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Chapter 2
•
Cardiovascular Care
39
Symptoms
Treatment
LV Preload HR
Contractility SVR
Exertional dyspnea or decreased
exercise tolerance
Exertional angina
Syncope
Presyncope
HF
Angina
Management of hypertension
Vasodilator therapy
Surgical and transcatheter AVR
Percutaneous aortic balloon
dilation
Statin therapy
Increase
Decrease Sinus Maintain
Increase
Exertional dyspnea
Angina
Signs of heart failure
Management of hypertension
Vasodilators
ACE inhibitors
ARBs
Beta blockers
Maintain or
increase
Increase
Maintain (may
need support)
Decrease
Decreased exercise tolerance
Exertional dyspnea
Anticoagulation therapy
Heart rate control
Mitral valve surgery (repair,
commissurotomy, or valve
replacement)
Increase
Decrease
Maintain
Maintain
Decreased exercise tolerance
Exertional dyspnea
LV dysfunction
Pulmonary hypertension
For primary MR either surgical
mitral valve repair (MVR)
Maintain
Increase
Maintain (may
need support)
Decrease
Fatigue, palpitations, dyspnea,
abdominal bloating, anorexia,
edema, progressive hepatic
dysfunction
Loop diuretics
Measures to reduce pulmonary
artery pressures and/or pulmonary
vascular resistance
Tricuspid valve surgery
Maintain or
Increase
Increase
Increase
Maintain
Variable and dependent on sever-
ity of associated valve disease and
degree of obstruction
Diuretics
Tricuspid valve surgery
Increase
Decrease
Maintain
Maintain or
Increase
None or variable and dependent
on severity of obstruction
Pulmonic valve commissurotomy
and valve replacement
Increase
Decrease
Maintain
Maintain
None or variable and dependent
on cause of PR and RV function
Surgery when signs and symptoms
of RV dysfunction occur and PR is
severe
Increase
Increase
Increase
Maintain or
decrease