2. Mitral valve stenosis
Objectives
at the 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
Objectives cont’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.
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
Pathophysiology cont’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
Pathophysiology cont’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
Pathophysiology contd.
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
Clinical manifestations:
• 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
Pathophysiology contd.
• Hoarseness
• Left ventricular failure( dyspnea, orthopnea,
pulmonary crackles, cough and hemoptysis)
• Right ventricular failure(neck vein distention,
peripheral edema)
14. Mitral valve stenosis
Diagnostic assessments
Chest radiographic film will show:
• Left atrial enlargement.
• Pulmonary venous congestion.
• Right ventricular enlargement.
16. Mitral valve stenosis
Echocardiogram
• Thickened mitral valve with diminished
movement of leaflets.
• Left atrial enlargement.
• Right ventricular enlargement
19. Mitral valve stenosis
Symptom can 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.
23. Mitral valve stenosis
Repair of 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.
24.
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.
26.
27. Mitral valve stenosis
Mitral valve 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
Mitral valve 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.
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.
37.
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
•
