Valvular Heart Disease Cheat Sheet
Stenosis vs regurgitation, mitral vs aortic symptoms, warfarin safety after valve replacement and endocarditis prevention — high-yield for the NCLEX-RN.
What's in this cheat sheet
Picture the heart as a four-room house with each valve a one-way door. Stenosis is a door jammed half-shut; regurgitation is a door that won't latch. This cheat sheet covers why valves fail, how to tell mitral from aortic problems by their symptoms, the pharmacology and surgery (including lifelong warfarin for mechanical valves), and the patient teaching for infection and bleeding prevention.
Pathophysiology & Etiology
Stenosis vs regurgitation, the four main valve lesions, and what damages valves (rheumatic fever, endocarditis, MI).
Assessment Findings
How mitral vs aortic and stenosis vs regurgitation present, with the low-output and congestion patterns.
Pharmacology & Surgery
Anticoagulants, antiplatelets, valve replacement options and the high-alert warfarin INR rules.
Patient Education & Safety
Endocarditis prevention with dental prophylaxis and bleeding precautions on anticoagulants.
Key Takeaways
High-yield facts most likely to appear on the NCLEX-RN.
Stenosis = narrowed valve, blood can't move forward; regurgitation = leaky valve, blood flows backward.
Mitral problems → pulmonary/systemic congestion (edema, ascites, pleural effusion); aortic problems → decreased cardiac output (angina, syncope, fatigue).
Mechanical valve replacement requires lifelong warfarin with a target INR of 2.5–3.5 and routine lab draws.
Keep vitamin K (green leafy vegetables) intake consistent — not increased, not decreased — to avoid INR swings.
Prevent endocarditis: avoid elective dental work for 6 months post-surgery and premedicate with antibiotics before future dental procedures.
On anticoagulants: soft-bristle toothbrush, electric razor, remove throw rugs, and watch for bruising or blood in urine/stool.
1. Pathophysiology & Etiology
Stenosis
The valve becomes stiff, thickened and narrowed — blood struggles to flow forward. A door jammed half-shut.
Regurgitation
The valve doesn't seal completely, so blood leaks backward into the chamber it just left. A door that won't latch.
What damages the valves
- Rheumatic fever — autoimmune scarring after untreated strep throat
- Infective endocarditis — bacterial infection of valve leaflets
- Myocardial infarction — necrotic tissue distorts valve structure
- Congenital defects and cardiomyopathy
2. Assessment Findings
Memory trick: LOW pump output = LOW oxygen delivery. Aortic lesions reduce output; mitral lesions cause congestion.
Symptoms by valve and lesion
| Valve | Stenosis | Regurgitation |
|---|---|---|
| Aortic | Angina, systolic murmur, syncope, orthopnea | Tachycardia, dyspnea, fatigue |
| Mitral | Cyanosis, activity intolerance, diastolic murmur, right-sided HF, clear lungs | Edema, pleural effusion, hepatomegaly, ascites |
3. Pharmacology & Surgical Management
Medications & surgery
- Anticoagulants — heparin (acute), warfarin (long-term, esp. post-valve replacement)
- Antiplatelets — aspirin, clopidogrel (reduce clot risk on diseased/replaced valves)
- Nitroglycerin — relieves angina from reduced coronary perfusion
- Valve replacement (mechanical needs lifelong warfarin) or balloon valvuloplasty for stenosis
4. Patient Education & Safety
Infection prevention
- Avoid elective dental procedures for 6 months following valve surgery
- Take prophylactic antibiotics before any future dental work to prevent endocarditis
- Report fever, chills, or unusual fatigue promptly — possible endocarditis
Bleeding precautions (on anticoagulants)
- Use a soft-bristle toothbrush; avoid aggressive brushing
- Switch to an electric razor — never a blade
- Remove throw rugs and keep walkways well-lit to prevent falls
- Watch for bruising, blood in urine/stool, or prolonged bleeding from cuts
Valvular Heart Disease Self-Test
6 quick questions — answers reveal after you submit.
Q1. How does the nurse best explain the difference between valve stenosis and regurgitation?
Q2. A client with mitral valve disease is most likely to present with which findings?
Q3. A client with a new mechanical mitral valve asks how long they will take warfarin. What is the nurse's best response?
Q4. Which statement about diet by a client taking warfarin indicates correct understanding?
Q5. A client had valve replacement surgery 2 months ago and now needs a dental cleaning. What does the nurse advise?
Q6. Which self-care measure is appropriate for a client on long-term anticoagulation after valve replacement?
Answered 0 / 6 — unanswered count as incorrect.