Question about Mitral Stenosis in Clinical Vignette

Question

A nurse is caring for an 85-year-old woman admitted to the hospital with a diagnosis of mitral stenosis. The patient has been experiencing dizziness and lightheadedness and fell before admission. During the physical examination, the nurse notes a diastolic murmur heard best at the left sternal border and crackles in the lungs. BP 130/80, P. 88, R. 16.

1. Considering the diagnosis of mitral stenosis explain why the patient has both a diastolic murmur and crackles in the lungs.
2. The patient is most concerned about her fall and the sensation of dizziness that has been progressing. Why would these symptoms be especially worrisome in a patient with mitral stenosis?
3. Whenever a patient has an abnormal valve, there is an increased incidence of bacterial endocarditis. What are the important preventive measures that should be included in this patient’s education plan?

Answer 1

a.You can see an enlarged left atrium and thickened but mobile mitral leaflets.Turbulent blood flow from the left atrium into the left ventricle is responsible for the murmur.Diastolic decrescendo murmur is occurring after an opening snap. It is associated with mitral stenosis.A high-pitched decrescendo diastolic murmur secondary to pulmonary regurgitation (Graham Steell murmur) may be audible at the upper sternal border.

b. Having regurgitation to lungs means that the patient is out of breath, less oxygen to the lung, more liquid, less oxygen to the brain, dizziness, cyanosis or paled lips, falling down. If the patient is not treated with diuretics, proper cardiovascular medication, it will happen more frequently.

c.Bacterial endocarditis can appear after an untreated infection in those patients. It is common that after a dental procedure, pharingoamigdalitis, skin infection, patients with this conditions get endocarditis. it is important that the patients know all of this to take of their health. Always preventive antibiotic therapy before any dental procedure. Antibiotic for 7-8 days after amigdalitis or skin lesions like forunculosis. They should always tell the doctor before a procedure or diagnosis and treatment that they suffer from mitral stenosis, so the doctor could help them get the right treatment plan for them.