Introduction to Mitral Valve Regurgitation (MR)

Speakers

• Anna and Chrissy, co-founders of Confident Care Academy
  • Anna: Future nurse anesthetist
  • Chrissy: Nurse anesthetist

Background

• Focus on post-operative cardiac surgery patient management.
• Importance of understanding mitral valve regurgitation distinct from other heart diseases.

Understanding Mitral Valve Regurgitation

• Definition: Backward flow of blood through the mitral valve.
• Valves: Act as one-way doors in the heart, ensure forward blood flow.

Anatomy & Function of the Mitral Valve

• Located between the left atrium and left ventricle.
• During diastole: Opens to allow oxygenated blood from the lungs to flow into the left ventricle.
• During systole: Closes to prevent blood backflow into the lungs, ensuring it moves into the aorta.

Importance of Forward Flow

• Critical in understanding heart function and failure.
• Key focus for new critical care nurses: Recognizing and addressing disruptions in forward flow.

Causes of Mitral Valve Regurgitation

• Mitral Valve Prolapse: Mild floppiness, not sealing properly.
• Papillary Muscle Rupture: Affects valve opening/closing.
• Calcification: Natural aging process causing valve stiffening.

Disease Progression and Management

• Backflow (regurgitation) leads to a range of complications:
  • Reduced Cardiac Output: Less blood pumped effectively.
  • Left Atrial Dilation: Results in electrical conduction issues, potential atrial fibrillation.
  • Pulmonary Hypertension: Backed up blood affecting lungs and then RV (right ventricle).
  • Right-Sided Heart Failure: Increased strain leading to systemic issues like liver failure.

Misconceptions and Fluid Management

• Myth: "All valves need fluid"
  • Reality: Not true for all cases, especially not mitral regurgitation.
  • Avoid Excess Fluid: In cases of mitral regurgitation, as it worsens backflow issues.

Post-Operative Considerations

• Ejection Fraction Misunderstandings: Post-surgery drop in EF may reveal pre-existing LV weakness.
• Post-op focus on minimizing fluid overload.

Strategies for Managing MR Patients

• Use of contractility agents like epinephrine and norepinephrine.
• Monitoring swan numbers, PA pressure, CVP.
• Favoring blood products over crystalloids for volume replacement.
• Avoiding phenylephrine as it raises afterload, impedes blood flow.

Additional Resources

• Confident Care Academy
  • Membership with resources for critical care nurses.
  • Ongoing education, case studies, and community support.

Conclusion

• Understanding the rationale behind treatment choices is critical.
• Importance of continuous learning and adapting in critical care environments.