MITRAL

REGURGITAT
ION
Prepared by:
SR. LEONY N. BERMEJO

MITRAL REGURGITATION
It is a valvular disease in which the mitral leaflets, which are comprised of two
tissue flaps, do not seal properly. As a result, blood leaks backwards in your heart
forcing a constant strain on your cardiac muscle. Over time, this disorder can result in
many complications including atrial fibrillation, an enlarged heart and congestive heart
failure.
This type of disease is also known as mitral incompetence and mitral
insufficiency, although most patients refer to it as a leaking heart valve. A mitral valve
prolapse is the most common anatomical defect that causes mitral valve regurgitation.
CAUSES
Mitral valve regurgitation is classified as primary and secondary. Primary mitral
regurgitation is caused by an abnormality in the mitral valve; secondary is caused by an
abnormality in the left ventricle of the heart.
Possible causes of mitral valve regurgitation include:

Mitral valve prolapsed. In this condition, the leaflets and tendon-like cords
supporting the mitral valve weaken and stretch so that with each contraction of the
left ventricle, the valve leaflets bulge (prolapse) into the left atrium. This common
heart defect can prevent the mitral valve from closing tightly and lead to
regurgitation.

Damaged tissue cords. Over time, the tissue cords that anchor the flaps of the
mitral valve to the heart wall may stretch or suddenly tear, especially in people with
mitral valve prolapse. A tear can cause substantial leakage through the mitral valve
relatively suddenly and may require repair by heart surgery. Trauma to the chest
also can rupture the cords.

Rheumatic fever. Rheumatic fever a complication of untreated strep throat

and once a common childhood illness in the United States can damage the mitral
valve, leading to mitral valve regurgitation later in life. Rheumatic fever is rare in the
United States, but still common in developing countries.

Endocarditis. The mitral valve may be damaged by an infection of the lining of

the heart (endocarditis) that can involve heart valves.

Heart attack. A heart attack can damage the area of the heart muscle that
supports the mitral valve, affecting the function of the valve. If the damage is
extensive enough, a heart attack can cause sudden and severe mitral valve
regurgitation.

Abnormality of the heart muscle (cardiomyopathy). Over time, certain

conditions, such as high blood pressure, can cause your heart to work harder,

gradually enlarging your heart's left ventricle. This can stretch the tissue around your
mitral valve, which can lead to leakage.
Congenital heart defects. Some babies are born with defects in their hearts,
including damaged heart valves.
Certain drugs. Prolonged use of certain drugs, such as ergotamine, used to
treat migraines and other conditions, can cause mitral valve regurgitation.

SIGNS AND SYMPTOMS

Signs and symptoms of mitral valve regurgitation, which depend on its severity and how
quickly the condition develops, can include:

Blood flowing turbulently through your heart (heart murmur)

Shortness of breath (dyspnea), especially with exertion or when you lie down

Fatigue, especially during times of increased activity

Cough, especially at night or when lying down

Heart palpitations sensations of a rapid, fluttering heartbeat

Swollen feet or ankles

Mitral regurgitation is often mild and progresses slowly. You may have no symptoms for
decades and be unaware that you have this condition, and it might not progress.
TREATMENT
Mitral valve regurgitation treatment depends on how severe your condition is, and if it's
getting worse. The goal of treatment is to improve your heart's function while minimizing
your signs and symptoms and avoiding future complications.
Watchful waiting
Some people, especially those with mild regurgitation, might not need treatment.
However, the condition may require monitoring by your doctor. You may need regular
evaluations, with the frequency depending on how severe your condition is.
Medications
Medication can't correct a mitral valve deformity. But medications such as diuretics can
relieve fluid accumulation in your lungs or legs, which can accompany mitral valve
regurgitation. Blood thinners (anticoagulants), which can help prevent blood clots, may
be used if you have atrial fibrillation.
High blood pressure makes mitral valve regurgitation worse, so if you have high blood
pressure, your doctor may prescribe medication to help lower it. Following a low-salt
diet helps prevent fluid buildup and helps control blood pressure.
Surgery
Your mitral valve may need surgical repair or replacement, even if it's not causing
symptoms. There are new guidelines for mitral valve surgery, recommending earlier

surgery for some people with primary mitral valve regurgitation caused by an
abnormality of the valve even if they have no symptoms.
Mitral valve surgery should be done at a high-volume mitral valve surgery center with a
reputation of excellence and cardiologists, imaging specialists and cardiac surgeons
with experience in treating mitral valve conditions.
Risks and benefits of surgery. Your surgery options include:

Valve repair. Mitral valve repair is a surgery that preserves your own valve. For
most people with mitral valve damage, repair is preferred over replacement.
Surgeons can repair the valve by reconnecting valve leaflets or by removing excess
valve tissue so that the leaflets can close tightly.
Frequently, repairing the valve includes tightening or replacing the ring around the
valve (annulus). This is called an annuloplasty. Methods of repairing mitral valves
without open-heart surgery are being used in select cases.

