Mitral Stenosis/Cardiac Questions

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?

Answer 1

1 In a case of severe mitral stenosis, your left atrium has to extend greater effort to pump the blood to the left ventricle through a narrowed valve. This then causes the pressure in the left atrium to increase leading to an enlargement of the walls of the atrium. If there is congestion of blood in the blood vessels, which is caused by a back pressure of blood. In these severe cases the back pressure can extend into the lungs and to the right ventricle. Because of this case, the patient has both a diastolic murmur and crackles in the lungs.

2 The patients fainting or dizziness is a result of the reduced blood supply to the ventricles which causes the blood that reaches the body to be reduced as well. This can cause the patient chest pain and further cardiac arrest.