Nurse Maureen would expect a client with mitral stenosis would demonstrate symptoms associated with congestion in the:
A. Right atrium
B. Superior vena cava
C. Aorta
D. Pulmonary
Correct Answer: D. Pulmonary
When mitral stenosis is present, the left atrium has difficulty emptying its contents into the left ventricle because there is no valve to prevent backward flow into the pulmonary vein, the pulmonary circulation is under pressure. Mitral valve areas less than 2 square centimeters causes an impediment to the blood flow from the left atrium into the left ventricle. This creates a pressure gradient across the mitral valve. As the gradient across the mitral valve increases, the left ventricle requires the atrial kick to fill with blood.
Option A: In mitral stenosis, the left atrium is the one which has difficulty in emptying its content, not the right atrium. Mitral valve area less than 1 square centimeter causes an increase in left atrial pressure. The normal left ventricular diastolic pressure is 5 mmHg. A pressure gradient across the mitral valve of 20 mmHg due to severe mitral stenosis will cause a left atrial pressure of about 25 mmHg. This left atrial pressure is transmitted to the pulmonary vasculature resulting in pulmonary hypertension.
Option B: Superior vena cava (SVC) syndrome is a collection of clinical signs and symptoms resulting from either partial or complete obstruction of blood flow through the SVC. This obstruction is most commonly a result of thrombus formation or tumor infiltration of the vessel wall. The most common signs and symptoms include face or neck swelling, upper extremity swelling, dyspnea, cough, and dilated chest vein collaterals.
Option C: Aortic regurgitation is a condition in which the aortic valve does not close properly, allowing blood to leak from the aorta back into the heart’s left ventricle. This leakage increases the left ventricle’s volume load, causing it to dilate and eventually fail – leading to pulmonary (lung) congestion.