., ventricular contraction).
- Blood then regurgitates from the left ventricle back
into the left atrium.
- About 15% of patients who develop murmurs
eventually experience heart enlargement, atrial
fibrillation, pulmonary hypertension, or heart
failure.
CLINICAL MANIFESTATIONS
- Most are asymptomatic
- Fatigue may occur regardless of activity level and
amount of rest or sleep.
- Shortness of breath is not correlated with activity
levels or pulmonary function.
- Atrial or ventricular dysrhythmias may produce the
sensation of palpitations, but palpitations have
been reported while the heart has been beating
normally.
- Chest pain, which is often localized to the chest, is
not correlated with activity and may last for days.
- Anxiety may be a response to the symptoms;
however, some patients report anxiety as the only
symptom.
ASSESSMENT AND DIAGNOSTIC FINDINGS
- Physical Examination of the Heart. Reveals 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. In addition to the mitral click, a
murmur of mitral regurgitation may be heard if
progressive valve leaflet stretching and
regurgitation have occurred.
- Doppler Echocardiography. Used to diagnose and
monitor the progression of MVP.
MEDICAL MANAGEMENT
- Directed at controlling the symptoms
- Eliminate caffeine and alcohol from the diet and to
stop smoking
- Most patients do not require any medications
although antiarrhythmic medications may be
prescribed.
- Mitral valve repair or replacement may be
necessary in the advance stages of the disease.
NURSING MANAGEMENT
- Health Teaching
o Educate the patient about the diagnosis and the
possibility that the condition is hereditary
o Patient may be at risk for infectious
endocarditis. Teach patient on how to minimize
the risk.
o Patient should inform the health care provider
id symptoms develop
o Caffeine and alcohol should be avoided
o Read product labels of over-the-counter
products such as cough medicines because it
may contain alcohol, caffeine, ephedrine and
epinephrine.
MITRAL REGURGITATION
- Involves blood flowing back from the left ventricle
into the left atrium during systole.
- Often the edges of the mitral valve leaflets do not
close during systole. The leaflets cannot close
completely because the leaflets and chordae
tendineae have thickened and fibrosed, resulting in
their contraction.
PATHOPHYSIOLOGY
- Mitral regurgitation may result from problems with
one or more of the leaflets, the chordae tendineae,
the annulus, or the papillary muscles.
- Regardless of the cause, blood regurgitates into the
atrium during systole.
- With each beat of the left ventricle, some of the
blood is forced back into the left atrium, adding to
the blood flowing in from the lungs.
- This causes the left atrium to stretch and eventually
hypertrophy and dilate
- The backward flow of blood from the ventricle
diminishes the volume of blood flowing into the
atrium from the lungs. As a result, the lungs
become congested, eventually adding extra strain
on the right ventricle.
CLINICAL MANIFESTATIONS
- Chronic mitral regurgitation is often asymptomatic
- Acute mitral regurgitation (e.g. that resulting from a
myocardial infarction) usually manifests as severe
congestive heart failure
- Dyspnea
- Fatigue
- Weakness
- Palpitations
- Shortness of breath on exertion
- Cough from pulmonary congestion
ASSESSMENT AND DIAGNOSTIC FINDINGS
- Doppler Echocardiography. To diagnose and
monitor the progression of mitral regurgitation.
- Transesophageal Echocardiography. Provides the
best images of the mitral valve.
MEDICAL MANAGEMENT
- angiotensin-converting enzyme (ACE) inhibitors
- angiotensin receptor blockers (ARBs)
- beta-blockers
- Once symptoms of heart failure develop, the
patient needs to restrict his or her activity level to
minimize symptoms.
- Surgical intervention consists of mitral valvuloplasty
(ie, surgical repair of the valve) or valve
replacement
MITRAL STENOSIS
- It is an obstruction of blood flowing from the left
atrium into the left ventricle.
- The leaflets often fuse together. Eventually, the
mitral valve orifice narrows and progressively
obstructs blood flow into the ventricle.
PATHOPHYSIOLOGY
- The left atrium has great difficulty moving blood
into the ventricle because of the increased
resistance of the narrowed orifice.
- Poor left ventricular filling can cause decreased
cardiac output.
- The increased blood volume in the left atrium
causes it to dilate and hypertrophy.
- Because there is no valve to protect the pulmonary
veins from the backward flow of blood from the
atrium, the pulmonary circulation becomes
congested.
- As a result, the right ventricle must contract against
an abnormally high pulmonary arterial pressure and
is subjected to excessive strain. Eventually, the right
ventricle fails.
CLINICAL MANIFESTATIONS
- Dyspnea on exertion as a result of pulmonary
venous hypertension.
- Symptoms usually develop after the valve opening
is reduced by one-third to one-half its usual size.
- Fatigue as a result of low cardiac output.
- Dry cough or wheezing. Due to the enlarged left
atrium may create pressure on the left bronchial
tree.
- Patients may expectorate blood (ie, hemoptysis)
- Experience palpitations
- Orthopnea
- Paroxysmal nocturnal dyspnea (PND)
- Repeated respiratory infections.
ASSESSMENT AND DIAGNOSTIC FINDINGS
- Doppler echocardiography is used to diagnose
mitral stenosis.
- Electrocardiography (ECG) and cardiac
catheterization with angiography may be used to
help determine the severity of the mitral stenosis.
MEDICAL MANAGEMENT
- Anticoagulants. To decrease the risk for developing
atrial thrombus and May also require treatment for
anemia.
- Avoid strenuous activities and competitive sports,
both of which increase the heart rate.
- Surgical intervention:
o Valvuloplasty, usually a commissurotomy to
open or rupture the fused commissures of the
mitral valve.
o Percutaneous transluminal valvuloplasty or
mitral valve replacement may be performed.
AORTIC STENOSIS
- Narrowing of the orifice between the left ventricle
and the aorta.
- Blood pressure is usually normal but may be low.
Pulse pressure may be low (30 mm Hg or less)
because of diminished blood flow.
ASSESSMENT AND DIAGNOSTIC FINDINGS
- Physical Examination
- Doppler echocardiography
MEDICAL MANAGEMENT
- Medications are prescribed to treat dysrhythmia
- Definitive treatment for aortic stenosis is surgical
replacement of the aortic valve.
- Patients who are symptomatic and are not surgical
candidates may benefit from one-balloon or two-
balloon percutaneous valvuloplasty procedures.

PATHOPHYSIOLOGY

- Progressive narrowing of the valve orifice occurs,

usually over several years to several decades.
- The left ventricle overcomes the obstruction to
circulation by contracting more slowly but with
greater energy than normal, forcibly squeezing the
blood through the smaller orifice.
- The obstruction to left ventricular outflow increases
pressure on the left ventricle, and the ventricular
wall thickens, or hypertrophies. When these
compensatory mechanisms of the heart begin to
fail, clinical signs and symptoms develop.

CLINICAL MANIFESTATIONS

- Mostly asymptomatic
- Exertional dyspnea. caused by increased pulmonary
venous pressure due to left ventricular failure.
- Orthopnea, PND, and pulmonary edema may also
occur, along with dizziness and syncope because of
reduced blood flow to the brain.
- Angina pectoris is a frequent symptom; it results
from the increased oxygen demands of the
hypertrophied left ventricle, the decreased time in
diastole for myocardial perfusion, and the
decreased blood flow into the coronary arteries.