A client diagnosed with mitral stenosis asks the nurse what is wrong with her heart. How can the nurse best explain this health problem?

Rheumatic fever: This inflammatory condition can affect various parts of the heart, including the mitral and aortic valves. Repeated episodes of rheumatic fever can lead to scarring and thickening of the heart valves, eventually causing stenosis (narrowing) of the mitral or aortic valve.

b. Endocarditis: This infection of the heart lining or valves can damage the structures, but it's not as directly linked to both mitral and aortic stenosis as rheumatic fever.

c. Marfan’s syndrome:Marfan syndrome is a genetic disorder that can affect connective tissue throughout the body, including the heart valves. It is commonly associated with aortic root dilatation and aortic regurgitation rather than aortic stenosis. While aortic valve involvement can occur in Marfan syndrome, it is not typically associated with mitral stenosis.

d. Female gender: While gender differences exist in the prevalence of certain cardiovascular conditions, such as rheumatic heart disease affecting more females than males, gender alone is not a significant risk factor for the development of either mitral or aortic stenosis.

Brain natriuretic peptide (BNP): BNP is a hormone released by the heart in response to increased ventricular pressure and volume overload. It is typically elevated in conditions such as heart failure. While monitoring BNP levels may provide information about cardiac function and volume status, it is not specifically ordered for managing a mechanical valve.

b. Cardiac enzymes: Cardiac enzymes, such as troponin and creatine kinase (CK), are markers of myocardial damage and are typically elevated in conditions such as myocardial infarction. They are not specifically ordered for managing a mechanical valve unless there are signs or symptoms suggestive of myocardial ischemia or infarction.

c. Blood urea nitrogen and creatinine:- Monitoring blood urea nitrogen (BUN) and creatinine levels is important for assessing renal function, especially in individuals at risk of renal impairment due to factors such as medications or underlying conditions. While renal function is important in overall cardiac management, these tests are not specifically ordered for managing a mechanical valve unless there are concerns about renal function due to medications such as anticoagulants.

d. PT/INR (Prothrombin Time/International Normalized Ratio): PT/INR monitoring is crucial for managing patients with mechanical heart valves, as these valves are thrombogenic and increase the risk of thromboembolic events such as stroke or valve thrombosis. Warfarin, an oral anticoagulant, is commonly prescribed to maintain therapeutic anticoagulation. PT/INR monitoring helps ensure that the patient is within the target therapeutic range to prevent both thrombotic and bleeding complications associated with the mechanical valve.