MITRAL INSUFFICIENCY/REGURGITATION

I. Definition and related terms:

a. a damaged mitral valve allows blood from the left ventricle to flow back into the left atrium during systole.

b. to handle the backflow, the atrium enlarges. So does the left ventricle, in part to make up for its lower output of blood.

II. Epidemiology

a. follows birth defects such as transposition of the great arteries.

b.in older clients, the mitral annulus may have become calcified.

c. cause unknown; may be linked to a degenerative process.

d. occurs in 5 to 10% of adults.

III. Findings

a.       client may be asymptomatic

b.      orthopnea, dyspnea, fatigue, weakness, weight loss

c.       chest pain and palpitations

d.      jugular vein distention

e.       peripheral edema

IV.            Management

a.       low-sodium diet - to prevent fluid retention

b.      oxygen as needed - to prevent tissue hypoxia

c.       antibiotics - to treat infection

d.      prophylactic antibiotics - to prevent infection

e.       surgery - mitral valvuloplasty or valve replacement

V.            Nursing interventions

a.       the cardio-care six

b.      monitor the cardio seven

c.       monitor for left-sided heart failure, pulmonary edema, adverse reactions to drug therapy, and cardiac dysrhythmias especially atrial and ventricular fibrillation

d.      if client has surgery, monitor postoperatively for hypotension, arrhythmias and thrombus formation

e.       client and family teaching

f.        diet restrictions and drugs

g.      explain tests and treatments

h.      prepare client for long-term antibiotic and follow-up care.

i.        stress the need for prophylactic antibiotics during dental care.

j.        teach client and family to report findings of heart failure: dyspnea and hacking, nonproductive cough.

VI.            Diagnostic findings

a.       EKG for arrythmias and changes of left atrial enlargement

b.      echocardiogram - to visualize regurgitant jets and flail chordae/leaflets

c.       cardiac cath shows regurgitation of blood from left ventricle to left atrium