Vavlular disorders

What does mitral valve function depend on?

-Mitral leaflets -Mitral annulus -Chordae tendineae -Papillary muscles -Left atrium -Left ventricle *A defect in any of these structures can cause mitral regurgitation (MR)

What are the overall goals for a pt w/ valvular disease?

-Normal heart function -Improved activity intolerance -Understanding of the disease process & health maintenance measures

What are the expected outcomes that a pt w/ valvular disease will do?

1. Maintain adequate tissue and organ perfusion 2. Achieve fluid balance 3. Achieve an optimal level of activity 4. Describe disease process & measures to prevent complications

Which condition is a common cause of aortic regurgitation? Select all that apply. One, some, or all responses may be correct. Syphilis Rheumatic heart disease Pneumonia Connective tissue problems Acute kidney failure

Syphilis Rheumatic heart disease Connective tissue problems

Drug therapy for MVP

β-Blockers may control palpitations and chest pain, but the nurse would also encourage the patient to stay hydrated, exercise regularly, and avoid caffeine.

Which class of medication is used to manage atrial dysrhythmias in patients with valvular heart disease? Select all that apply. One, some, or all responses may be correct. β-blockers Positive inotropes (digoxin) Electrical cardioversion Calcium channel blockers Diuretics

β-blockers Calcium channel blockers

What are causes of valve disease in adults are related to?

-Endocarditis -Rheumatic heart disease -HTN -Autoimmune disorders

What are the clinical problems for the pt w/ valvular disease?

-Impaired cardiac function -Fatigue -Fluid imbalance

What clinical manifestation is observable in chronic aortic regurgitation AR? A. Pulse paradoxus B. "Water hammer" pulse C. Low pitched systolic murmur D. Loud S3 and S4

B. "Water hammer" pulse

Why is nitroglycerin used cautiously with AS?

Can significantly reduce BP & worsen chest pain *The drug can worsen chest pain due to the decrease in preload & drop in BP

Diagnostic studies for valvular heart disease

Echocardiogram shows valve structure, function, and heart chamber size. Transesophageal echocardiography and Doppler color-flow imaging help diagnose and monitor valvular heart disease progression. Real-time 3D echocardiography can help assess mitral valve and congenital heart disease. Chest x-ray shows the heart size, altered pulmonary circulation, and valve calcification. ECG identifies HR, rhythm, and any ischemia or ventricular hypertrophy. Heart catheterization: -Detects pressure changes in the heart chambers -Records pressure differences across the valves -Measures the size of valve openings

Which action by the nurse would be a part of health promotion for patients with valvular heart disease? Conducting screening tests for valvular problems Conducting genetic testing for risk factors Providing prophylactic antibiotics Assessing communities for risk patterns

Providing prophylactic antibiotics Encouraging early treatment of streptococcal infections and providing prophylactic antibiotics for patients with a history of RF are critical in preventing acquired rheumatic valve disease.

What is the etiology & pathophysiology of tricuspid and pulmonic valve disease?

Regurgitation & stenosis can also occur w/ tricuspid & pulmonary valves Tricuspid Regurgitation (TR): -Tricuspid regurgitation (TR) can be primary or secondary. -Primary TR is less common and is due to IE or congenital malformation. -Secondary TR is caused by RV dilatation from pulmonary hypertension, cor pulmonale, or pulmonary outflow tract obstruction. -Patient does not show jugular venous distention (JVD), enlarged liver, and peripheral edema until regurgitation is severe. -Diagnosis is made by history, physical, and echocardiogram. *Prognosis is poor for severe TR Tricuspid Stenosis: -Tricuspid stenosis is usually caused by RF. -Signs and symptoms include: ->Fluttering discomfort in the neck ->Fatigue ->Right upper quadrant pain Pulmonary Regurgitation: -Pulmonary regurgitation is often asymptomatic. -Crescendo-decrescendo murmur is present. -Potential causes include pulmonary hypertension, surgical repair of tetralogy of Fallot (TOF), or congenital valve disease. -Can cause RV dilation. Pulmonic stenosis: -Pulmonic stenosis is often due to congenital heart disease. ->Results in RV hypertension and hypertrophy ->Largely asymptomatic -When symptoms develop, they are similar to those of AS (syncope, dyspnea, angina). -Symptoms typically do not present until adulthood

Which information would the nurse keep in mind when caring for a patient requiring valve repair? The California Heart Association classification is used to decide whether to repair or replace a valve. Valve repair is preferred over valve replacement. Annuloplasty is repair used for aortic or pulmonic valves. Repair can be relied on to restore all function.

