Other Medications: If the incompetent valve is replaced surgically with a synthetic valve, patients are prescribed long-term anticoagulation therapy such as warfarin (Coumadin) to prevent thrombi from forming on the synthetic valve. Initially, heparin is given along with the warfarin, and the prothrombin time (PT) is monitored. As the PT value becomes therapeutic, the heparin is discontinued.


Physical and psychological rest decreases cardiac workload, which reduces the metabolic demands on the myocardium. Physical rest is enhanced by providing assistance with activities of daily living and encouraging activity restrictions. Most patients with advanced AI are placed on activity restrictions to decrease cardiac workload. If the patient is on bedrest, advise her or him to use the bedside commode, because research has shown it creates less workload for the heart than using the bedpan. If the patient can tolerate some activities, those that increase isometric work, such as lifting heavy objects, are more detrimental than activities such as walking or swimming.

Encourage the patient to avoid sudden changes in position to minimize increased cardiac demand. If the patient is hospitalized, instruct the patient to sit on the edge of the bed before standing. If pulmonary congestion is present, elevate the head of the bed slightly to enhance respiration.

Reducing psychological stress is a challenge. Approach the patient and family in a calm, relaxed manner. Decrease the fear of the unknown by providing explanations and current information and encouraging questions. To help the patient maintain or re-establish a sense of control, permit the patient to participate in decisions about aspects of care within his or her knowledge. If the patient decides to have valve surgery, offer to let her or him speak with someone who has already had the surgery. Seeing and talking with someone who has undergone surgery and lives with a replacement valve is usually very therapeutic.

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