Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

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 Management of hypertension Vasodilators ACE inhibitors ARBs Beta blockers Anticoagulation therapy Heart rate control Mitral valve surgery (repair, commissurotomy, or valve replacement)

Increase

Decrease Sinus Maintain

Increase

Exertional dyspnea Angina Signs of heart failure

Maintain or increase

Increase

Maintain (may need support)

Decrease

Decreased exercise tolerance Exertional dyspnea

Increase

Decrease

Maintain

Maintain

Decreased exercise tolerance Exertional dyspnea LV dysfunction Pulmonary hypertension Fatigue, palpitations, dyspnea, abdominal bloating, anorexia, edema, progressive hepatic dysfunction

For primary MR either surgical mitral valve repair (MVR)

Maintain

Increase

Maintain (may need support)

Decrease

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