Valve repair is preferred over valve replacement.

What are the valves involved in valvular disease?

*There are 2 av valves (mitral & tricuspid) and 2 semilunar valves (aortic & pulmonic) -Pressure on either side of an open valve is normally equal. -In a stenotic valve, valve opening is smaller due to limited leaflet opening. -Forward flow of blood is impaired. -Creates a difference in pressure on the 2 sides of the open valve. -The amount of stenosis (constriction or narrowing) is seen in pressure differences (the higher the difference, the greater the stenosis). -When regurgitation occurs (referred to as incompetence or insufficiency), there is incomplete closure of the valve and backward flow of blood (Fig. 40.7).

What are the causes of valvular disease?

*Worldwide, the most common cause of mitral stenosis is rheumatic heart disease Less common causes are: -Congenital mitral stenosis -Rheumatoid arthritis -Radiation exposure -Systemic lupus erythematosus

What are the s/s of MVP?

-A characteristic of MVP is a regurgitation murmur that is louder during systole. MVP does not alter S1 or S2 heart sounds. Patients may also have chest discomfort caused by abnormal tension on the papillary muscles. -Episodes tend to occur in clusters, especially during periods of stress. Sometimes accompanied by dyspnea, palpitations, and syncope: ->Does not respond to antianginal treatment (e.g., nitrates) *IE may occur with MR associated with MVP. -Most patients with MVP have a benign, manageable course. For those who do develop symptomatic MR, no current therapy delays the need for valve surgery

What are the effects of atrial regurgitation?

-AR causes retrograde (backward) blood flow from the ascending aorta into the left ventricle during diastole ->Results in volume overload ->Left ventricle compensates for chronic AR by dilation & hypertrophy ->Myocardial contractility declines; blood volume in left atrium & pulmonary bed increases ->Leads to pulmonary HTN & right ventricular (RV) failure

Causes of aortic regurgitation

-Acute AR is left-threatening emergency and can result from: ->Trauma ->IE -Aortic dissection chronic AR generally result from: ->Rheumatic heart disease (RHD) ->Congenital bicuspid aortic valve ->Syphilis ->Postsurgical cause ->CT problem

What are the key nursing interventions for the pt w/ valvular disease?

-Designing activities considering the patient's limitations. -Appropriate exercise plan can increase cardiac tolerance. -Patient should limit activities that cause fatigue and dyspnea. -Need to avoid strenuous physical exercise because damaged valves may not handle the increased CO. -Develop patient's care plan to emphasize: -Conserving energy -Setting priorities -Taking planned rest periods -Discouraging tobacco use. -Considering a referral to a vocational counselor if the patient has a physically or emotionally demanding job. -Performing ongoing cardiac assessments to monitor the effectiveness of drugs. -Teach the actions and side effects of drugs to increase adherence. -Patient must understand the importance of prophylactic antibiotic therapy to prevent IE. When valvular heart disease can no longer be managed medically, surgery is needed. -Patient on anticoagulants (e.g., warfarin) after surgery for valve replacement must have international normalized ratio (INR) checks regularly to determine proper dosage and adequacy of therapy. -INR values of 2.5 to 3.5 are therapeutic for patients with most mechanical valves. -Teaching the patient to follow up with an HCP regularly and when to seek urgent medical care. -Tell patient to notify the HCP of: -Any signs of infection, HF, bleeding -Any planned invasive or dental work -Encourage patients to wear a Medic *Alert device or bracelet and carry the manufacturer's valve information card.

What are the factors involved in device choice when considering valve replacement?

-Desirable valves are nonthrombogenic, durable, and create minimal stenosis. -A wide variety of prosthetic mechanical or biologic (tissue) valves are available Mechanical valves: -Mechanical valves are made from artificial materials. ->Consist of combinations of metal alloys, pyrolytic carbon, and Dacron -They are more durable and last longer than biologic valves. -There is Increased risk for thromboembolism. -Patients need long-term anticoagulation therapy, which increases risk of bleeding. -Subject to leaking and risk of IE. Biologic valves: -Biologic valves are made from bovine, porcine, or human (cadaver) heart tissue. ->Usually contain some human-made materials -The "decellularizing" process allows for decreased calcification of bioprosthetic valve. Produce a more natural pattern of blood flow compared with mechanical valves. -Anticoagulation therapy is not needed with biologic valves because of their low thrombogenicity. -Less durable and tend to cause: ->Early calcification ->Tissue degeneration ->Stiffening of the leaflets Subject to leaking and risk of IE.