Valve replacement. Your surgeon removes the narrowed valve and replaces it
with a mechanical or tissue valve. Mechanical valves, made from metal, are durable
but carry the risk of blood clots forming. If you receive a mechanical mitral valve,
you'll need to take an anticoagulant medication, such as warfarin (Coumadin), for life
to prevent blood clots.
Tissue valves which may come from a pig, cow or human deceased donor
may eventually need to be replaced.
OTHER MANAGEMENT
low-sodium diet - to prevent fluid retention
oxygen as needed - to prevent tissue hypoxia
antibiotics - to treat infection
prophylactic antibiotics - to prevent infection
surgery - mitral valvuloplasty or valve replacement
NURSING MANAGEMENT
monitor for left-sided heart failure, pulmonary edema, adverse reactions to drug
therapy, and cardiac dysrhythmias especially atrial and ventricular fibrillation
if client has surgery, monitor postoperatively for hypotension, arrhythmias and
thrombus formation
client and family teaching
diet restrictions and drugs
explain tests and treatments
prepare client for long-term antibiotic and follow-up care.
stress the need for prophylactic antibiotics during dental care.
teach client and family to report findings of heart failure: dyspnea and hacking,
nonproductive cough.

QUESTIONARE
1. What degree of mitral regurgitation is usually present before surgery is
considered?
2. What is the most effective therapy for mitral regurgitation?
3. What are clinical signs of mitral regurgitation?
4. What hemodynamic effects does mitral regurgitation (MR) have?
5. Who develops mitral regurgitation?
6. What is mitral regurgitation?
7. What are the signs and symptoms of MR?
8. How is MR managed?
9. When should the patient be referred for surgery?
10. What is the most common cause of mitral regurgitation?

CONGESTIVE
HEART
FAILURE
Prepared by:

SR. LEONY N. BERMEJO

CONGESTIVE HEART FAILURE (CHF)

Congestive heart failure (CHF) is a syndrome of pulmonary or systemic circulatory
congestion caused by decreased myocardial contractility, resulting in inadequate CO to
meet oxygen requirements of tissues. The incidence of heart failure increases with
aging.
Heart failure classification: Left-sided (or left ventricular) or Right-sided (or right
ventricular).
CAUSES
CHF or Heart failure often develops after other conditions have damaged or weakened
your heart. Over time, the heart can no longer keep up with the normal demands placed
on it to pump blood to the rest of your body.
Any of the following conditions can damage or weaken your heart and can cause heart
failure. Some of these can be present without your knowing it:

Coronary artery disease and heart attack. Coronary artery disease is the most
common form of heart disease and the most common cause of heart failure. Over
time, arteries that supply blood to your heart muscle narrow from a buildup of fatty
deposits, a process called atherosclerosis. Blood moves slowly through narrowed
arteries, leaving some areas of your heart muscle weak and chronically deprived of
oxygen-rich blood. In some cases, the blood flow to the muscle is just enough to
keep the muscle alive but not functioning well. A heart attack occurs if plaques
formed by the fatty deposits in your arteries rupture. This causes a blood clot to
block blood flow to an area of the heart muscle, weakening the heart's pumping
ability and often leaving permanent damages.
High blood pressure (hypertension). Blood pressure is the force of blood
pumped by your heart through your arteries. If your blood pressure is high, your
heart has to work harder than it should to circulate blood throughout your body. Over
time, the heart muscle may become thicker to compensate for the extra work it must
perform. Eventually, your heart muscle may become either too stiff or too weak to
effectively pump blood.
Faulty heart valves. The valves of your heart keep blood flowing in the proper
direction through the heart. A damaged valve, due to a heart defect, coronary artery
disease or heart infection, forces your heart to work harder to keep blood flowing as
it should. Over time, this extra work can weaken your heart. Faulty heart valves,
however, can be fixed or replaced if found in time.
Damage to the heart muscle (cardiomyopathy). Some of the many causes of
heart muscle damage (cardiomyopathy) include infections, alcohol abuse, and the
toxic effect of drugs such as cocaine or some drugs used for chemotherapy. Genetic

