Cardiac Regurgitation
Nursing Assessment
Etiology
Past Medical History
Signs and symptoms
Management
Complications of a leaky valve
Pathophysiology
Incidence
Nursing Diagnosis
Activity intolerance, related to imbalance between oxygen supply and demand, as evidence by fatigue with excursion.
Goal: Increase activity tolerance
1) Assess activity tolerance to provide proper care.
2) Encourage patient to help plan activity progression, may encourage patient’s compliance with the plan.
3) Alternate periods of rest and activity, to prevent fatigue and encourage activity tolerance.
4) Teach patient how to conserve energy while performing ADLs, to reduce oxygen demand.
5) Teach patient exercises to increase strength and endurance to improve breathing and oxygenation.
Nursing Diagnosis
Decrease cardiac output, related to heart malfunction, as evidence by blood backflow into the heart.
Goal: Patient will maintain proper cardiac output.
1) Monitor and record heart rate for proper assessment.
2) Weight patient daily, to detect fluid retention.
3) Measure and record intake and output adequately, to be aware of possible decreased tissue perfusion.
4) Gradually increase patient activities, to adjust to increased oxygen demands.
5) Maintain dietary restrictions to reduce risk of cardiac disease.
Nursing Diagnosis
Ineffective tissue perfusion, related to decreased in peripheral blood circulation, as evidence by cold clammy extremities.
Goal: Patient will experience adequate perfusion.
1) Evaluate involved extremities for clinical signs, to create a baseline of care.
2) Position extremities at or below heart level, to promote blood flow.
3) Encourage increase walking activity, to promote collateral circulation.
4) Encourage smoking cessation, to decrease further damage.
5) Administer oxygen if needed, to prevent tissue damage.
Medications
Mitral
Myocardial infarction, degenerative changes of valve, ischemia of left ventricle, rheumatic heart disease, infective carditis, systemic lupus erythematous, cardiomyopathy, ischemic heart disease
Mitral most cases is caused by MI, chronic rheumatic heart disease, mitral valve prolapse, ischemic papillary muscle dysfunction, infective endocarditis (IE).
Mitral Can occur at any age. It affects both sexes equally. It is the second most common valvular problem after aortic stenosis. It is identified in 4% of patients with mitral valve prolapse.
Mitral
✴ Allows blood to flow backward from the left ventricle to the left atrium because of incomplete valve closure during systole.
✴ Both the left ventricle and atrium work harder to preserve an adequate cardiac output.
❤Acute mitral valve regurgitation ❤- causes an increase in pressure and volume which transmits to the pulmonary bed, causing pulmonary edema and cardiogenic shock.
❤Chronic mitral valve regurgitation❤ - The additional volume results in left arterial enlargement, left ventricular dilation and hypertrophy, and a reduction in cardiac output.
Pulmonary hypertension, Heart enlargement (heart failure, pulmonary edema), Endocarditis, Heart rhythm abnormalities (Atrial fibrillation), Death
Mitral
Heart sounds - High pitch blowing sound at apex; Murmur heard during systole
Mental status- Restless/confusion
Vital signs- HR/BP
Manually peripheral pulses- Weak rate
Lungs - Orthopnea or paroxysmal nocturnal
Mitral Similar to management in patients with HF- restrict activity level, Surgery
Recommended in patients with symptoms of heart failure (Valvuloplasty & Mitral valve replacement)
Mitral After load reduction
ACE Inhibitors, ARBs, Beta-blockers, Hydralazine
Diagnostic
Mitral Echocardiography
Aortic
Infective or rheumatic endocarditis, congenital abnormalities, syphilis, dissecting aneurysm, blunt chest trauma
Aortic
Most = asymptomatic.
Some = forceful heartbeat in head or neck, marked arterial pulsations visible or palpable at carotid or temporal arteries, exertion dyspnea, fatigue, breathing difficulties.
Aortic Acute- caused by trauma, infective endocarditis and aortic dissection. Chronic- caused by rheumatic heart disease, syphilis, congenital bicuspid aortic valve and chronic connective tissue diseases
Aortic occurs more commonly in men than women. Generally, prevalence and severity increase with age.
Aortic
✴ Regurgitation causes blood flow from the ascending aorta into the left ventricle during diastole, resulting in volume overload.
✴ Initially the left ventricle compensates by dilation and hypertrophy. Myocardial contractility decreases and blood volume in the left atrium and pulmonary bed increases leading to pulmonary hypertension and right ventricular failure.
Aortic Vasodilators- calcium channel blockers (felodipine & nifedipine)
diltiazem and verapamil are CI
ACE inhibitors (Captopril, enalapril, lisinopril, ramipril)
hydralazine
Aortic
Heart sounds - Diastole murmur; Austin flint murmur
Peripheral pulse
Watsons water hammer pulse - Bounding/forceful
Corrgan’s pulse - Forceful/visible
Widened pulse pressure - Marked arterial pulsations
Pistole shot pulse!!! - Short/loud/ snapping sounds
BP - Hill’s signs (Systolic BP higher in legs than in arms)
Aortic Transesophageal echocardiography, cardiac MRI, cardiac catheterization
Aortic Avoid physical exertion,
Surgery
Preferred before left ventricular failure occurs
Recommended in patients with left ventricular hypertrophy (Valvuloplasty & Aortic valve replacement)
Mitral Chronic = asymptomatic. Acute = severe congestive heart failure, dyspnea, fatigue, weakness, palpitations, SOB on exertion, cough from pulmonary congestion.