What are the key points that the nurse would keep in mind when implementing care of valvular disease?

-Encouraging early treatment of streptococcal infections. -Providing prophylactic antibiotics for patients with a history of rheumatic fever (RF) is critical in preventing acquired rheumatic valve disease. ->Patients at risk for IE and any patient with certain heart conditions must receive prophylactic antibiotics. -Teaching the person with a history of RF, IE, or congenital heart disease to report symptoms of valvular heart disease.

Choice of valves

-Patients with biologic valves who have atrial fibrillation need long-term anticoagulation. -Some patients with biologic valves or annuloplasty with prosthetic rings may need anticoagulation the first few months after surgery until endothelial cells cover the suture lines (endothelialized). -The choice of valves depends on many factors. ->A mechanical valve may be best for a younger patient because it is more durable ->.If a patient cannot take an anticoagulant (e.g., women of childbearing age), a biologic valve is an option. ->Frail patients with comorbidities need to be evaluated by a qualified heart team for a full evaluation before considering surgery.

What are the effects of valvular disease?

-Rheumatic IE causes scarring of the valve leaflets & the chordae tendineae -Contractures & adhesions develop between commissures (junctional areas) -Stenotic mitral valve takes on a "fish mouth" shape due to thickening & shortening -Severe mitral annular calcifications can cause stenosis in older adults -Deformities block blood flow & create a pressure difference between the left atrium & left ventricle during diastole. -Left atrial pressure and volume increase. -Causes higher pulmonary vasculature pressure. -Overloaded left atrium places the patient at risk for atrial fibrillation. -In chronic mitral stenosis, pressure overload in the left atrium, pulmonary bed, and right ventricle.

What is the cause of MVP?

-Unknown -Increased familial incidence -often autosomal dominant -MVP in this group results from connective tissue defect affecting only the valve, as part of Marfan's syndrome or other hereditary condition, that affects collagen structure

What are serious complications for pt's w/ mitral valve prolapse?

-Usually benign but complications can occur -Mitral regurgitation -Infective endocarditis -Sudden cardiac death -HF -Cerebral ischemia

Which statement describes the mechanism of valvular regurgitation? A. Incomplete valve closure and blood backflow B. Forward flow of blood impaired by valve narrowing C. Pressures are different on the 2 sides of the valve D. Valves close and block blood flow

A. Incomplete valve closure and blood backflow

What is mitral valve prolapse?

Abnormality of the mitral valve leaflets & the papillary muscles or chordae that allows the leaflets to prolapse back into the left atrium during systole

Which focus would be the priority when planning interventions for a patient considering returning to work after treatment for valve disease? Dietary measures to control cholesterol Activities to improve activity tolerance Interventions to reduce pain and nausea Interventions to increase fluid intake

Activities to improve activity tolerance

Which treatment would the nurse anticipate next for a 32-year-old female patient with valvular heart disease who has been treated with metoprolol and digoxin for several years and has recently undergone transcutaneous valvuloplasty with continued dyspnea and pulmonary edema? Anticoagulant therapy Biologic valve replacement Open surgical valvuloplasty Mechanical valve replacement

Biologic valve replacement Female patients of childbearing age typically receive biologic valve replacements because they are not candidates for anticoagulation therapy.

Which information would the nurse include when describing percutaneous transluminal balloon valvuloplasty to a patient? Select all that apply. One, some, or all responses may be correct. Uses a balloon-tipped catheter Done to separate valve leaflets A double balloon is used Done in the catheterization laboratory Can treat multiple types of stenosis Permanent fix for stenosis

Can treat multiple types of stenosis Done in the catheterization laboratory Done to separate valve leaflets Uses a balloon-tipped catheter

Objective data Nursing assessment for valvular heart disease

Cardiovascular -Abnormal heart sounds, including murmurs, S3, and S4. Dysrhythmias, including atrial fibrillation, premature ventricular contractions. Tachycardia. ↑ or ↓ in pulse pressure, hypotension, water-hammer or thready peripheral pulses. Gastrointestinal -Ascites, hepatomegaly, unexplained weight gain General -Fever Respiratory -Crackles, wheezes, hoarseness Skin -Diaphoresis, flushing, cyanosis, clubbing, peripheral edema Possible Diagnostic Findings -Cardiomegaly on chest x-ray. ECG abnormalities specific to involved valve. Echocardiogram (valve disorders, chamber dilation), heart catheterization (abnormal valves, chamber pressures, CO, and blood flow, depending on involved valve)

