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
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