Calcific AS and TAVI

Shanmugapriya^1*, Shanthi², Umarani³

¹Critical Ward Senior Staff Nurse, Kauvery Hospital, Heart city, Trichy, Tamil Nadu

²Critical Ward Senior Nursing Supervisor, Kauvery Hospital, Heart city, Trichy, Tamil Nadu

³Assistant Nursing Superintendent, Kauvery Hospital , Heart city, Trichy, Tamil Nadu

*Correspondence

Introduction

AF with RVR is a common, serious cardiac arrythmia characterized by a chronic irregular and fast heart rate typically exceeding 100bpm. In this condition the upper chambers of the heart are quivering chaotically instead of breathing normally. Because of this chaos, electrical signals are sent irregularly and too fast to the ventricles. The ventricles respond by beating very fast, usually over 100 beats per minute at rest. This can reduce cardiac output because of this AF with RVR is considered a medical emergency or high-risk condition especially if the patient is unstable.

Case Presentation

An 85-year-old female presented to the emergency department with complaints of giddiness and palpitations for the past five days associated with dyspnea. She had an accidental fall one month prior, following which she was diagnosed with a traumatic hip fracture and managed conservatively she was initially treated at specialty and referred for further management. At time of admission ECG was taken. ECG revealed atrial fibrillation with rapid ventricular response. Inj. Cordarone infusion was started. Patient reverted with normal sinus rhythm.

Her past machinal history was significant for systemic hypertension in medical management and post aortic valve replacement in 2008, Echo revealed calcific AS. TAVI procedure was done. Patient discharged.

K/C/O moderate MR / Post AV in position severe TR / Severe PAH / LA / RA enlarged / Mild LV dysfunction.

Clinical Findings

Giddiness
Palpitations
Dyspnea

Calcific Aortic Stenosis

Calcific aortic stenosis is a progressive chaise with no effective medical therapy that ultimately requires aortic valve replacement (AVR) for revere valve obstruction. Echocardiography is the primary diagnostic approach to define valve anatomy, measure aortic stenosis severity and evaluate the left ventricular response to chronic pressure overload, in symptomatic patients’ markers of chaise progression include the degree of leaflet calcification, hemodynamic severity of stenosis, adverse left ventricular longitudinal strain, myocardial fibrosis and pulmonary hypertension. The onset of symptoms portends a predictably high mortality rate unless AVR is performed, In symptomatic patients, AVR improves symptoms, improves survival and in patients with left ventricular dysfunction, improve systolic function, poor outcomes after AVR are associated with low flow low gradient aortic stenosis severe ventricular fibrosis oxygen dependent lungs disease frailty advanced renal dysfunction and a high comorbidity score. However, in most patients with severe symptoms AVR is life saving bioprosthetic valves are recommended for patient’s aged >65 years. Transcatheter AVR is now available for patients with severe comorbidities is recommended in patients who are cleaned inoperable and is a reasonable alternative to surgical AVR in high-risk patients.

Diagnosis

Primarily diagnosed Via echocardiography to measure valve thickness, calcification and blood flow velocity ( V max > 4 m/s indicates severe stenosis)

Medication

Drug name	Strength	Dose
Inj. Magnex forte	1.5gm IV	BD
Inj. Cardarone infusion	150 mg	24 Hrs
Inj. Heparin IV	4000 IU	TDS
Tab. Aztolet	10mg	OD
Tab. Concor	2.5mg	BD (1/2)
Inj. Patocid	40mg IV	OD
Tab. Dreamer	0.5mg	OD
Syp. Keylyte	10ml	BD

TAVI

It replaces the narrowed aortic valve without open-heart surgery. A bioprosthetic valve mounted on a catheter is delivered to the heart and expanded inside the disease valve.

A catheter is inserted usually through the femoral artery in the grain.
The catheter is guided to the aortic valve using imaging.
The new valve is expanded (Balloon – expandable or self-expanding)
The new valve pushes the old, calcified valve aside and starts functioning immediately.

Common Access Routes

Transfemoral (through femoral artery) most common
Transapical (through apex of heart)
Transaortic
Trans subclavian

Indications

Severe symptomatic aortic stenosis
High surgical risk or inoperable patients

Advantages

No open-heart surgery
Smaller incision
Shorter hospital stays
Faster recovery
Suitable for elderly or frail patients

Complications

Stroke
Vascular injury
Paravalvular leak
Need for permanent pacemaker
Valve malposition

Nursing Management

Continuous ECG monitoring for arrythmias
Check vital signs frequently (Every 15 – 30 min)
Observe for signs of heart failure or hypotension
Monitor femoral puncture site for bleeding, hematoma, swelling
Check distal pulses and limp perfusion
Maintain bed rest for 4 – 6 Hrs if femoral access used
Antiplatelet therapy (Eg: Aspirin, clopidogrel)
Pain relief and antibiotics as ordered.

Patient Education

Teach wound care and signs of infection
Encourage gradual activity increase
Explaining importance of medication adherence
Schedule follow up echocardiography and cardiology visits
Advice to reports chest pain shortness of breath, dizziness or bleeding immediately

Nursing Diagnosis

Decreased cardiac output
Risk for bleeding
Acute pain
Risk for infection
Knowledge deficit

Intervention

Monitor the vital signs and ECG continuously
Gave cardiac medications and antiplatelet drugs as ordered.
Access sites for bleeding or hematoma
Check distal pulses and limp color, temperature
Provide analysis or prescribed antibiotics
Provide comfortable positioning
Maintain strict aseptic technique
Monitor temperature and WBC counts
Teach wound care and activity restrictions
Educating patients about medications

Discharge

Patients were admitted to symptoms of dyspnea and giddiness, and palpitation. TAVI procedure was successfully performed without complication. Post procedure recovery was stable with normal vital signs and good valve function. Follow up cardiologist after one week for clinical evaluation and echocardiography.

Calcific AS and TAVI

Calcific AS and TAVI

Shanmugapriya1*, Shanthi2, Umarani3

Nightingale Journals

Shanmugapriya^1*, Shanthi², Umarani³