factors play an important role in two common types of cardiomyopathy. One is

hypertrophic cardiomyopathy a condition of abnormally thick heart muscle. The
other is dilated cardiomyopathy a condition where the heart muscle is weak and
the heart enlarges.
Myocarditis. Myocarditis is an inflammation of the heart muscle. It's most
commonly caused by a virus and can lead to left-sided heart failure.
Heart defects you're born with (congenital heart defects). If your heart and its
chambers or valves haven't formed correctly, the healthy parts of your heart have to
work harder to pump blood through your heart, which in turn may lead to heart
failure.
Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may
cause your heart to beat too fast. This creates extra work for your heart. Over time,
your heart may weaken, leading to heart failure. A slow heartbeat may prevent your
heart from getting enough blood out to the body and may also lead to heart failure.
Other diseases. Chronic diseases such as diabetes, hyperthyroidism,
hypothyroidism, emphysema, or a buildup of iron (hemochromatosis) or protein
(amyloidosis) also may contribute to heart failure. Causes of acute heart failure
include viruses that attack the heart muscle, severe infections, allergic reactions,
blood clots in the lungs, the use of certain medications or any illness that affects the
whole body.

SIGNS AND SYMPTOMS

Left-sided heart failure
Dyspnea on exertion, paroxysmal nocturnal dyspnea, or orthopnea
Moist crackles on lung auscultation
Frothy, blood-tinged sputum
Tachycardia with S3 heart sound
Pale, cool extremities
Peripheral and central cyanosis
Decreased peripheral pulses and capillary refill time longer than 3 seconds
Decreased urinary output (<30 ml/hour)
Easy fatigability
Insomnia and restlessness
Right-sided heart failure
Dependent pitting edema (peripheral and sacral)
Weight gain
Nausea and anorexia

 Jugular vein distention (JVD)

Liver congestion (e.g. hepatomegaly), ascites or weakness
TREATMENT
Treatment goals are to eliminate or reduce etiologic factors, reduce the workload on the
heart, increase the force and efficiency of myocardial contractions with pharmacologic
agents, and eliminate the excessive accumulation of body water.
Smoking, alcohol and excess fluid intake are prohibited.
Medications and oxygen (including intubation) are prescribed as indicated.
Nutritional therapy may include sodium restriction (2 to 3 g/day) and avoidance of
excess fluid intake to prevent, control, or eliminate edema.
Surgical management: coronary bypass surgery, PTCA, other innovative therapies as
indicated (e.g. mechanical assist devices, transplantation)
Pharmacologic therapy
o Alone or in combination: vasodilator therapy (angiotensin-converting enzyme (ACE)
inhibitors), select beta-blockers, calcium channel blockers, diuretic therapy, and cardiac
glycosides
o Dobutamine, anticoagulants, beta-blockers, as indicated
o Possibly antihypertensives or antianginal medications and anticoagulants.

NURSING MANAGEMENT
Provide ongoing assessment.
Monitor hemodynamic parameters and heart rate and rhythm through the multilumen
pulmonary artery catheter.
Weigh the client daily. Notify the health care provider if the client gains 3 lb or more per
day which is a sign of fluid retention.
Monitor serum electrolyte levels daily.
Prevent complications of immobility.
Instruct the client in or assist in performing range of motion exercises.
Apply antiembolism stockings to prevent deep vein thrombosis.
Provide a low-sodium diet, as prescribed.
To decrease fluid retention and subsequently the workload of the heart.
Provide client and family teaching for the client.
Provide referrals.

QUESTIONARES
1.
2.
3.
4.

Congestive heart failure (or CHF) is the name for what kind of failure?
What is not characteristically one of the main symptoms of CHF?
What is not a primary cause of CHF?
What do cardiologists call an evaluation of the amount of blood pumped by the
heart with each beat?
5. What is the technical term which describes the coronary arteries as being
narrowed by hardened plaque, which limits the free flow of oxygen and
overworks the heart?
6. What is the name for shortness of breath when lying down?
7. If the heart weakness limits a person's life too much, what major alternative will
work more permanently than changing diets and attitudes?
8. What do you think is the most important thing to do to help prevent this chronic
and life-threatening illness?
9. What is the name for a blood thinner?
10. Which medicine is not prescribed routinely for CHF?