Which characteristic is observed with pulmonic stenosis? Select all that apply. One, some, or all responses may be correct. Causes right ventricular hypertension Patients are asymptomatic Symptoms do not present until adulthood Seldom occurs with congenital anomalies Presents a crescendo-decrescendo murmur

Causes right ventricular hypertension Patients are asymptomatic Symptoms do not present until adulthood

What is aortic valve stenosis & what causes it?

Congenital aortic stenosis (AS) is generally found in childhood, adolescence, young adult hood In older adults, AS: -Is a result of RF or degeneration, similar to coronary artery disease -Is the most frequent degenerative valve disorder -Affects 3% of people over 65 years of age -Isolated AS is usually nonrheumatic, however, AS due to rheumatic heart disease accompanies mitral valve disease. ->In rheumatic valve disease, fusion and calcification cause valve leaflets to stiffen and retract, resulting in stenosis. -AS causes obstruction of blood flow from the left ventricle to the aorta during systole. Results in: -Left ventricular hypertrophy -Increased myocardial O2 consumption because of increased myocardial mass As disease progresses and compensation fails, reduced CO leads to: -Decreased tissue perfusion -Pulmonary hypertension -HF *Left untreated, severe AS has a poor prognosis.

What valve disorder are most common cause in children & teens?

Congenital heart conditions

Which heart change is seen in a patient with stenosis caused by rheumatic infectious endocarditis? Select all that apply. One, some, or all responses may be correct. Left atrial pressure and volume increase Contractures and adhesions develop Higher pulmonic vasculature pressure Stenotic mitral valve takes on a "fish mouth" shape Severe mitral annular calcification occurs

Contractures and adhesions develop Higher pulmonic vasculature pressure Stenotic mitral valve takes on a "fish mouth" shape Severe mitral annular calcification occurs

Which clinical manifestation is associated with aortic valve stenosis? A. Right ventricular hypertrophy B. Increased blood flow from the left ventricle C. Decreased myocardial O2 consumption D. Pulmonary hypertension

D. Pulmonary hypertension

What is the medical management of MR depend on?

Depends on the cause of the regurgitation. -Primary MR typically requires valve repair/replacement before significant left ventricular failure or pulmonary HTN develops -Medical management include guideline directed medical therapy (GDMT)

S/s of chronic severe AR

Develop a water-hammer pulse (strong, quick beat that collapses immediately) Heart sounds may include: -Soft/absent S1,S2,S3 or S4 -Soft, high pitched diastolic murmur -Pt's w/ chronic AR are asymptomatic for years -Exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea develop only after considerable heart dysfunction has occurred. -Angina occurs less often than in AS.

Which clinical manifestation may be present in a patient with valvular disease? Select all that apply. One, some, or all responses may be correct. Exertional dyspnea Loud, high-pitched 2nd heart sound Systolic murmur Hemoptysis Hoarseness Chest pain

Hemoptysis Hoarseness Chest pain Exertional dyspnea

Subject data Nursing assessment of valvular disease

Important Health Information -Health history: RF, IE; congenital defects, MI, chest trauma, CMP; syphilis, Marfan's syndrome, streptococcal infections Functional Health Patterns -Health perception-health management: IV drug use, fatigue -Activity-exercise: Palpitations, generalized weakness, activity intolerance, dizziness, fainting, dyspnea on exertion, cough, hemoptysis, orthopnea -Sleep-rest: Paroxysmal nocturnal dyspnea -Cognitive-perceptual: Angina or atypical chest pain

Which clinical manifestation is seen in severe tricuspid regurgitation? Select all that apply. One, some, or all responses may be correct. Pulmonary edema Jugular vein distension JVD Enlarged liver Peripheral edema Pericardial tamponade

Jugular vein distension JVD Enlarged liver Peripheral edema

Which strategy would the nurse use when designing patient activities for the patient with valvular disease? Limit activities that cause fatigue Plan consistent activities to meet desired exercise time Include strenuous exercises Include training to extend patient abilities

Limit activities that cause fatigue

Findings of echocardiography for MVP

M-mode and 2-D echocardiography can confirm MVP. Dysrhythmias which may cause palpitations, lightheadedness, and syncope include: Premature ventricular contractions Paroxysmal supraventricular tachycardia Ventricular tachycardia

Pathophysiology of mitral regurgitation (MR)

MR allows blood to flow backward from the left ventricle to the left atrium because of incomplete valve closure during systole. Both left ventricle and left atrium must work harder to preserve an adequate CO. In acute MR, sudden increase in pressure and volume transmits back to the pulmonary bed. -Results in pulmonary edema and cardiogenic shock In chronic MR, added volume results in: -Left atrial enlargement -Left ventricular dilation and hypertrophy -Decrease in CO

What is the etiology of mitral regurgitation?

