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When caring for a patient with mitral valve stenosis, the nurse should monitor for which of the following symptoms associated with this condition?

Explanation

• Mitral stenosis is a narrowing of the mitral orifice and thickening of the mitral valve leaflets, which impedes blood flow into the left ventricle. Blood picks up oxygen in the lungs and re-enters the heart into the left atrium, then must pass through the narrowed and thickened mitral valve into the left ventricle of the heart. The left ventricle is the main chamber, which pumps oxygen-rich blood to the body through the aorta.

• As blood strains to pass through the mitral valve, pressures rise in the left atrium and then in the lungs, where the blood meets vascular resistance as it backs up. This causes pulmonary congestion and shortness of breath, which is worse with activity (as oxygen needs increase).

• If untreated, the pressure and fluid buildup in the lungs increases the workload of the right side of the heart, which has to pump harder to send blood into the lungs to be oxygenated. Over time, right-sided heart failure develops. Complications include secondary pulmonary hypertension, atrial fibrillation, and thrombus.

• Symptoms associated with mitral stenosis include fatigue (especially with activity), edema in the arms and legs (as right-sided heart failure develops), coughing (sputum may be blood- tinged),  chest pain, and palpitations. A third heart sound may be heard on auscultation, and patients often have a low oxygen saturation even with supplemental 02. it is diagnosed by echocardiography.

• The most common cause of mitral valve stenosis is rheumatic heart disease caused by rheumatic fever, which can develop after a strep infection (strep throat).

• Incorrect: Fluid overload of the pulmonary circulation can impair gas exchange, potentially leading to respiratory acidosis as CO2 builds up.

• Incorrect: Hypoventilation refers to slow breathing. Patients with mitral stenosis have shortness of breath from pulmonary congestion, which often contributes to faster breathing to compensate.

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