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Mitral valve stenosis powerpoint
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- 2. Mitral valve stenosis Objectives atthe end of this session the class will be able to : 1. State what mitral stenosis is. 2. Possible causes. 3. Say what some risk factors are. 4. Describe the pathophysiology. 5. State clinical manifestations 6. Say what the diagnostic assessments tools are.
- 3. Mitral valve stenosis Objectivescont’d. We will also look at the: A. Medical management. B. Surgical management. B. Nursing Implications.
- 4. Mitral valve stenosis •Mitral stenosis is a disorder of the mitral valve, which involves a blockage of blood flow due to abnormalities of the mitral valve leaflets.
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- 6. Mitral valve stenosis •Possible causes: • Infective endocarditis • Calcification of the valve leaflets • Lupus erythromatosus • Rheumatoid arthritis
- 7. Mitral valve stenosis Riskfactors include: • Acute rheumatic fever • Infectious endocarditis • Beta hemolytic streptococcal infections(precursor to rheumatic heart disease)
- 8. Mitral Valve Stenosis Pathophysiology •In mitral stenosis the valves become calcified and restricted in movement. There is a narrowing of the valvular orifice, preventing normal blood flow from left atrium to ventricle.
- 9. Mitral valve stenosis Pathophysiologycont’d The valve orifice is normally 4-6 cm2, with mild stenosis it is reduced to 2cm2. This result in an increase in pressures required, and generated to facilate blood flow from left atrium to left ventricle.
- 10. Mitral valve stenosis Pathophysiologycont’d. In critical mitral stenosis, valve opening is reduced to 1 cm2.the obstruction creates a pressure gradient of 20 mmHg raising right atrial pressures to 25 mmHg
- 11. Mitral valve stenosis Pathophysiologycontd. This in turn increases pulmonary and venous capillary pressures. The left atrium hypertrophies and the right ventricle hypertrophies because of chronic pulmonary hypertension, from which right ventricular failure can result.
- 12. Mitral valve stenosis Clinicalmanifestations: • Diastolic rumbling, low pitched murmur heard at apex using bell of stethoscope. • Loud snapping S1 heard using diaphragm of stethoscope • Fatigue • Palpitations • Narrowed pulse pressure
- 13. Mitral valve stenosis Pathophysiologycontd. • Hoarseness • Left ventricular failure( dyspnea, orthopnea, pulmonary crackles, cough and hemoptysis) • Right ventricular failure(neck vein distention, peripheral edema)
- 14. Mitral valve stenosis Diagnosticassessments Chest radiographic film will show: • Left atrial enlargement. • Pulmonary venous congestion. • Right ventricular enlargement.
- 15. Mitral valve stenosis Electrocardiogram •Left atrial hypertrophy • P-mitrale (prolonged, notched P wave) • Right ventricular hypertrophy • Atrial fibrillation
- 16. Mitral valve stenosis Echocardiogram •Thickened mitral valve with diminished movement of leaflets. • Left atrial enlargement. • Right ventricular enlargement
- 17. Mitral valve stenosis Echocardiogram Increasedpressure gradient across mitral valve • Increased left atrial pressures • Increased pulmonary vascular resistance • Decreased cardiac output.
- 18. Mitral valve stenosis Medicalmanagement
- 19. Mitral valve stenosis Symptomcan be improved with • Diuretics to reduce fluid accumulation in the lungs or elsewhere. • Blood thinners (anticoagulants) to help prevent blood clots. A daily aspirin may be included.
- 20. Mitral valve stenosis •Beta blockers or calcium channel blockers to slow the heart rate, and allow the heart to fill more effectively. • Anti-arrhythmic to treat atrial fibrillation or other rhythm disturbances associated with mitral valve stenosis.
- 21. Mitral valve stenosis •Beta blockers or calcium channel blockers to slow the heart rate, and allow the heart to fill more effectively. • Anti-arrhythmic to treat atrial fibrillation or other rhythm disturbances associated with mitral valve stenosis.
- 22. Mitral valve stenosis Surgericalmanagement
- 23. Mitral valve stenosis Repairof valves includes: Balloon valvotomy. This procedure is the preferred treatment for mitral valve stenosis. A doctor uses a catheter and a tiny balloon to stretch open the narrowed valve. It is minimally invasive.
- 25. Mitral valve stenosis Commisurotomy •This is typically an open-heart surgery using a heart lung bypass machine. The surgeon removes calcium deposits and other scar tissue from the valve leaflets to widen the valve.
- 27. Mitral valve stenosis Mitralvalve replacement surgery, might be done if the valve is damaged beyond repair. This surgery is typically an open-heart surgery using a heart-lung bypass machine.
- 28. Mitral valve stenosis Mitralvalve replacement surgery • Might be done if the valve is damaged beyond repair. This is typically an open-heart surgery using a heart-lung bypass machine. • If you have valve replacement surgery, a mechanical or tissue valve will be used to replace your heart valve.
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- 30. Mitral valve stenosis NursingImplications
- 31. Mitral valve stenosis •Help the patient relax to promote oxygenation. • Place the patient in high Fowler’s position to enhance lung expansion/oxygenation. • Administer oxygen as ordered. • Carefully record the time morphine is given and the amount administered.
- 32. Mitral valve stenosis •Watch for complications of treatment such as electrolyte depletion. • Urge the patient to comply with the prescribed medication regimen to avoid future episodes of pulmonary edema.
- 33. Mitral valve stenosis •Explain all procedure to the patient and his family to educate and alleviate anxiety about procedure. • Emphasize reporting early signs of fluid overload as this can cause impaired gas exchange and threaten oxygenation.
- 34. Mitral valve stenosis •Allow the patient to express his concerns over being unable to meet his/her responsibilities because of activity restrictions. • Monitor vital signs for early detection of changes.
- 35. Mitral valve stenosis •Place the patient in an upright position to relieve dyspnea, if needed. • Prepare the patient for valve replacement or percutaneous balloon valvuloplasty, as indicated. • Keep the patient on a low-sodium diet .
- 36. Mitral valve stenosis •Review all prescribed medications with the patient to educate the patient and promote cooperative behaviors. • Assist the patient with bathing as necessary to protect patient from injury, and maintain energy reserve.
- 38. References Morton, f (2009)critical care nursing (9th edition),(L,W Wilkins Ed)Philadelphia.USA.Wolters Kluwer. • Polaski, A.Tatro.S (2002) Core Principles and Practice of Medical Surgerical nursing. Philadelphia, Pennsylvania 19106 • Armstrong.G (2017) Mitral Valve Stenosis.MSD manual. Retrieved fromhttps://www.msdmanuals.com/home/heart- and-blood-vessel-disorders/heart-valve- disorders/mitral-stenosis •