MR may result from problems with leaflets or from surrounding structures: In primary (degenerative) MR, a problem with leaflets causes the regurgitation. In secondary (functional) MR, myocardial disease causes regurgitation. Most cases are caused by: -Myocardial infarction -Chronic rheumatic heart disease -Mitral valve prolapse -Ischemic papillary muscle dysfunction -Infective endocarditis

What are the s/s of valvular disease?

Main symptom is exertional dyspnea from reduced lung compliance Heart sounds include: -Loud 1st heart sound -Low-pitched diastolic murmur Less often, pt's may have: -Hoarseness (from atrial enlargement pressing on laryngeal nerve) -Hemoptysis (from pulmonary hypertension) -Chest pain (from decreased cardiac output [CO] and coronary perfusion) -Emboli can form in left atrium from atrial fibrillation and cause a stroke. -Fatigue and palpitations from atrial fibrillation may occur.

Clinical manifestations of aortic valve stenosis

Manifestations develop when the valve orifice becomes about 1/3 of its normal size Classic triad reflecting left ventricular failure: -Angina -Syncope -Exertional dyspnea Auscultation often reveals a crescendo-decrescendo, holosystolic murmur that may radiate to the carotids. -Some patients may be asymptomatic

Which genetic condition is associated with mitral valve prolapse (MVP)? Marfan's syndrome Turner syndrome Down syndrome Klinefelter syndrome

Marfan's syndrome MVP in this group results from a connective tissue defect affecting only the valve, as part of Marfan's syndrome, or another hereditary condition that affects collagen structure.

What is aortic regurgitation?

May be the result of primary disease of the aortic valve leaflets, the aortic root, or both.

Which complication is associated with mitral valve prolapse? Select all that apply. One, some, or all responses may be correct. Infectious endocarditis (IE) Myocardial infarction Sudden cardiac death (SCD) Heart failure (HF) Pleural effusion Mitral regurgitation (MR)

Mitral regurgitation Infective endocarditis Sudden cardiac death Heart failure

Both aortic stenosis & mitral regurgitation (MR) often occur in which population?

Older adults who have some form of heart disease

Conservative therapy for caring for pt's w/ valvular heart disease

Overall tx focuses on preventing exacerbations of: -HF -Acute pulmonary edema -Thromboembolism -Reccurent RF -IE HF is tx w/ vasodilators, positive inotropes, b-blockers, diuretics and low-sodium diet -Atrial dysrhythmias are common Tx w/: -Calcium channel blockers -b-blockers -Antidysrhythmic -Electrical cardioversion *Anticoagulant therapy is used in patients with atrial fibrillation to prevent systemic or pulmonary emboli.

Percutaneous transluminal balloon valvuloplasty

PTBV -An alternative treatment for some patients with valvular heart disease is percutaneous transluminal balloon valvuloplasty (PTBV): -Fused commissures are split open. -Treats mitral, tricuspid, pulmonic, and aortic stenosis. The PTBV procedure is typically done in the cardiac catheterization laboratory: -Involves threading a balloon-tipped catheter from femoral artery or vein to stenotic valve. -Balloon is inflated to separate valve leaflets: ->Single or double-balloon technique may be used. ->Using a single Inoue balloon with hourglass shape allows sequential inflation. ->Technique is most popular because it is easy and has good results with few complications.

