64

Cardiovascular system

Three types
of mechanical
disruption can
affect heart
valves: stenosis,
or narrowing, of
the valve opening;
incomplete closure
of the valve; and
prolapse of the valve.

Dont lose your

motivation in the
middle of your exam
preparation. Its
important to keep a
positive
attitude for the long
haul.

disorders as endocarditis (most common),

congenital defects, and inflammation, and
they can lead to heart failure.
Valvular heart disease occurs in several
forms. The most common include:
aortic insufficiency, in which blood flows
back into the left ventricle during diastole,
causing fluid overload in the ventricle, which
dilates and hypertrophies (The excess volume
causes fluid overload in the left atrium and,
finally, the pulmonary system. Left ventricular failure and pulmonary edema eventually
result.)
mitral insufficiency, in which blood from
the left ventricle flows back into the left
atrium during systole, causing the atrium to
enlarge to accommodate the backflow (As a
result, the left ventricle also dilates to accommodate the increased volume of blood from
the atrium and to compensate for diminishing
cardiac output.)
mitral stenosis, in which narrowing of the
valve by valvular abnormalities, fibrosis, or
calcification obstructs blood flow from the
left atrium to the left ventricle (Consequently,
left atrial volume and pressure rise and the
chamber dilates.)
mitral valve prolapse (MVP), in which
one or both valve leaflets protrude into the
left atrium (MVP syndrome is the term used
when the anatomic prolapse is accompanied
by assessment findings unrelated to the valvular abnormality.)
tricuspid insufficiency, in which blood
flows back into the right atrium during systole, decreasing blood flow to the lungs and
left side of the heart. (Cardiac output also
lessens. Fluid overload in the right side of the
heart can eventually lead to right-sided heart
failure.)

Mitral valve prolapse

Rheumatic fever

CAUSES

Mitral valve prolapse

Aortic insufficiency

Endocarditis
Hypertension
Idiopathic origin
Rheumatic fever
Syphilis

Mitral stenosis
Rheumatic fever

Mitral valve prolapse

MI involving papillary muscles
Unknown

Tricuspid insufficiency

Endocarditis
Rheumatic fever
Right-sided heart failure
Trauma

ASSESSMENT FINDINGS
Aortic insufficiency

Angina
Cough
Dyspnea
Fatigue
Palpitations
Pulmonary vein congestion
Rapidly rising and collapsing pulses

Mitral insufficiency

Angina
Dyspnea
Fatigue
Orthopnea
Peripheral edema

Mitral stenosis

Dyspnea on exertion
Fatigue
Orthopnea
Palpitations
Peripheral edema
Weakness

Chest pain
Fatigue
Headache
Palpitations
Possibly asymptomatic

Tricuspid insufficiency
Mitral insufficiency
Hypertrophic cardiomyopathy
Left ventricular failure

313419NCLEX-RN_Chap03.indd 64

Dyspnea
Fatigue
Peripheral edema

4/8/2010 7:01:52 PM