Which clinical manifestation might affect sleep for patients with valvular disease? Restless leg syndrome Insomnia Paroxysmal nocturnal dyspnea Sleep apnea

Paroxysmal nocturnal dyspnea

S/s of acute AR

Patients with acute AR have sudden signs of cardiovascular collapse indicating left ventricular failure and cardiogenic shock, a life-threatening emergency. Patient develops: -Severe dyspnea -Chest pain -Hypotension

Mitral regurgitation clinical manifestations

Pt's w/ acute MR have: -Three peripheral pulses -Cool, clammy extremities -Low CO may mask a new systolic murmur -Rapid assessment (heart catheterization) & intervention (valve repair or replacement) are critical Pt's w/ chronic MR may remain asymptomatic for years: -These pt's need to be monitored carefully -Early symptoms of left ventricular failure may include weakness, fatigue, palpitations & dyspnea -These gradually progress to orthopnea, paroxysmal nocturnal dyspnea & peripheral edema ->Increased left ventricular volume leads to an audible 3rd sound ->The murmur is a loud holosystolic murmur at the apex radiating to the left axilla

Which diagnostic test is used to identify valvular disease? Select all that apply. One, some, or all responses may be correct. Cardiac troponin protein Real-time 3D echocardiography Brain natriuretic peptide (BNP) Chest x-ray Heart catheterization

Real-time 3D echocardiography Chest x-ray Heart catheterization

What is the surgical valve repair done in tx valvular disease?

The decision for valve repair or replacement depends on the patient's symptoms using the New York Heart Association classification system for functional disability. -Procedure: -The procedure used depends on: ->Valves involved ->Pathology and severity of the disease ->Patient's clinical condition

Which statement describes what occurs in the heart in the patient with valvular stenosis? The valve opening is larger and does not close effectively. There is a difference of pressure on the 2 sides of the valve. The valve can no longer move. The backward flow of blood is restricted.

There is a difference of pressure on the 2 sides of the valve. In a stenotic valve, the valve opening is smaller due to limited leaflet opening. The forward flow of blood is impaired. This creates a difference in pressure on the 2 sides of the open valve.

What are other transcatheter therapies options for tx valvular heart disease?

Transcatheter Edge-to-Edge Repair Transcatheter edge-to-edge repair is available for patients with severe MR who are at very high risk for open surgery. Transcatheter Pulmonary Valve Replacement Transcatheter pulmonary valve replacement is approved for use in pediatric and adult patients with pulmonary valve disease caused by congenital heart disease. Transcatheter Aortic Valve Replacement (TAVR) Transcatheter aortic valve replacement (TAVR) is an option for patients with severe, symptomatic AS. In over 90% of patients, procedure is done using a transfemoral approach. Evaluation for TAVR includes: -Echocardiogram -Coronary CT angiogram -Potentially a heart catheterization -Imaging can determine valve size and help in planning procedure -3 commercially available TAVR valves in the United States. ->The Edwards Sapien 3 valve is made of bovine pericardial tissue. It is a balloon-expandable valve -The CoreValve transcatheter aortic valve is a self-expanding valve made of porcine pericardial tissue (Fig. 40.10D). -The 3rd valve, Lotus, is available for use in patients deemed high risk for open surgery. It is currently in clinical trials for patients at a lower surgical risk.

Which information would the nurse keep in mind when using nitroglycerin to treat aortic stenosis (AS)? Can contribute to development of a heart murmur Use with caution due to side effects Given prophylactically to asymptomatic patients Can be effective in treating dyspnea

Use with caution due to side effects Use nitroglycerin cautiously in patients with AS since significant hypotension may occur.

Valve repair for pt's w/ valvular disease

Valve repair is preferred over replacement when clinically appropriate: -Repair has a lower operative mortality rate than valve replacement. -It is often used in mitral or tricuspid valve disease. -It may not restore total valve function. Open surgical valvuloplasty involves repair of the valve by suturing the torn leaflets, chordae tendineae, or papillary muscles: -It is mainly used to treat mitral or TR. Minimally invasive valve surgery involves a mini-sternotomy or parasternal approach. It may include robotic and thoracoscopic surgical systems. Advantages include: -Shorter lengths of stay -Fewer blood transfusions -Less pain -Lower risk for sternal infection -Postoperative atrial fibrillation For patients with mitral or TR, further valve repair or reconstruction using annuloplasty is an option. Annuloplasty involves reconstruction of the annulus, with or without the aid of prosthetic rings.

Interprofessional Care: Valvular Heart Disease

Valve replacement *Use cautiously in pt's w/ aortic stenosis

For which condition would the nurse instruct the patient with valvular heart disease to seek urgent medical care during discharge teaching? Select all that apply. One, some, or all responses may be correct. infection Heart failure (HF) Bleeding Planned invasive or dental work Vomiting

infection Heart failure (HF) Bleeding Planned invasive or dental work